Re: Re: City Ordinances

[Guest guest]

Great post Gene...Florida is much like AZ on the CON....they regulate not only

who can provide emergency and non-emergency but also who can do BLS and ALS...it

is all done at the County level. Some counties have 10 or 12 CON's for

different agencies (BTW, the municiple agencies have to have them too...counties

have a lot of power there) and some counties (like the PUM in Pinellas) have

one. The counties choice.

Dudley

Re: Re: City Ordinances

>

>

> I agree with your comments, and would also like to toss another cat into

> this fight.

>

> I seem to remember that TDSHS says that a patient (or patient's

> representative) can call ANY provider directly for service (emergency or

> non-emeergency), whether that provider is the " official " 911 provider for

> that area or not.

>

> If the patient requests a specific provider - for whatever reason - can

> the city refuse to permit that provider to respond? Or penalize them when

> they do? Would that be a conspiracy in restraint of trade, to use the

> federal anti-trust terminology?

>

>

> Kim wrote:

>

>

> 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. ;-) )

>

>

>

>

>

[Guest guest]

Great post Gene...Florida is much like AZ on the CON....they regulate not only

who can provide emergency and non-emergency but also who can do BLS and ALS...it

is all done at the County level. Some counties have 10 or 12 CON's for

different agencies (BTW, the municiple agencies have to have them too...counties

have a lot of power there) and some counties (like the PUM in Pinellas) have

one. The counties choice.

Dudley

Re: Re: City Ordinances

>

>

> I agree with your comments, and would also like to toss another cat into

> this fight.

>

> I seem to remember that TDSHS says that a patient (or patient's

> representative) can call ANY provider directly for service (emergency or

> non-emeergency), whether that provider is the " official " 911 provider for

> that area or not.

>

> If the patient requests a specific provider - for whatever reason - can

> the city refuse to permit that provider to respond? Or penalize them when

> they do? Would that be a conspiracy in restraint of trade, to use the

> federal anti-trust terminology?

>

>

> Kim wrote:

>

>

> 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. ;-) )

>

>

>

>

>

[Guest guest]

Thank you, Forrest, for this history. You are entirely correct in your

recollection and your analysis.

Gene Gandy, JD, LP

> The regulatory issue is always an interesting one.  To the best of my

> knowledge only 3 states have chosen, or still have, turf and tariff

> authority for ambulances: Arizona, New Jersey, and Connecticut.  Most all

> the states have health and safety regulatory authority.  Traditionally, a

> " lesser " entity can not supercede the authority of the " greater " regulatory

> authority.  When the airline industry de-regulated in the 80's the states

> that were regulating air ambulances were only allowed to set health and

> safety standards, not service area and rates even though state law allowed

> regulation of all ambulance services.  Regulation of federal and tribal EMS

> services was also non-existent.

>

> The rights of municipalities to regulate and/or allow sole provider licenses

> have been played out in the federal courts, especially for EMS, in several

> states.  I had direct experience in the early days of EMS in Arizona which

> had authority for service area and rates.  The State and the City of Tucson

> were sued in federal court by Kords ambulance when the City of Tucson put

> paramedics on the streets and they began transporting.  The City FD was sued

> under the clause prohibiting government from competing with private

> enterprise.  Kords won that battle.  The City had to stop transporting

> except in " life threatening emergencies " when no ambulance was available.

> It was reaffirmed that the State had the right to require the City of Tucson

> to file for a Certificate of Necessity with the Arizona Corporation

> Commission (the ambulance regulatory agency at the time).

>

> Several years later the City of Phoenix decided to issue and RFP for sole

> provider for 911 service within the City.  The initial winner of the RFP was

> a local private ambulance service.  The City of Phoenix was challenged on

> their sole provider RFP by the fire department which lost.  The RFP

> reissued, and the fire department then won.  The original winner of the RFP

> sued the City of Phoenix in about every court anyone could find to file suit

> with.  The end result after years of litigation was that the right of the

> municipality to issue the RFP and sole provider license was upheld.  The

> City had included in their RFP that the successful provider had to be

> certificated in the State before the RFP was implemented.  The FD did not

> have a CON at that point and had to apply to DHS to obtain one.  They were

> awarded a CON based on necessity because the private sector collectively

> could not meet the response time criteria.  (I don't recall exactly but

> average response time for an ambulance to arrive on scene in the City was

> 20+ minutes at the time).  I don't recall if the right of the City of

> Phoenix to restrict the State's right to control turf and tariff was

> challenged.  Since the RFP was for 911 traffic only, the RFP did not limit

> the providers in the City.  The fire department also wisely allowed the

> patient's right to choose so long it was not life threatening, and so long

> and the provider was a certificated provider for the City, i.e., an approved

> provider by DHS to operate in the City of Phoenix (Their were only 7 total

> including the City).

>

> Similar battles over the right of municipalities to regulate sole provider

> authority have been fought by the cable TV folks. the trash  pick-up, and

> other " public utilities " , both gas and electric.  Whether it's for health

> and safety, or just the ability to require a license, municipalities had

> traditionally had their right to do so upheld in court.

>

> I don't claim to be an expert, just sharing experience.  The Arizona

> experience has been played out in several other states as well.  Pick a

> public utility model and check the history.  Almost every one was challenged

> when they first were put in place.  The cable TV history is even longer and

> bloodier than EMS..

>

> Just a footnote to the regulatory issue, something to consider is what the

> " penalties " will be for violation.  In Arizona violation of CON resulted in

> Civil Penalties.  We recently had a VERY exhaustive thread about penalties

> for violating a municipality's requirement for licensing, the results of

> refusal to comply, and the way that can quickly lead to other violations of

> criminal statutes.

>

> Forrest C. Wood, Jr.

> TxWoody@...

>

>

>

>

>

[Guest guest]

I will not debate the validity of municipal regulation of EMS in Texas or

elsewhere It is well settled in the law. You may not like it, but it is the

law and you're not going to do anything about it, so let's move on. There is

nothing further to be said on the subject that is constructive.

I recommend that we take such philosophical debate to the off-topic list,

which exists for that purpose.

Let's concentrate on something that we can do something about, such as an

overhaul of the EMS regulatory structure in Texas.

Let's also try to get back to talking about patient care and treatment

topics. One reason I left this list and have been concentrating on the

Paramedicine and EKG Club lists is that I learn something from them.

I haven't learned anything from this list in a long time.

When it becomes relevant again, maybe some of us who now lurk will come back.

Best,

Gene Gandy

> wegandy1938@a... wrote:

> >

> > This became intolerable, and various approaches were tried to

> limit this

> > unfettered " Road Warrior " competition.  

> >

> > One of the approaches was to declare one provider to do all 911

> and transfers

> > within an area...

>

> For clarification, 911 did not even exist at that time.  The

> implementation of 911 has done more for the regulation of EMS than

> any ordinance has ever done.  And I suggest that with 911 now being

> the standard, and all 911 calls going to a single provider, the

> problem you cite no longer exists.  Consequently, such regulatory

> ordinances on non-emergency services are indeed nothing but

> unreasonable restrictions upon free trade.

>

> As I stated in the previous post, you can bet the plumbers of Texas

> would not stand for exclusivity contracts such as those that are

> applied to our industry.

>

> Rob

>

>

>

>

>

>

>

>

>

[Guest guest]

The ordinaces I am refering to are Weslaco's and

Edinburg's.

I agree. But in the case of a certain 911 provider,

what about telling a caller from let's say Alton that

they will be late because the only unit available is

coming from let's say Donna, roughly 20-25 miles away.

Shouldn't the 911 provider be required to also

utilize a closer service that can provide the same

level care instead of having to wait 20-30 minutes for

an ambulance in rush hour traffic. And you can ensure

proper care and treatment by sending a supervisor.

The 911 providers should be held accountable everytime

they are late to a 911 call. Too many 911 providers

also have transfer contracts and tie up 911 units with

transfers and therefore the 911 caller suffers in the

end. This is where SSM fails. Every city should have

it's designated units and more units added to cover

the transfers. Not let's see how far I can stretch 10

units. Now I am not for transfer companies solely. I

criticize both 911 and transfer. I really want to do

something about our current status in Hidalgo County

because as of now I heard a rumor that there are 58

applications waiting just for Hidalgo County alone.

This is getting ridiculous and a CON would definately

help everyone.

Salvador Capuchino

EMT-P

--- Danny wrote:

> Sal I don't know of any county ordinances in Hidalgo

> County that even

> mention EMS.

> I agree that if someone wants a specific provider

> that they have the

> right to call them. But that provider should also be

> honest and tell

> them that they will probably pass 3 or 4 fire

> stations and 3 or 4

> 9-1-1 providers that are more than likely closer and

> will not respond

> because they chose not to activate the 9-1-1 system.

> And when

> something bad happens the first people they will sue

> ( because

> remember we live in Hidalgo County!)is the city or

> county and the

> 9-1-1 provider.

>

> Danny

> Failure is not an option

>

>

>

> > > The same way the city can dictate which garbage

> > > collection company you can,

> > > can’t, or must use. Cities have

> the power to

> > > regulate business to some

> > > extent within their jurisdiction. The courts

> have

> > > upheld these so called “

> > > sole-provider†ordinances.

> > >

> > > The problem you run into is that cities are

> expected

> > > to protect their

> > > citizens. Also, they (at least larger cities)

> are

> > > expected to provide EMS

> > > coverage. In days past this meant huge

> subsidies to

> > > EMS services to provide 911

> > > coverage. With the sole-provider model

> subsidies

> > > are becoming a thing of the

> > > past. By allowing ABC EMS to have a

> sole-provider

> > > contract the governing entity

> > > can escape the EMS subsidy and revert those

> monies

> > > to more important

> > > services.

> > >

> > > Competition is a good thing, even in EMS.

> However,

> > > too much competition

> > > causes the level of care for everyone involved

> to

> > > diminish because the money

> > > just isn’t there to sustain any

> single company.

> > > There must be regulation. We

> > > aren’t going to change that.

> > >

> > > I’m not picking sides, just saying

>

>

=== message truncated ===

__________________________________________________

[Guest guest]

The ordinaces I am refering to are Weslaco's and

Edinburg's.

I agree. But in the case of a certain 911 provider,

what about telling a caller from let's say Alton that

they will be late because the only unit available is

coming from let's say Donna, roughly 20-25 miles away.

Shouldn't the 911 provider be required to also

utilize a closer service that can provide the same

level care instead of having to wait 20-30 minutes for

an ambulance in rush hour traffic. And you can ensure

proper care and treatment by sending a supervisor.

The 911 providers should be held accountable everytime

they are late to a 911 call. Too many 911 providers

also have transfer contracts and tie up 911 units with

transfers and therefore the 911 caller suffers in the

end. This is where SSM fails. Every city should have

it's designated units and more units added to cover

the transfers. Not let's see how far I can stretch 10

units. Now I am not for transfer companies solely. I

criticize both 911 and transfer. I really want to do

something about our current status in Hidalgo County

because as of now I heard a rumor that there are 58

applications waiting just for Hidalgo County alone.

This is getting ridiculous and a CON would definately

help everyone.

Salvador Capuchino

EMT-P

--- Danny wrote:

> Sal I don't know of any county ordinances in Hidalgo

> County that even

> mention EMS.

> I agree that if someone wants a specific provider

> that they have the

> right to call them. But that provider should also be

> honest and tell

> them that they will probably pass 3 or 4 fire

> stations and 3 or 4

> 9-1-1 providers that are more than likely closer and

> will not respond

> because they chose not to activate the 9-1-1 system.

> And when

> something bad happens the first people they will sue

> ( because

> remember we live in Hidalgo County!)is the city or

> county and the

> 9-1-1 provider.

>

> Danny

> Failure is not an option

>

>

>

> > > The same way the city can dictate which garbage

> > > collection company you can,

> > > can’t, or must use. Cities have

> the power to

> > > regulate business to some

> > > extent within their jurisdiction. The courts

> have

> > > upheld these so called “

> > > sole-provider†ordinances.

> > >

> > > The problem you run into is that cities are

> expected

> > > to protect their

> > > citizens. Also, they (at least larger cities)

> are

> > > expected to provide EMS

> > > coverage. In days past this meant huge

> subsidies to

> > > EMS services to provide 911

> > > coverage. With the sole-provider model

> subsidies

> > > are becoming a thing of the

> > > past. By allowing ABC EMS to have a

> sole-provider

> > > contract the governing entity

> > > can escape the EMS subsidy and revert those

> monies

> > > to more important

> > > services.

> > >

> > > Competition is a good thing, even in EMS.

> However,

> > > too much competition

> > > causes the level of care for everyone involved

> to

> > > diminish because the money

> > > just isn’t there to sustain any

> single company.

> > > There must be regulation. We

> > > aren’t going to change that.

> > >

> > > I’m not picking sides, just saying

>

>

=== message truncated ===

__________________________________________________

[Guest guest]

The ordinaces I am refering to are Weslaco's and

Edinburg's.

I agree. But in the case of a certain 911 provider,

what about telling a caller from let's say Alton that

they will be late because the only unit available is

coming from let's say Donna, roughly 20-25 miles away.

Shouldn't the 911 provider be required to also

utilize a closer service that can provide the same

level care instead of having to wait 20-30 minutes for

an ambulance in rush hour traffic. And you can ensure

proper care and treatment by sending a supervisor.

The 911 providers should be held accountable everytime

they are late to a 911 call. Too many 911 providers

also have transfer contracts and tie up 911 units with

transfers and therefore the 911 caller suffers in the

end. This is where SSM fails. Every city should have

it's designated units and more units added to cover

the transfers. Not let's see how far I can stretch 10

units. Now I am not for transfer companies solely. I

criticize both 911 and transfer. I really want to do

something about our current status in Hidalgo County

because as of now I heard a rumor that there are 58

applications waiting just for Hidalgo County alone.

This is getting ridiculous and a CON would definately

help everyone.

Salvador Capuchino

EMT-P

--- Danny wrote:

> Sal I don't know of any county ordinances in Hidalgo

> County that even

> mention EMS.

> I agree that if someone wants a specific provider

> that they have the

> right to call them. But that provider should also be

> honest and tell

> them that they will probably pass 3 or 4 fire

> stations and 3 or 4

> 9-1-1 providers that are more than likely closer and

> will not respond

> because they chose not to activate the 9-1-1 system.

> And when

> something bad happens the first people they will sue

> ( because

> remember we live in Hidalgo County!)is the city or

> county and the

> 9-1-1 provider.

>

> Danny

> Failure is not an option

>

>

>

> > > The same way the city can dictate which garbage

> > > collection company you can,

> > > can’t, or must use. Cities have

> the power to

> > > regulate business to some

> > > extent within their jurisdiction. The courts

> have

> > > upheld these so called “

> > > sole-provider†ordinances.

> > >

> > > The problem you run into is that cities are

> expected

> > > to protect their

> > > citizens. Also, they (at least larger cities)

> are

> > > expected to provide EMS

> > > coverage. In days past this meant huge

> subsidies to

> > > EMS services to provide 911

> > > coverage. With the sole-provider model

> subsidies

> > > are becoming a thing of the

> > > past. By allowing ABC EMS to have a

> sole-provider

> > > contract the governing entity

> > > can escape the EMS subsidy and revert those

> monies

> > > to more important

> > > services.

> > >

> > > Competition is a good thing, even in EMS.

> However,

> > > too much competition

> > > causes the level of care for everyone involved

> to

> > > diminish because the money

> > > just isn’t there to sustain any

> single company.

> > > There must be regulation. We

> > > aren’t going to change that.

> > >

> > > I’m not picking sides, just saying

>

>

=== message truncated ===

__________________________________________________

[Guest guest]

This situation occurred in a county that does not include a major metropolitan

area. The county had a contract with a private service to serve as the 911

provider for the county (less some areas as described next). Within the county

there existed one or more subordinate areas which decided to contract with a

different private service to provide their 911 service. This is an allowed

practice under TDSHS, etc.

Over time, some residents of the county who lived in the area covered by the

main county provider developed issues with that provider (over various issues,

including excessive response times). These citizens (and others around them who

knew of the issues) would then call another service for emergency response. If

they were close enough to call the service in the subordinate political area

they called that service directly rather than calling 911. Others, too distant

for that service to effectively cover, called providers outside the county.

TDSHS determined that this was not a violation of any regulation, policy or

rule, and that a service can choose to respond - whether they have a " duty to

respond " or not - to a direct call from anyone, regardless of their location.

In other words, as far as TDSHS was concerned, the county's contracted 911

provisder did not have true exclusivity. They might be the provider to which

calls made to 911 were assigned, but neither they nor the county could prevent

citizens from calling any service they wanted to. Nor could they prohibit the

service receiving such a direct call from responding into " their " service area.

The situation that triggered this particular thread appears to be somewhat

similar to the one I just described. In the LaPorte situation, there was

apparently a city ordinance involved as well, however, which complicates things.

From what I read, a LaPorte resident called a private service (outside LaPorte)

directly, after the LaPorte dispatcher declined to send the " official " 911

service on the grounds that it was " not an emergency. " The responding

ambulance, apparently applying different criteria to define an emergency

situation, agreed to respond and contacted the LaPorte dispatcher for permission

to respond as emergency traffic.

At this time, a LaPorte EMS supervisor decided to respond to the call - for

which he apparently did not even have the full address!! Arriving near the

scene, he prevented the responding " non-LaPorte approved " unit from getting to

the patient. Since an EMS supervisor is not a sworn police officer, I do not

understand what authority he had to do this, but he did. Eventually, LaPorte

EMS personnel attended the patient (guess it became an emergency after all??),

but their arrival was somewhat later than the arrival of the outside ambulance

on (or actually " near " ) the scene.

The actions of the LaPorte EMS supervisor delayed the start of patient care.

Whether the delay was three minutes, seven minutes or thirty minutes is

immaterial. The actions of the LaPorte EMS supervisor resulted in a delay in

the patient receiving care. Even if there was no actual harm to the patient in

this case, such a delay could potentially have significant adverse effects in

some cases. The circumstances of this case make it appear that the reason for

preventing the outside ambulance from reaching the patient - regardless of what

the LaPorte supervisor, the LaPorte EMS service or the city may say - was to

preserve LaPorts's exclusivity policy. That policy appears to put patient

interests secondary to city power and revenues.

The State licenses physicians, and the city has very limited regulatory powers

regarding the practice of medicine. The city certainly cannot tell its citizens

that they can only see those physicians who are " approved " by the city and then

prohibit the citizens from going to other state-licensed physicians outside the

city. They can tell the citizens that if they go to a city-funded clinic, they

will be seen by one of the doctors at that clinic, and not by a physician from

another city. Similarly, if a call is made to 911 asking for an ambulance, it

is reasonable that the city (or whoever is doing the dispatching) will send the

" official " 911 service, whatever it is.

Once the 911 system declines the call, however, and tells the caller that they

have to call a private service directly, it would seem only common sense that

the city is voluntarily giving up control over which service is called by that

citizen.

The City of Houston regulates EMS services for those calls that both originate

in and terminate in the city. They do not attempt to regulate those calls that

start inside teh city and end outside, or those that start outside the city and

end inside the city. This particular incident would have been a call

originating in the city, but (assuming the destination would have been a

hospital ER), would have probably ended in either Baytown (Bay Coast MC / San

Jacinto Methodist) or Pasadena (Bayshore). If this incident had occured in

Houston, as I understand it, the responding private service would not have

required any city " permit " or approval to do so.

To use the terminology that Gene did below, if it is unreasonable and an abuse

of power to deny an outside service to make a transfer INTO the territory from

an outlying area, why is it not unreasonable and an abuse of power to deny an

outside service to make a transfer OUT OF the territory to an outlying area?

That is what LaPorte is apparently trying to do here.

Mor grist for the discussion mill, I guess.

" Just my opinion " as has been said before - and we all have those, don't we?

wegandy1938@... wrote:

The " restraint of trade " issue has been litigated in Texas, and the Courts

ruled that the police power trumps restraint of trade issues. So the

municipality has, through the police power, the power to determine who operates

within

the boundaries of the municipality.

This is quite similar to the power to regulate franchises for cable TV and so

forth.

As Dr. B has recalled, 30 years ago a chaotic situation existed in some of

the large cities in Texas, where competing funeral homes ran ambulance services,

raced each other to the scene of wrecks and sometimes actually engaged in

tugs of war over dead bodies. The unfortunate living were taken by the slower

services to respond and " hotshotted " without treatment to the hospital.

This became intolerable, and various approaches were tried to limit this

unfettered " Road Warrior " competition.

One of the approaches was to declare one provider to do all 911 and transfers

within an area, with outside services being allowed to bring patients into a

hospital, and for outside services to come into the territory for the purpose

of transferring a patient outside the territory. All intraterritory

transfers were done by the contracted service, 3rd service, or designated

service.

This was determined to be a perfectly legal regulatory scheme.

It is not generally feasible for the designated provider to take patients

from an in-territory hospital to a city 200 miles distant, although if the

designated provider wanted to do it, in my opinion, it would be legal.

It is unreasonable and an abuse of power to deny an outside service to make a

transfer INTO the territory from an outlying area. And this is not done by

any municipality that I have ever heard of.

Providers in Texas occupy a very privileged status. In many states, AZ

being the one I am most familiar with, having lived there, no service can

operate

until granted a Certificate of Need by the state EMS authority. CON's are

not handed out easily. It is practically impossible for the situation to exist

that now exists in County, where there are somewhere between 110 and

120 licensed ambulance providers. In AZ there might be 3. This sort of

control has been litigated at the federal level and declared to be within the

powers of the state. So don't even think about litigating this unless you have

approximately $1,000,000 in spare cash available for legal fees and some very

high powered attorneys ready to try to find a novel and innovative way around

these rulings.

Bottom line: Cities can regulate ambulance services. Period.

As to a regulation that supposedly says that a patient can ask for any

ambulance service he wants to transport him, I am unable to find such a

regulation

in the Texas Statutes or the Texas Administrative Code. If anyone has a

specific citation to such a rule, please let me know.

Gene G.

> 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.

>

> BEB

>

> E. Bledsoe, DO, FACEP

> Midlothian, Texas

>

> Don't miss the Western States EMS Cruise!

> http://proemseducators.com/index.html

>

>

> _____

>

> From: [mailto: ] On

> Behalf Of STEVE BOWMAN

> Sent: Monday, January 30, 2006 11:20 AM

> To:

> Subject: Re: Re: City Ordinances

>

>

> I agree with your comments, and would also like to toss another cat into

> this fight.

>

> I seem to remember that TDSHS says that a patient (or patient's

> representative) can call ANY provider directly for service (emergency or

> non-emeergency), whether that provider is the " official " 911 provider for

> that area or not.

>

> If the patient requests a specific provider - for whatever reason - can

> the city refuse to permit that provider to respond? Or penalize them when

> they do? Would that be a conspiracy in restraint of trade, to use the

> federal anti-trust terminology?

>

>

> Kim wrote:

>

>

> 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. ;-) )

>

>

>

>

>

[Guest guest]

This situation occurred in a county that does not include a major metropolitan

area. The county had a contract with a private service to serve as the 911

provider for the county (less some areas as described next). Within the county

there existed one or more subordinate areas which decided to contract with a

different private service to provide their 911 service. This is an allowed

practice under TDSHS, etc.

Over time, some residents of the county who lived in the area covered by the

main county provider developed issues with that provider (over various issues,

including excessive response times). These citizens (and others around them who

knew of the issues) would then call another service for emergency response. If

they were close enough to call the service in the subordinate political area

they called that service directly rather than calling 911. Others, too distant

for that service to effectively cover, called providers outside the county.

TDSHS determined that this was not a violation of any regulation, policy or

rule, and that a service can choose to respond - whether they have a " duty to

respond " or not - to a direct call from anyone, regardless of their location.

In other words, as far as TDSHS was concerned, the county's contracted 911

provisder did not have true exclusivity. They might be the provider to which

calls made to 911 were assigned, but neither they nor the county could prevent

citizens from calling any service they wanted to. Nor could they prohibit the

service receiving such a direct call from responding into " their " service area.

The situation that triggered this particular thread appears to be somewhat

similar to the one I just described. In the LaPorte situation, there was

apparently a city ordinance involved as well, however, which complicates things.

From what I read, a LaPorte resident called a private service (outside LaPorte)

directly, after the LaPorte dispatcher declined to send the " official " 911

service on the grounds that it was " not an emergency. " The responding

ambulance, apparently applying different criteria to define an emergency

situation, agreed to respond and contacted the LaPorte dispatcher for permission

to respond as emergency traffic.

At this time, a LaPorte EMS supervisor decided to respond to the call - for

which he apparently did not even have the full address!! Arriving near the

scene, he prevented the responding " non-LaPorte approved " unit from getting to

the patient. Since an EMS supervisor is not a sworn police officer, I do not

understand what authority he had to do this, but he did. Eventually, LaPorte

EMS personnel attended the patient (guess it became an emergency after all??),

but their arrival was somewhat later than the arrival of the outside ambulance

on (or actually " near " ) the scene.

The actions of the LaPorte EMS supervisor delayed the start of patient care.

Whether the delay was three minutes, seven minutes or thirty minutes is

immaterial. The actions of the LaPorte EMS supervisor resulted in a delay in

the patient receiving care. Even if there was no actual harm to the patient in

this case, such a delay could potentially have significant adverse effects in

some cases. The circumstances of this case make it appear that the reason for

preventing the outside ambulance from reaching the patient - regardless of what

the LaPorte supervisor, the LaPorte EMS service or the city may say - was to

preserve LaPorts's exclusivity policy. That policy appears to put patient

interests secondary to city power and revenues.

The State licenses physicians, and the city has very limited regulatory powers

regarding the practice of medicine. The city certainly cannot tell its citizens

that they can only see those physicians who are " approved " by the city and then

prohibit the citizens from going to other state-licensed physicians outside the

city. They can tell the citizens that if they go to a city-funded clinic, they

will be seen by one of the doctors at that clinic, and not by a physician from

another city. Similarly, if a call is made to 911 asking for an ambulance, it

is reasonable that the city (or whoever is doing the dispatching) will send the

" official " 911 service, whatever it is.

Once the 911 system declines the call, however, and tells the caller that they

have to call a private service directly, it would seem only common sense that

the city is voluntarily giving up control over which service is called by that

citizen.

The City of Houston regulates EMS services for those calls that both originate

in and terminate in the city. They do not attempt to regulate those calls that

start inside teh city and end outside, or those that start outside the city and

end inside the city. This particular incident would have been a call

originating in the city, but (assuming the destination would have been a

hospital ER), would have probably ended in either Baytown (Bay Coast MC / San

Jacinto Methodist) or Pasadena (Bayshore). If this incident had occured in

Houston, as I understand it, the responding private service would not have

required any city " permit " or approval to do so.

To use the terminology that Gene did below, if it is unreasonable and an abuse

of power to deny an outside service to make a transfer INTO the territory from

an outlying area, why is it not unreasonable and an abuse of power to deny an

outside service to make a transfer OUT OF the territory to an outlying area?

That is what LaPorte is apparently trying to do here.

Mor grist for the discussion mill, I guess.

" Just my opinion " as has been said before - and we all have those, don't we?

wegandy1938@... wrote:

The " restraint of trade " issue has been litigated in Texas, and the Courts

ruled that the police power trumps restraint of trade issues. So the

municipality has, through the police power, the power to determine who operates

within

the boundaries of the municipality.

This is quite similar to the power to regulate franchises for cable TV and so

forth.

As Dr. B has recalled, 30 years ago a chaotic situation existed in some of

the large cities in Texas, where competing funeral homes ran ambulance services,

raced each other to the scene of wrecks and sometimes actually engaged in

tugs of war over dead bodies. The unfortunate living were taken by the slower

services to respond and " hotshotted " without treatment to the hospital.

This became intolerable, and various approaches were tried to limit this

unfettered " Road Warrior " competition.

One of the approaches was to declare one provider to do all 911 and transfers

within an area, with outside services being allowed to bring patients into a

hospital, and for outside services to come into the territory for the purpose

of transferring a patient outside the territory. All intraterritory

transfers were done by the contracted service, 3rd service, or designated

service.

This was determined to be a perfectly legal regulatory scheme.

It is not generally feasible for the designated provider to take patients

from an in-territory hospital to a city 200 miles distant, although if the

designated provider wanted to do it, in my opinion, it would be legal.

It is unreasonable and an abuse of power to deny an outside service to make a

transfer INTO the territory from an outlying area. And this is not done by

any municipality that I have ever heard of.

Providers in Texas occupy a very privileged status. In many states, AZ

being the one I am most familiar with, having lived there, no service can

operate

until granted a Certificate of Need by the state EMS authority. CON's are

not handed out easily. It is practically impossible for the situation to exist

that now exists in County, where there are somewhere between 110 and

120 licensed ambulance providers. In AZ there might be 3. This sort of

control has been litigated at the federal level and declared to be within the

powers of the state. So don't even think about litigating this unless you have

approximately $1,000,000 in spare cash available for legal fees and some very

high powered attorneys ready to try to find a novel and innovative way around

these rulings.

Bottom line: Cities can regulate ambulance services. Period.

As to a regulation that supposedly says that a patient can ask for any

ambulance service he wants to transport him, I am unable to find such a

regulation

in the Texas Statutes or the Texas Administrative Code. If anyone has a

specific citation to such a rule, please let me know.

Gene G.

> 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.

>

> BEB

>

> E. Bledsoe, DO, FACEP

> Midlothian, Texas

>

> Don't miss the Western States EMS Cruise!

> http://proemseducators.com/index.html

>

>

> _____

>

> From: [mailto: ] On

> Behalf Of STEVE BOWMAN

> Sent: Monday, January 30, 2006 11:20 AM

> To:

> Subject: Re: Re: City Ordinances

>

>

> I agree with your comments, and would also like to toss another cat into

> this fight.

>

> I seem to remember that TDSHS says that a patient (or patient's

> representative) can call ANY provider directly for service (emergency or

> non-emeergency), whether that provider is the " official " 911 provider for

> that area or not.

>

> If the patient requests a specific provider - for whatever reason - can

> the city refuse to permit that provider to respond? Or penalize them when

> they do? Would that be a conspiracy in restraint of trade, to use the

> federal anti-trust terminology?

>

>

> Kim wrote:

>

>

> 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. ;-) )

>

>

>

>

>

[Guest guest]

This situation occurred in a county that does not include a major metropolitan

area. The county had a contract with a private service to serve as the 911

provider for the county (less some areas as described next). Within the county

there existed one or more subordinate areas which decided to contract with a

different private service to provide their 911 service. This is an allowed

practice under TDSHS, etc.

Over time, some residents of the county who lived in the area covered by the

main county provider developed issues with that provider (over various issues,

including excessive response times). These citizens (and others around them who

knew of the issues) would then call another service for emergency response. If

they were close enough to call the service in the subordinate political area

they called that service directly rather than calling 911. Others, too distant

for that service to effectively cover, called providers outside the county.

TDSHS determined that this was not a violation of any regulation, policy or

rule, and that a service can choose to respond - whether they have a " duty to

respond " or not - to a direct call from anyone, regardless of their location.

In other words, as far as TDSHS was concerned, the county's contracted 911

provisder did not have true exclusivity. They might be the provider to which

calls made to 911 were assigned, but neither they nor the county could prevent

citizens from calling any service they wanted to. Nor could they prohibit the

service receiving such a direct call from responding into " their " service area.

The situation that triggered this particular thread appears to be somewhat

similar to the one I just described. In the LaPorte situation, there was

apparently a city ordinance involved as well, however, which complicates things.

From what I read, a LaPorte resident called a private service (outside LaPorte)

directly, after the LaPorte dispatcher declined to send the " official " 911

service on the grounds that it was " not an emergency. " The responding

ambulance, apparently applying different criteria to define an emergency

situation, agreed to respond and contacted the LaPorte dispatcher for permission

to respond as emergency traffic.

At this time, a LaPorte EMS supervisor decided to respond to the call - for

which he apparently did not even have the full address!! Arriving near the

scene, he prevented the responding " non-LaPorte approved " unit from getting to

the patient. Since an EMS supervisor is not a sworn police officer, I do not

understand what authority he had to do this, but he did. Eventually, LaPorte

EMS personnel attended the patient (guess it became an emergency after all??),

but their arrival was somewhat later than the arrival of the outside ambulance

on (or actually " near " ) the scene.

The actions of the LaPorte EMS supervisor delayed the start of patient care.

Whether the delay was three minutes, seven minutes or thirty minutes is

immaterial. The actions of the LaPorte EMS supervisor resulted in a delay in

the patient receiving care. Even if there was no actual harm to the patient in

this case, such a delay could potentially have significant adverse effects in

some cases. The circumstances of this case make it appear that the reason for

preventing the outside ambulance from reaching the patient - regardless of what

the LaPorte supervisor, the LaPorte EMS service or the city may say - was to

preserve LaPorts's exclusivity policy. That policy appears to put patient

interests secondary to city power and revenues.

The State licenses physicians, and the city has very limited regulatory powers

regarding the practice of medicine. The city certainly cannot tell its citizens

that they can only see those physicians who are " approved " by the city and then

prohibit the citizens from going to other state-licensed physicians outside the

city. They can tell the citizens that if they go to a city-funded clinic, they

will be seen by one of the doctors at that clinic, and not by a physician from

another city. Similarly, if a call is made to 911 asking for an ambulance, it

is reasonable that the city (or whoever is doing the dispatching) will send the

" official " 911 service, whatever it is.

Once the 911 system declines the call, however, and tells the caller that they

have to call a private service directly, it would seem only common sense that

the city is voluntarily giving up control over which service is called by that

citizen.

The City of Houston regulates EMS services for those calls that both originate

in and terminate in the city. They do not attempt to regulate those calls that

start inside teh city and end outside, or those that start outside the city and

end inside the city. This particular incident would have been a call

originating in the city, but (assuming the destination would have been a

hospital ER), would have probably ended in either Baytown (Bay Coast MC / San

Jacinto Methodist) or Pasadena (Bayshore). If this incident had occured in

Houston, as I understand it, the responding private service would not have

required any city " permit " or approval to do so.

To use the terminology that Gene did below, if it is unreasonable and an abuse

of power to deny an outside service to make a transfer INTO the territory from

an outlying area, why is it not unreasonable and an abuse of power to deny an

outside service to make a transfer OUT OF the territory to an outlying area?

That is what LaPorte is apparently trying to do here.

Mor grist for the discussion mill, I guess.

" Just my opinion " as has been said before - and we all have those, don't we?

wegandy1938@... wrote:

The " restraint of trade " issue has been litigated in Texas, and the Courts

ruled that the police power trumps restraint of trade issues. So the

municipality has, through the police power, the power to determine who operates

within

the boundaries of the municipality.

This is quite similar to the power to regulate franchises for cable TV and so

forth.

As Dr. B has recalled, 30 years ago a chaotic situation existed in some of

the large cities in Texas, where competing funeral homes ran ambulance services,

raced each other to the scene of wrecks and sometimes actually engaged in

tugs of war over dead bodies. The unfortunate living were taken by the slower

services to respond and " hotshotted " without treatment to the hospital.

This became intolerable, and various approaches were tried to limit this

unfettered " Road Warrior " competition.

One of the approaches was to declare one provider to do all 911 and transfers

within an area, with outside services being allowed to bring patients into a

hospital, and for outside services to come into the territory for the purpose

of transferring a patient outside the territory. All intraterritory

transfers were done by the contracted service, 3rd service, or designated

service.

This was determined to be a perfectly legal regulatory scheme.

It is not generally feasible for the designated provider to take patients

from an in-territory hospital to a city 200 miles distant, although if the

designated provider wanted to do it, in my opinion, it would be legal.

It is unreasonable and an abuse of power to deny an outside service to make a

transfer INTO the territory from an outlying area. And this is not done by

any municipality that I have ever heard of.

Providers in Texas occupy a very privileged status. In many states, AZ

being the one I am most familiar with, having lived there, no service can

operate

until granted a Certificate of Need by the state EMS authority. CON's are

not handed out easily. It is practically impossible for the situation to exist

that now exists in County, where there are somewhere between 110 and

120 licensed ambulance providers. In AZ there might be 3. This sort of

control has been litigated at the federal level and declared to be within the

powers of the state. So don't even think about litigating this unless you have

approximately $1,000,000 in spare cash available for legal fees and some very

high powered attorneys ready to try to find a novel and innovative way around

these rulings.

Bottom line: Cities can regulate ambulance services. Period.

As to a regulation that supposedly says that a patient can ask for any

ambulance service he wants to transport him, I am unable to find such a

regulation

in the Texas Statutes or the Texas Administrative Code. If anyone has a

specific citation to such a rule, please let me know.

Gene G.

> 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.

>

> BEB

>

> E. Bledsoe, DO, FACEP

> Midlothian, Texas

>

> Don't miss the Western States EMS Cruise!

> http://proemseducators.com/index.html

>

>

> _____

>

> From: [mailto: ] On

> Behalf Of STEVE BOWMAN

> Sent: Monday, January 30, 2006 11:20 AM

> To:

> Subject: Re: Re: City Ordinances

>

>

> I agree with your comments, and would also like to toss another cat into

> this fight.

>

> I seem to remember that TDSHS says that a patient (or patient's

> representative) can call ANY provider directly for service (emergency or

> non-emeergency), whether that provider is the " official " 911 provider for

> that area or not.

>

> If the patient requests a specific provider - for whatever reason - can

> the city refuse to permit that provider to respond? Or penalize them when

> they do? Would that be a conspiracy in restraint of trade, to use the

> federal anti-trust terminology?

>

>

> Kim wrote:

>

>

> 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. ;-) )

>

>

>

>

>

[Guest guest]

Or what about delaying 911 calls because all your

trucks are tied up doing transfers and emergencies?

TDH considers dialysis and HBO to be life-threatening.

The non-emergency side needs regulation and OVERSIGHT

because I have seen several companies running in

direct violation of TDSHS rules. But with one rep to

serve an area of at least 100 providers, do the math.

But sometimes the cities do not care about these

issues or politics get in the way.

Salvador Capuchino

EMT-P

--- fremsdallas@... wrote:

> Wes,

>

> My argument is not about safety or health or even

> emergency calls. I agree

> that a city or county should have the right to

> determine who responds to the

> emergency calls. What I am arguing is the

> restriction of the non-emergency

> calls. A permit system is great at weeding out the

> unscrupulous providers.

> However, to fully exclude properly permitted and

> operated services from doing

> business in an area is borderline folly.

>

> If a citizen lives in say Arlington or Forth Worth

> for example or even in

> east Texas who requires ambulance transport for

> dialysis or to another

> hospital, that person or their legal guardian should

> have the right to choose their

> transport provider.

>

> I am not discussing city permits, state permits,

> equipment or even pro forma

> cash flow statements--those are turned in to get the

> original

> permits/licensure or during a public bid. I am

> discussing what appears to be the outright

> restriction of trade.

>

> Is it in the interest of the public safety (for the

> sake of argument) for a

> public utility model to have a history of not

> meeting response time

> requirements for emergency calls, delay their

> non-emergency calls for several hours

> and delay the opening of sorely needed ICU beds, ER

> beds or med-surg beds?

> Would it not be in the best interest, health and

> safety of the citizens to have

> a list of approved alternates for the non emergency

> work or even emergency

> overload?

>

>

> [Non-text portions of this message have been

> removed]

>

>

>

>

>

[Guest guest]

When I was first beginning in EMS , While working full time in LE I would work

extra jobs as a EMT-B for a transfer company to gain experience. I did gain some

knowledge in areas such and using pumps and vents ect. and other types of care

that is more directed in the area of transfer. What I learned after being at

this service for a year was that they were concerned about the amount of money

that the company could bring in more than the quality of care given. I seen many

abuses such as a fully ambulatory Pt. with a tooth ache being transported to and

from a VA hospital for some meds. and I believe this is a disgusting abuse of

the system. I have seen this service move equipment from one truck to another to

pass inspection. I have observed that a lot of the companies just hire in a

medic without any formal type of interview process that would test the ability

of these potential employees as medics. They are just interested in staffing a

truck so it can roll and make more money.I know

that there are a lot of companies out there in the business of transfers that

do a good job but I don't think that enough is being done to run the bad

companies out of business. DSHS is way understaffed and does not have the

resources to deal with these issues in a rapid manner. I have met some of these

DSHS employees and know that they do the best that they can but they are

overwhelmed by the work load at times. Thank God I work for a 911 provider where

the medics have a lot of pride in the quality of care and pretty much self

regulate with in the service. If you perform poor Pt. care are fail to provide

the care needed you want be at our service very long.

I think that the EMS world needs to work toward demanding more education and

training for its medics and quite staffing truck with medics fresh out of school

without the proper FTO training and proving skills. I have heard more than once

that being a LP does not given any indication of a better medic. Well my wife is

pursuing a BS in EMS through University of Texas ( San ) and is currently

in a 16 week 12 lead course. When is the last time you attended a 12 lead class

that lasted more than a few hours or days. The old days of getting some college

hours in any subject and then proclaiming to be a LP does not cut it. Education!

Education! is the key.

Yes I not only think EMS should be regulated but find it absolutely necessary

to oversee and eliminate some of the less than desirable services.

If you quite studying right after you obtained your patched you are cheating

you patients and yourself.

THEDUDMAN@... wrote:

When someone breaks in your house...do you call any police department you want

or does the municipality have that monopolized? What about when you have a

fire? Open up the phone book to AAAFire Department and call them?

The fact of the matter is, EMS still has a place in public safety (both

emergency and non-emergency) and as such, municipalities and/or counties and/or

states can (and in my opinion should) not only mandate who is going to provide

this service but also who is NOT.

This is one area in Texas where we are behind the curve in my opinion.

Dudley

Re: Re: City Ordinances

That's because if they are called, they go do the job, yes they are licensed and

regulated but a private citizen can call any plumber they want. UNLIKE this

thing going on with EMS where a City will tell you who you can and cannot use to

provide non emergency medical service. this is the point I am trying to make.

ExLngHrn@... wrote:

I was attempting to make an analogy. Plumbers, like some ambulance

services, may be simultaneously regulated by both the state and the

municipality.

However, I've never heard plumbers complaining that people don't have " freedom

of choice. "

-Wes

In a message dated 1/30/2006 9:41:59 PM Central Standard Time,

asearch4reason@... writes:

try the yellow pages.. (is this spelled correctly?). ANd what did plumbers

have to do with this??

ExLngHrn@... wrote:

Hello Mr./Ms./Mrs. ASearch4Reason: (I didn't know what else to call you

since you didn't sign your post.)

Government regulation of private, non-emergency ambulance transports is a

" some what dictator ship? " (I had a bit of a hard time following your

reasoning because of the rampant spelling and grammatical issues.) Actually,

it's not

a somewhat dictatorship. Court cases have held that government has the

power to regulate EMS.

EMS is a very crucial service and we complain about regulating it. Yet, I

wonder if TexasPlumbers-L would be filled with people complaining that the

state licenses plumbers and that most cities additionally inspect plumbing

before issuing a certificate of occupancy for a new building?

I'm still a bit confused. Can you point me to a specific provision either

in Constitutional or statutory law that guarantees your right to choose a

particular ambulance service?

Best regards,

Wes Ogilvie, MPA, JD, EMT-B

Austin, Texas

In a message dated 1/30/2006 8:10:37 PM Central Standard Time,

asearch4reason@... writes:

So I guess then the telephone books should be " City Specific " and not let

any and all other services place an add. This wayno PRIVATE TAX PAYING

CITIZEN

calls for an ambulance that is not called to a location that is being

" monopolized " by a Goverment entity. I agree with that " too much compition

causes

the level of care to diminish " and I do believe that there are private

companies that hire anyone with a " pulse and a patch " to cover their calls.

This is a

VERY SCARY situation. But at what piont in time does this become a some

what

dictator ship. If my family has used " Ambulance ABC " for the last 5 yrs,

there comes a sort of bond. This is just swiped away because CITY A wants

full

control. If I call for an ambulance for my family for a NON-EMERGENCY

transport, and I am PAYING out of MY POCKET, I really would have a hard

time knowing

that the city where I PAY TAXES AND ELECT officials are going to tell me

who

I can and cannot use to medically take care of my family.

As everyone else, I too am not taking sides, as a matter of fact, I work PT

for a city that is doing this very thing. All I am saying is that If I call

for a Transfer ambulance from my HOME, I should be able to use who ever I

damn

well please, this is my right as an American CItizen.

Stay safe everyone....

" E. Tate " wrote:

The same way the city can dictate which garbage collection company you can,

canââ,¬â " ¢t, or must use. Cities have the power to regulate business to some

extent within their jurisdiction. The courts have upheld these so called â

â,¬Å "

sole-providerââ,¬Â ordinances.

The problem you run into is that cities are expected to protect their

citizens. Also, they (at least larger cities) are expected to provide EMS

coverage. In days past this meant huge subsidies to EMS services to

provide 911

coverage. With the sole-provider model subsidies are becoming a thing of

the

past. By allowing ABC EMS to have a sole-provider contract the governing

entity

can escape the EMS subsidy and revert those monies to more important

services.

Competition is a good thing, even in EMS. However, too much competition

causes the level of care for everyone involved to diminish because the money

just isnââ,¬â " ¢t there to sustain any single company. There must be

regulation. We

arenââ,¬â " ¢t going to change that.

Iââ,¬â " ¢m not picking sides, just saying thatââ,¬â " ¢s how the cookie

crumbles.

Tater

fremsdallas@... wrote: I would think that the freedom of choice and a

free market economy trumps a

city ordinance. How can a city dictate which ambulance provider(s) can or

cannot be used by a private citizen--especially if it is a private request

originating on private property and being paid for privately??

[Non-text portions of this message have been removed]

[Guest guest]

When I was first beginning in EMS , While working full time in LE I would work

extra jobs as a EMT-B for a transfer company to gain experience. I did gain some

knowledge in areas such and using pumps and vents ect. and other types of care

that is more directed in the area of transfer. What I learned after being at

this service for a year was that they were concerned about the amount of money

that the company could bring in more than the quality of care given. I seen many

abuses such as a fully ambulatory Pt. with a tooth ache being transported to and

from a VA hospital for some meds. and I believe this is a disgusting abuse of

the system. I have seen this service move equipment from one truck to another to

pass inspection. I have observed that a lot of the companies just hire in a

medic without any formal type of interview process that would test the ability

of these potential employees as medics. They are just interested in staffing a

truck so it can roll and make more money.I know

that there are a lot of companies out there in the business of transfers that

do a good job but I don't think that enough is being done to run the bad

companies out of business. DSHS is way understaffed and does not have the

resources to deal with these issues in a rapid manner. I have met some of these

DSHS employees and know that they do the best that they can but they are

overwhelmed by the work load at times. Thank God I work for a 911 provider where

the medics have a lot of pride in the quality of care and pretty much self

regulate with in the service. If you perform poor Pt. care are fail to provide

the care needed you want be at our service very long.

I think that the EMS world needs to work toward demanding more education and

training for its medics and quite staffing truck with medics fresh out of school

without the proper FTO training and proving skills. I have heard more than once

that being a LP does not given any indication of a better medic. Well my wife is

pursuing a BS in EMS through University of Texas ( San ) and is currently

in a 16 week 12 lead course. When is the last time you attended a 12 lead class

that lasted more than a few hours or days. The old days of getting some college

hours in any subject and then proclaiming to be a LP does not cut it. Education!

Education! is the key.

Yes I not only think EMS should be regulated but find it absolutely necessary

to oversee and eliminate some of the less than desirable services.

If you quite studying right after you obtained your patched you are cheating

you patients and yourself.

THEDUDMAN@... wrote:

When someone breaks in your house...do you call any police department you want

or does the municipality have that monopolized? What about when you have a

fire? Open up the phone book to AAAFire Department and call them?

The fact of the matter is, EMS still has a place in public safety (both

emergency and non-emergency) and as such, municipalities and/or counties and/or

states can (and in my opinion should) not only mandate who is going to provide

this service but also who is NOT.

This is one area in Texas where we are behind the curve in my opinion.

Dudley

Re: Re: City Ordinances

That's because if they are called, they go do the job, yes they are licensed and

regulated but a private citizen can call any plumber they want. UNLIKE this

thing going on with EMS where a City will tell you who you can and cannot use to

provide non emergency medical service. this is the point I am trying to make.

ExLngHrn@... wrote:

I was attempting to make an analogy. Plumbers, like some ambulance

services, may be simultaneously regulated by both the state and the

municipality.

However, I've never heard plumbers complaining that people don't have " freedom

of choice. "

-Wes

In a message dated 1/30/2006 9:41:59 PM Central Standard Time,

asearch4reason@... writes:

try the yellow pages.. (is this spelled correctly?). ANd what did plumbers

have to do with this??

ExLngHrn@... wrote:

Hello Mr./Ms./Mrs. ASearch4Reason: (I didn't know what else to call you

since you didn't sign your post.)

Government regulation of private, non-emergency ambulance transports is a

" some what dictator ship? " (I had a bit of a hard time following your

reasoning because of the rampant spelling and grammatical issues.) Actually,

it's not

a somewhat dictatorship. Court cases have held that government has the

power to regulate EMS.

EMS is a very crucial service and we complain about regulating it. Yet, I

wonder if TexasPlumbers-L would be filled with people complaining that the

state licenses plumbers and that most cities additionally inspect plumbing

before issuing a certificate of occupancy for a new building?

I'm still a bit confused. Can you point me to a specific provision either

in Constitutional or statutory law that guarantees your right to choose a

particular ambulance service?

Best regards,

Wes Ogilvie, MPA, JD, EMT-B

Austin, Texas

In a message dated 1/30/2006 8:10:37 PM Central Standard Time,

asearch4reason@... writes:

So I guess then the telephone books should be " City Specific " and not let

any and all other services place an add. This wayno PRIVATE TAX PAYING

CITIZEN

calls for an ambulance that is not called to a location that is being

" monopolized " by a Goverment entity. I agree with that " too much compition

causes

the level of care to diminish " and I do believe that there are private

companies that hire anyone with a " pulse and a patch " to cover their calls.

This is a

VERY SCARY situation. But at what piont in time does this become a some

what

dictator ship. If my family has used " Ambulance ABC " for the last 5 yrs,

there comes a sort of bond. This is just swiped away because CITY A wants

full

control. If I call for an ambulance for my family for a NON-EMERGENCY

transport, and I am PAYING out of MY POCKET, I really would have a hard

time knowing

that the city where I PAY TAXES AND ELECT officials are going to tell me

who

I can and cannot use to medically take care of my family.

As everyone else, I too am not taking sides, as a matter of fact, I work PT

for a city that is doing this very thing. All I am saying is that If I call

for a Transfer ambulance from my HOME, I should be able to use who ever I

damn

well please, this is my right as an American CItizen.

Stay safe everyone....

" E. Tate " wrote:

The same way the city can dictate which garbage collection company you can,

canââ,¬â " ¢t, or must use. Cities have the power to regulate business to some

extent within their jurisdiction. The courts have upheld these so called â

â,¬Å "

sole-providerââ,¬Â ordinances.

The problem you run into is that cities are expected to protect their

citizens. Also, they (at least larger cities) are expected to provide EMS

coverage. In days past this meant huge subsidies to EMS services to

provide 911

coverage. With the sole-provider model subsidies are becoming a thing of

the

past. By allowing ABC EMS to have a sole-provider contract the governing

entity

can escape the EMS subsidy and revert those monies to more important

services.

Competition is a good thing, even in EMS. However, too much competition

causes the level of care for everyone involved to diminish because the money

just isnââ,¬â " ¢t there to sustain any single company. There must be

regulation. We

arenââ,¬â " ¢t going to change that.

Iââ,¬â " ¢m not picking sides, just saying thatââ,¬â " ¢s how the cookie

crumbles.

Tater

fremsdallas@... wrote: I would think that the freedom of choice and a

free market economy trumps a

city ordinance. How can a city dictate which ambulance provider(s) can or

cannot be used by a private citizen--especially if it is a private request

originating on private property and being paid for privately??

[Non-text portions of this message have been removed]

[Guest guest]

When I was first beginning in EMS , While working full time in LE I would work

extra jobs as a EMT-B for a transfer company to gain experience. I did gain some

knowledge in areas such and using pumps and vents ect. and other types of care

that is more directed in the area of transfer. What I learned after being at

this service for a year was that they were concerned about the amount of money

that the company could bring in more than the quality of care given. I seen many

abuses such as a fully ambulatory Pt. with a tooth ache being transported to and

from a VA hospital for some meds. and I believe this is a disgusting abuse of

the system. I have seen this service move equipment from one truck to another to

pass inspection. I have observed that a lot of the companies just hire in a

medic without any formal type of interview process that would test the ability

of these potential employees as medics. They are just interested in staffing a

truck so it can roll and make more money.I know

that there are a lot of companies out there in the business of transfers that

do a good job but I don't think that enough is being done to run the bad

companies out of business. DSHS is way understaffed and does not have the

resources to deal with these issues in a rapid manner. I have met some of these

DSHS employees and know that they do the best that they can but they are

overwhelmed by the work load at times. Thank God I work for a 911 provider where

the medics have a lot of pride in the quality of care and pretty much self

regulate with in the service. If you perform poor Pt. care are fail to provide

the care needed you want be at our service very long.

I think that the EMS world needs to work toward demanding more education and

training for its medics and quite staffing truck with medics fresh out of school

without the proper FTO training and proving skills. I have heard more than once

that being a LP does not given any indication of a better medic. Well my wife is

pursuing a BS in EMS through University of Texas ( San ) and is currently

in a 16 week 12 lead course. When is the last time you attended a 12 lead class

that lasted more than a few hours or days. The old days of getting some college

hours in any subject and then proclaiming to be a LP does not cut it. Education!

Education! is the key.

Yes I not only think EMS should be regulated but find it absolutely necessary

to oversee and eliminate some of the less than desirable services.

If you quite studying right after you obtained your patched you are cheating

you patients and yourself.

THEDUDMAN@... wrote:

When someone breaks in your house...do you call any police department you want

or does the municipality have that monopolized? What about when you have a

fire? Open up the phone book to AAAFire Department and call them?

The fact of the matter is, EMS still has a place in public safety (both

emergency and non-emergency) and as such, municipalities and/or counties and/or

states can (and in my opinion should) not only mandate who is going to provide

this service but also who is NOT.

This is one area in Texas where we are behind the curve in my opinion.

Dudley

Re: Re: City Ordinances

That's because if they are called, they go do the job, yes they are licensed and

regulated but a private citizen can call any plumber they want. UNLIKE this

thing going on with EMS where a City will tell you who you can and cannot use to

provide non emergency medical service. this is the point I am trying to make.

ExLngHrn@... wrote:

I was attempting to make an analogy. Plumbers, like some ambulance

services, may be simultaneously regulated by both the state and the

municipality.

However, I've never heard plumbers complaining that people don't have " freedom

of choice. "

-Wes

In a message dated 1/30/2006 9:41:59 PM Central Standard Time,

asearch4reason@... writes:

try the yellow pages.. (is this spelled correctly?). ANd what did plumbers

have to do with this??

ExLngHrn@... wrote:

Hello Mr./Ms./Mrs. ASearch4Reason: (I didn't know what else to call you

since you didn't sign your post.)

Government regulation of private, non-emergency ambulance transports is a

" some what dictator ship? " (I had a bit of a hard time following your

reasoning because of the rampant spelling and grammatical issues.) Actually,

it's not

a somewhat dictatorship. Court cases have held that government has the

power to regulate EMS.

EMS is a very crucial service and we complain about regulating it. Yet, I

wonder if TexasPlumbers-L would be filled with people complaining that the

state licenses plumbers and that most cities additionally inspect plumbing

before issuing a certificate of occupancy for a new building?

I'm still a bit confused. Can you point me to a specific provision either

in Constitutional or statutory law that guarantees your right to choose a

particular ambulance service?

Best regards,

Wes Ogilvie, MPA, JD, EMT-B

Austin, Texas

In a message dated 1/30/2006 8:10:37 PM Central Standard Time,

asearch4reason@... writes:

So I guess then the telephone books should be " City Specific " and not let

any and all other services place an add. This wayno PRIVATE TAX PAYING

CITIZEN

calls for an ambulance that is not called to a location that is being

" monopolized " by a Goverment entity. I agree with that " too much compition

causes

the level of care to diminish " and I do believe that there are private

companies that hire anyone with a " pulse and a patch " to cover their calls.

This is a

VERY SCARY situation. But at what piont in time does this become a some

what

dictator ship. If my family has used " Ambulance ABC " for the last 5 yrs,

there comes a sort of bond. This is just swiped away because CITY A wants

full

control. If I call for an ambulance for my family for a NON-EMERGENCY

transport, and I am PAYING out of MY POCKET, I really would have a hard

time knowing

that the city where I PAY TAXES AND ELECT officials are going to tell me

who

I can and cannot use to medically take care of my family.

As everyone else, I too am not taking sides, as a matter of fact, I work PT

for a city that is doing this very thing. All I am saying is that If I call

for a Transfer ambulance from my HOME, I should be able to use who ever I

damn

well please, this is my right as an American CItizen.

Stay safe everyone....

" E. Tate " wrote:

The same way the city can dictate which garbage collection company you can,

canââ,¬â " ¢t, or must use. Cities have the power to regulate business to some

extent within their jurisdiction. The courts have upheld these so called â

â,¬Å "

sole-providerââ,¬Â ordinances.

The problem you run into is that cities are expected to protect their

citizens. Also, they (at least larger cities) are expected to provide EMS

coverage. In days past this meant huge subsidies to EMS services to

provide 911

coverage. With the sole-provider model subsidies are becoming a thing of

the

past. By allowing ABC EMS to have a sole-provider contract the governing

entity

can escape the EMS subsidy and revert those monies to more important

services.

Competition is a good thing, even in EMS. However, too much competition

causes the level of care for everyone involved to diminish because the money

just isnââ,¬â " ¢t there to sustain any single company. There must be

regulation. We

arenââ,¬â " ¢t going to change that.

Iââ,¬â " ¢m not picking sides, just saying thatââ,¬â " ¢s how the cookie

crumbles.

Tater

fremsdallas@... wrote: I would think that the freedom of choice and a

free market economy trumps a

city ordinance. How can a city dictate which ambulance provider(s) can or

cannot be used by a private citizen--especially if it is a private request

originating on private property and being paid for privately??

[Non-text portions of this message have been removed]