Re: City Ordinances New CON

[Guest guest]

This is what I am trying to do Dudley, stimulate discussion of the

topic. I for one, know that EMS needs to be cleaned up in this

great state of ours. I mean one DSHS EMS compliance officer

overseeing 100 EMS agencies as Salvador stated, thats a whole lot of

pressure on one person. Is this possibly where an EMS commission

comes in? Wes's idea of the RAC trying to formulate a plan, thus

making it more of a local issue? Or is that just putting more

pressure on the RACs?

Yes I know that unfunded mandates die horrible deaths during the

legislative sessions. With all the great minds here surely we can

come up with viable ideas to help in this matter. There is a whole

bunch of area outside the little box we sometimes get stuck in.

stephen stephens

> Honestly ,

>

> It should be a county function preferably....EMS is a local issue

and even Austin would have a hard time determining how many

ambulances Uvalde needed...the other issue with CON's is does it say

only who can operate or how many units each agency can operate as

well?

>

> This could go a long way to cleaning up EMS in Texas...however

counties don't have the money to perform this and any legislation

that attempts to make this a county mandated function will die a

horrible death...because one the state says the counties are

mandated to provide it...that then equals funding...

>

> Still, I think it is worth discussing and trying to come up with a

similar idea...

>

> Dudley

>

> Re: City Ordinances New CON

>

>

> What is everyones opinion to let DSHS issue Certificates of

> Necessity. I have heard several people discuss this. Would this

> actually put EMS compliance more into the hands of DSHS?

>

> One of the things I have seen happen time and time again, is a

> provider comes into an area and thinks they will make money and

then

> a month later they pull out because they realized there was no

money

> to be made. Then once again, the local service in one provider

area

> picks up the slack in that other service area and thus places a

> burden on that local service.

>

> I would point out that I am not suggesting that DSHS be granted

the

> ability to set rate because I personally think that should be left

> up to the provider. However, would it be beneficial for them to

> select the number of ambulances needed in a given " turf " area?

Would

> this be more of a bureacratic night mare?

>

> Lets get this one going. Woody, did the CON's make a difference?

> stephen stephens

>

>

>

> >

> > 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@c...

> >

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