Tuesday, March 6, 2012

They be Fussin'

I have lived here for 47 of my 51 years. During that time, emergency medical transport has always been provided by private companies. I have a vague recollection of  Howard's, a small company, providing service when I was a kid, before consolidating service in the Redlands/San Gorgonio pass area and leaving town.

Then for years, it was Goodhew ambulance, a company headquartered  in L. A. with a division here in the inland empire. Goodhew was the ambulance company providing service when I became an EMT and through my early years with the RFD.  At one time, Goodhew had five ambulances dedicated to city 911 service. These ambulances were housed in our fire stations and were dispatched by us. We knew them and they us..

Since I have been around, the city has always required that ambulance companies pay a franchise fee to operate in the city. In addition, the company that holds the franchise is the sole provider for emergency and non-emergency transport originating in the city..

At some point, Goodhew was bought out by Med Trans, who then sold out to AMR, which now holds the city franchise. There are still a few former Goodhew employees who work for AMR, I used to see them occasionally around town.

When the RFD became an ALS provider, the franchise fees charged to AMR were used to fund our paramedic program. This in essence, is still the case today. AMR pays the franchise fee and gets to be the sole provider of 911 emergency transport and non emrgency transport. As the franchise holder, they are the only ambulance company that can pick up a patient within the city, whether on the street, at a residence, at a con-home or a hospital. If the trip starts here, it will be AMR who does the driving.

AMR also is the exclusive emergency ambulance transport to the vast majority of the county, though non- emergency or retail ambulance service is provided by several other providers. Cavalry Ambulance and Mission Ambulance and several others provide non-emergency transport to other areas in the county and would like to do so in the city.

Mission ambulance and Alpha ambulance have both applied for a city franchise, only to be turned down. Both actions were recommended by the fire chief, who oversees the ambulance franchise program for the city.

Needless to say, Mission Ambulance was not happy with the city's decision and asked the state EMS authority to get involved. The state emsa has written an opinion that the city does not have the authority to limit non emergency ambulance service within it's borders. The state's opinion will likely require the county to get involved as they control the county-wide plan. This battle does not appear to be over.

The city's position is that Mission ambulance has not proven a need for a second ambulance service operating within the city. The city also believes that AMR's retail ambulance service subsidizes the 911 transport service as retail service tends to be paid for more often than emergency service does. I tend to agree.

The issue has become larger than it has ever been and does not appear to be going away. There is merit to both sides of the argument, the city creating a monopoly and limiting competition versus the need for a stable EMS transport system in the city. Unless the city wants to get into the 911 transport business, I'll have to go for the latter. Stability is key and AMR has met our needs to this point.

I'm just sayin'.

Thanks for reading,


  1. Totally hear you. Here in NY, to operate in a municipality, an ambulance company has to have a Certificate Of Need from the municipality attesting to the necessity for them to operate there. CONs, once obtained, are considered assets of the corporation, and change hands frequently when one ambulance service is gobbled up by another. My county has three or four private ALS providers, who will also provide BLS coverage under contract to municipalities wishing to establish that coverage, and also numerous local BLS fire department ambulance corps. It's ostensibly a two-tiered system, but it's unwieldy and difficult to understand. We often don't know which ALS unit will be arriving for an EMS call, since none of the providers are large enough to cover their areas, and when one runs out of units (which occurs every day or two) the county dispatchers pick another (seemingly at random) and dispatch it. Many of the fire chiefs (including me) wish that the county would establish a two-tiered county EMS system and do away with the chaos. Unfortunately, there are so many municipal egos involved that I doubt it will ever happen.

  2. I'm kind of shocked that Medicare doesn't have an issue with such an arrangement. Certainly seems like it skirts awfully close to their anti-kickback regulations. Other privates have gotten in trouble for dropping off muffins to the morning shift at their local ER. Meanwhile AMR is essentially buying the franchise in Riverside.

    Obviously it works, to a point, and you're right that stability is usually better. The dichotomy just seems odd.

  3. NYEMT - The system you describe does seem somewhat convoluted, it appears that there has to be a better way. To us in the field oops, I mean you in the field, it should be an easy fix. Its money an politics that get in the way.

    BH - I agree it does seem odd, though I'd bet that medicare doesn't know, care or care to know. Again, I'll take the stability of the status quo, unless of course something proven to be better comes along.

    Thanks for the comments.