The Santa Barbara County Superior Court hearing for the lawsuit between American Medical Response and the county over an ambulance services permit has been further delayed to late December, and the state Attorney General’s Office has filed an amicus brief weighing in on the legal issues in the meantime.
Longtime ambulance services provider AMR sued the Board of Supervisors and other county entities in September after the board approved permits for County Fire to provide services and denied them to AMR.
With the board’s permit decisions, AMR’s emergency medical services contract is set to end in February, with County Fire to start providing those services on March 1.
The Attorney General’s Office filed an amicus curiae brief on behalf of the California Emergency Medical Services Authority on the legal issues in the lawsuit.
The brief said that local officials, including a county’s Board of Supervisors, “can and do play an important oversight role in the administration of emergency services,” including final approval over Local Emergency Medical Services Agency recommendations for provider agreements. The state EMS Act mandates that a county’s LEMSA play a leading role in local EMS policy.
“However, to the extent AMR proves the underlying factual basis for its claims, the county’s actions appear to side-step the oversight mandated by the EMS Act and, thus, necessarily weaken the law’s protections that ensure the quality and equitable access of EMS care,” the state wrote in its brief to the court.
The county’s EMS Agency is within the Public Health Department, where staff reviewed ambulance permit applications. They determined that both County Fire and AMR were qualified applicants, but did not recommend approval or denial of any particular permits to the Board of Supervisors.
“The resolution of this matter is of substantial importance to EMSA, because the allegations in the complaint, if true, raise concerns that the EMS Act’s intended design and patient protections may be undermined,” the Attorney General’s Office wrote.
“Specifically, the allegations concerning the county’s adoption and application of a permitting system paint a picture of near-unilateral county Board of Supervisors authority to make local EMS policy without any substantive input or recommendation from the local designated EMS professionals, as required by the EMS Act.”
In its lawsuit, AMR is asking the court for a preliminary injunction — which would basically undo the permit approval — and alleges that the county is violating the state’s emergency medical services law.
A court hearing to consider this was initially set for Dec. 1 but then continued to Dec. 8. The Dec. 8 hearing was again rescheduled to Dec. 22 to give the court time to review amicus curiae briefs and other documents filed.
County Fire Association Defends Permit Decision
Another brief was filed by the Fire Chiefs Association of Santa Barbara County, longtime supporters of County Fire’s bid to get the ambulance contracts.
That organization argued in its brief to the court that AMR’s requested injunction is not in the public interest, and that AMR’s and EMSA’s arguments that the county’s ordinance is preempted by state law is not accurate.
The Fire Chiefs Association cites a section of the Vehicle Code for this, saying that the section allows the county to regulate emergency ambulance services through a permitting and licensing ordinance on an exclusive or non-exclusive basis.
The association also said that some of AMR’s and EMSA’s arguments involving federal antitrust laws should be disregarded as the issues fall under federal jurisdiction.
The Fire Chiefs Association added that granting the injunction request would “harm the financial viability of emergency ambulance services, increase health care costs without improving service quality, and disrupt the delivery of such services.”
County’s Ambulance Services Contract Process
Originally, the county put out a request for proposals for an exclusive ambulance services contract. Proposals were reviewed and scored by an independent panel. Within this process, AMR’s proposal scored 300 points higher than County Fire’s.
After multiple appeals by County Fire, the Board of Supervisors switched from the bidding process for an exclusive contract to a non-exclusive, permit-based system.
Both agencies applied for permits, and the board approved three permits for County Fire and denied AMR’s application for a permit.
AMR sued in September, shortly after that vote.
In court documents, county attorneys have said that “AMR refused to account for community benefit in its bid and application,” and that the county is justified in its approval of County Fire’s permits and denial of AMR’s application.
County attorneys also previously said that, if AMR’s injunction request is granted, “the county’s ambulance system will be thrown into chaos.”
In a response to the county’s opposition of the injunction, attorneys for AMR said the county’s permit-based ordinance creates an open system, but that the county’s decisions have not reflected that and this is the county’s “back door” way of granting an exclusive contract to County Fire.
AMR is also alleging that the county is undermining the EMS Act and the local EMS agency’s — which in Santa Barbara County is the Public Health Department — authority.
“LEMSAs must exercise all the statutory powers they are delegated under the EMS Act,” AMR’s attorneys said in its response. “These include the authorities to set standards for, regulate and contract with providers.
“AMR is likely to prevail on the merits because state law prohibits counties from creating back doors around their LEMSAs and selecting preferred providers through discretionary permits. In a truly open system, LEMSAs must approve all providers that meet EMS Act standards, State Authority regulations, and LEMSA policies. … The county’s evidence makes it clear it has made no effort to prepare for an open system that can actually accommodate multiple providers.”
The first case management conference and a hearing on the injunction request are scheduled to take place at 10 a.m. Dec. 22 at the Santa Barbara County Courthouse.