Guest guest Posted January 29, 2006 Report Share Posted January 29, 2006 Politics is politics anywhere, not just in Texas. Unfortunately, too many believers in " free enterprise " are all for the government intervening when it could help them. However, when regulation might impact them, you hear the howls of " free enterprise. " -Wes In a message dated 1/29/2006 10:14:19 PM Central Standard Time, scapuchino@... writes: This is Texas and unfortunately politics will always play a roll. Salvador Capuchino EMTP --- Kim wrote: > I agree that regulation is needed. > > But... > > It's just unfortunate though that the ones who are > doing the " regulating " of > ambulance services in many cities (in other words, > granting or denying > franchises) are *not* the ones who are actually in > the trenches of patient > care. It's not the hospital physicians, nurses, or > nursing home staff who > are allowed to decide which competent and licensed > ambulance service may > assume care of their patients... it's a city > governmental and administrative > body who does. And as such, the hospital cannot > call the transfer service > they *want* to use for the best patient care when > the choice is severely > limited to a single service because of long-standing > city ordinance and > franchise protections. > > I've recently learned a hard lesson that politics > will always play a factor > in local government, no matter how good or honorable > your intentions and > labours. If regulation and permission to operate > was granted by a medical > body of the city, I would be more optimistic of the > whole situation. I see > it as a cold day in Hades before a city will ever > relinquish that control > willingly, and so the patient may never experience > " the best care " . The > patient will only receive " the available care " per > ordinance, as the only > service in town has little reason to improve beyond > the lowest standard when > protected by the city. > > > > > > > > > It amazes me that these actions in South Texas are > met with such surprise > > and indignation when they have been a part of the > EMS landscape for over > > 20 > > years, While the free-market should prevail, all > one has to do is look at > > the medical helicopter industry and see that EMS, > in whatever form, never > > can manage itself and government must step in. > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 29, 2006 Report Share Posted January 29, 2006 Politics is politics anywhere, not just in Texas. Unfortunately, too many believers in " free enterprise " are all for the government intervening when it could help them. However, when regulation might impact them, you hear the howls of " free enterprise. " -Wes In a message dated 1/29/2006 10:14:19 PM Central Standard Time, scapuchino@... writes: This is Texas and unfortunately politics will always play a roll. Salvador Capuchino EMTP --- Kim wrote: > I agree that regulation is needed. > > But... > > It's just unfortunate though that the ones who are > doing the " regulating " of > ambulance services in many cities (in other words, > granting or denying > franchises) are *not* the ones who are actually in > the trenches of patient > care. It's not the hospital physicians, nurses, or > nursing home staff who > are allowed to decide which competent and licensed > ambulance service may > assume care of their patients... it's a city > governmental and administrative > body who does. And as such, the hospital cannot > call the transfer service > they *want* to use for the best patient care when > the choice is severely > limited to a single service because of long-standing > city ordinance and > franchise protections. > > I've recently learned a hard lesson that politics > will always play a factor > in local government, no matter how good or honorable > your intentions and > labours. If regulation and permission to operate > was granted by a medical > body of the city, I would be more optimistic of the > whole situation. I see > it as a cold day in Hades before a city will ever > relinquish that control > willingly, and so the patient may never experience > " the best care " . The > patient will only receive " the available care " per > ordinance, as the only > service in town has little reason to improve beyond > the lowest standard when > protected by the city. > > > > > > > > > It amazes me that these actions in South Texas are > met with such surprise > > and indignation when they have been a part of the > EMS landscape for over > > 20 > > years, While the free-market should prevail, all > one has to do is look at > > the medical helicopter industry and see that EMS, > in whatever form, never > > can manage itself and government must step in. > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 30, 2006 Report Share Posted January 30, 2006 In a message dated 30-Jan-06 11:27:21 Central Standard Time, bbledsoe@... writes: Wes or Gene should probably answer this, but I think a municipal ordinance trumps TDSHS " rules " since the former is actually a law and the latter a rule or guideline. You may be surprised there, ...in most states, executive rules and guidelines promoted by divisions and bureaus created and funded by the legislature, have the effective force of state law, just like CMS regulations have the effective force of Federal Law. and it's a generally held guideline that local ordinances can be more strict than state laws (unless there is a state preemption), and state laws may be more strict than federal laws, but no lower level division can make a particular law *less* strict...this is where the Pot Legalization efforts in California and Oregon are falling afoul of the courts... ck S. Krin, DO FAAFP Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 30, 2006 Report Share Posted January 30, 2006 In a message dated 30-Jan-06 11:27:21 Central Standard Time, bbledsoe@... writes: Wes or Gene should probably answer this, but I think a municipal ordinance trumps TDSHS " rules " since the former is actually a law and the latter a rule or guideline. You may be surprised there, ...in most states, executive rules and guidelines promoted by divisions and bureaus created and funded by the legislature, have the effective force of state law, just like CMS regulations have the effective force of Federal Law. and it's a generally held guideline that local ordinances can be more strict than state laws (unless there is a state preemption), and state laws may be more strict than federal laws, but no lower level division can make a particular law *less* strict...this is where the Pot Legalization efforts in California and Oregon are falling afoul of the courts... ck S. Krin, DO FAAFP Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 30, 2006 Report Share Posted January 30, 2006 In a message dated 30-Jan-06 11:27:21 Central Standard Time, bbledsoe@... writes: Wes or Gene should probably answer this, but I think a municipal ordinance trumps TDSHS " rules " since the former is actually a law and the latter a rule or guideline. You may be surprised there, ...in most states, executive rules and guidelines promoted by divisions and bureaus created and funded by the legislature, have the effective force of state law, just like CMS regulations have the effective force of Federal Law. and it's a generally held guideline that local ordinances can be more strict than state laws (unless there is a state preemption), and state laws may be more strict than federal laws, but no lower level division can make a particular law *less* strict...this is where the Pot Legalization efforts in California and Oregon are falling afoul of the courts... ck S. Krin, DO FAAFP Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 30, 2006 Report Share Posted January 30, 2006 In a message dated 30-Jan-06 11:53:38 Central Standard Time, ExLngHrn@... writes: Pretty good for a brief lesson in administrative law and in the authority of local governments. I'll write you a letter of recommendation for law school in the event that you don't play enough golf as a physician. <tongue firmly in cheek> -Wes Ogilvie What I'm planning to check out when we move to MO is if they still allow challenges to the Bar....and if they do, I'll find me a nice friendly judge to clerk and investigate for in my 'spare time'...a couple of years of 'reading the Law' like that, and I'll bet that I can beat the Bar exam without more than a basic 'Kaplan board course' under my belt. ck S. Krin, DO FAAFP Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 30, 2006 Report Share Posted January 30, 2006 In a message dated 30-Jan-06 14:09:30 Central Standard Time, ExLngHrn@... writes: My advice is to check out BarBri when you decide you want to challenge/take the Bar exam. thanks... is a good outfit. ck S. Krin, DO FAAFP Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 30, 2006 Report Share Posted January 30, 2006 Re: Re: City Ordinances > > Politics is politics anywhere, not just in Texas. Unfortunately, too > many > believers in " free enterprise " are all for the government intervening when > it > could help them. However, when regulation might impact them, you hear > the > howls of " free enterprise. " > > -Wes > Yes, that's true Wes... and you know I have a lot of respect towards your opinions. But that doesn't mean one should drop the idea or efforts to create a more balanced system, one that incorporates the optimal amount of regulation by a more *unbiased* and medically-educated party (obviously, avoiding bias completely is impossible when dealing with human nature) and still allowing enough free enterprise to give the patients a chance at better care. Why are the same people who decide on zoning ordinances, water rights, city budgets, and sewer line rerouting the same people who decide what's best for the patient in a non-emergency transfer situation? Because they were elected to do so. But are they physicians or RNs? When a hospital nurse has NO choice but to call a particular existing ambulance service because a city ordinance says they can use no other, regulation has gone too far. Especially when the patient's condition would benefit significantly from onboard critical care equipment and skilled crews with another service, and the helicopter option is simply unavailable due to weather. That patient does not benefit from a lower level of care, especially if the granting of franchises in that city was primarily based on " call volume " numbers. The patients have been cheated. I'm 100% in support of franchises or permits when the city feels that a standard is required beyond the extensive TDSHS licensing process. I'm 100% for franchises to maintain a fluid, sound 9-1-1 system that does not allow rouge services to steal away calls. But what about non-emergency transfers by TDSHS licensed services who offer a higher level of competancy? Why not allow them to obtain a permit from the city based on that competancy, and not a vote by elected officials? I'm sure many of us agree that quite a few ambulance services leave much to be desired, and need to adhere to higher expectations. This should be the goal of franchising or permitting; it seems obvious since the local ordinances I've read list staffing, basic equipment, insurance, and vehicle safety requirements for the application process. But I never specifically read that the franchising process should protect the financial future of the existing transfer service. But obviously, I've learned that it does. In support of Dr. Bledsoe's observations with air services, I've personally accepted care of patients from particular air services that leaves me wondering just how many rivets still remained on the bird before takeoff. Yes, regulation is needed for both air and ground, but based on medical competancy and good service. I am not for the idea of franchises when " protecting the existing business concern " is the prevailing factor instead. If as a franchise-holder, I have to compete head-to-head with a " big service " because of lack of business protections, then I say bring it on! The best service will care about their crews, their patients, and their equipment first, and it will show. (And with that lecture, let's see if this email program is going to behave itself better today, unlike yesterday. ;-) ) Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 30, 2006 Report Share Posted January 30, 2006 No arguments there. Just saying that sometimes, the city officials who know nothing about EMS may get " guidance " from friendly folks from the local transfer services who want to protect their turf. They like that kind of government interference. Now, if you get the city officials mandating certain standards, those same friendly folks become very unfriendly, claiming that the city shouldn't regulating private business. Pardon my cynicism. It's Monday morning. -Wes Re: Re: City Ordinances 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. ;-) ) Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 30, 2006 Report Share Posted January 30, 2006 No arguments there. Just saying that sometimes, the city officials who know nothing about EMS may get " guidance " from friendly folks from the local transfer services who want to protect their turf. They like that kind of government interference. Now, if you get the city officials mandating certain standards, those same friendly folks become very unfriendly, claiming that the city shouldn't regulating private business. Pardon my cynicism. It's Monday morning. -Wes Re: Re: City Ordinances 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. ;-) ) Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 30, 2006 Report Share Posted January 30, 2006 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?? Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 30, 2006 Report Share Posted January 30, 2006 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?? Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 30, 2006 Report Share Posted January 30, 2006 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?? Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 30, 2006 Report Share Posted January 30, 2006 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. ;-) ) Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 30, 2006 Report Share Posted January 30, 2006 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. ;-) ) Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 30, 2006 Report Share Posted January 30, 2006 I'm not aware of that statute or rule. Could be interesting to watch me call Austin/ County EMS if I go someplace else in Texas. LOL -Wes 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. ;-) ) Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 30, 2006 Report Share Posted January 30, 2006 I'm not aware of that statute or rule. Could be interesting to watch me call Austin/ County EMS if I go someplace else in Texas. LOL -Wes 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. ;-) ) Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 30, 2006 Report Share Posted January 30, 2006 I'm not aware of that statute or rule. Could be interesting to watch me call Austin/ County EMS if I go someplace else in Texas. LOL -Wes 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. ;-) ) Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 30, 2006 Report Share Posted January 30, 2006 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. ;-) ) Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 30, 2006 Report Share Posted January 30, 2006 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. ;-) ) Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 30, 2006 Report Share Posted January 30, 2006 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. ;-) ) Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 30, 2006 Report Share Posted January 30, 2006 Pretty good for a brief lesson in administrative law and in the authority of local governments. I'll write you a letter of recommendation for law school in the event that you don't play enough golf as a physician. <tongue firmly in cheek> -Wes Ogilvie Re: Re: City Ordinances In a message dated 30-Jan-06 11:27:21 Central Standard Time, bbledsoe@... writes: Wes or Gene should probably answer this, but I think a municipal ordinance trumps TDSHS " rules " since the former is actually a law and the latter a rule or guideline. You may be surprised there, ...in most states, executive rules and guidelines promoted by divisions and bureaus created and funded by the legislature, have the effective force of state law, just like CMS regulations have the effective force of Federal Law. and it's a generally held guideline that local ordinances can be more strict than state laws (unless there is a state preemption), and state laws may be more strict than federal laws, but no lower level division can make a particular law *less* strict...this is where the Pot Legalization efforts in California and Oregon are falling afoul of the courts... ck S. Krin, DO FAAFP Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 30, 2006 Report Share Posted January 30, 2006 Pretty good for a brief lesson in administrative law and in the authority of local governments. I'll write you a letter of recommendation for law school in the event that you don't play enough golf as a physician. <tongue firmly in cheek> -Wes Ogilvie Re: Re: City Ordinances In a message dated 30-Jan-06 11:27:21 Central Standard Time, bbledsoe@... writes: Wes or Gene should probably answer this, but I think a municipal ordinance trumps TDSHS " rules " since the former is actually a law and the latter a rule or guideline. You may be surprised there, ...in most states, executive rules and guidelines promoted by divisions and bureaus created and funded by the legislature, have the effective force of state law, just like CMS regulations have the effective force of Federal Law. and it's a generally held guideline that local ordinances can be more strict than state laws (unless there is a state preemption), and state laws may be more strict than federal laws, but no lower level division can make a particular law *less* strict...this is where the Pot Legalization efforts in California and Oregon are falling afoul of the courts... ck S. Krin, DO FAAFP Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 30, 2006 Report Share Posted January 30, 2006 I am not ready for that mandatory frontal lobotomy most law schools require prior to the LSAT. 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 ExLngHrn@... Sent: Monday, January 30, 2006 11:49 AM To: Subject: Re: Re: City Ordinances Pretty good for a brief lesson in administrative law and in the authority of local governments. I'll write you a letter of recommendation for law school in the event that you don't play enough golf as a physician. <tongue firmly in cheek> -Wes Ogilvie Re: Re: City Ordinances In a message dated 30-Jan-06 11:27:21 Central Standard Time, bbledsoe@... writes: Wes or Gene should probably answer this, but I think a municipal ordinance trumps TDSHS " rules " since the former is actually a law and the latter a rule or guideline. You may be surprised there, ...in most states, executive rules and guidelines promoted by divisions and bureaus created and funded by the legislature, have the effective force of state law, just like CMS regulations have the effective force of Federal Law. and it's a generally held guideline that local ordinances can be more strict than state laws (unless there is a state preemption), and state laws may be more strict than federal laws, but no lower level division can make a particular law *less* strict...this is where the Pot Legalization efforts in California and Oregon are falling afoul of the courts... ck S. Krin, DO FAAFP Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 30, 2006 Report Share Posted January 30, 2006 I am not ready for that mandatory frontal lobotomy most law schools require prior to the LSAT. 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 ExLngHrn@... Sent: Monday, January 30, 2006 11:49 AM To: Subject: Re: Re: City Ordinances Pretty good for a brief lesson in administrative law and in the authority of local governments. I'll write you a letter of recommendation for law school in the event that you don't play enough golf as a physician. <tongue firmly in cheek> -Wes Ogilvie Re: Re: City Ordinances In a message dated 30-Jan-06 11:27:21 Central Standard Time, bbledsoe@... writes: Wes or Gene should probably answer this, but I think a municipal ordinance trumps TDSHS " rules " since the former is actually a law and the latter a rule or guideline. You may be surprised there, ...in most states, executive rules and guidelines promoted by divisions and bureaus created and funded by the legislature, have the effective force of state law, just like CMS regulations have the effective force of Federal Law. and it's a generally held guideline that local ordinances can be more strict than state laws (unless there is a state preemption), and state laws may be more strict than federal laws, but no lower level division can make a particular law *less* strict...this is where the Pot Legalization efforts in California and Oregon are falling afoul of the courts... ck S. Krin, DO FAAFP Quote Link to comment Share on other sites More sharing options...
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