Re: Re: City Ordinances

[Guest guest]

Just illustrating the absurdity of assuming that the free market will work

in every situation, as the core assumption that markets work is that the

consumer has all of the information needed to make an informed decision.

-Wes

In a message dated 1/30/2006 9:01:45 PM Central Standard Time,

THEDUDMAN@... writes:

Wes,

Once you get all this information from the EMS crew, how long do you wait on

scene to obtain all this on the possible ED's you could be transported to?

Or do you only care this much about the ride to the hospital and not the

hospital care itself? What about your private physician? Do you get this on

his/her office staff?

Just curious...

Dudley

Re: Re: City Ordinances

> Economists say that the free market works best when the consumer has full

> information. Do you provide consumers with full information about your

> service? In such a system, I'd ask the following:

> Who is your medical director?

> Who will be transporting me?

> What equipment do you carry?

> How much insurance do you have?

> May I see the personnel and disciplinary records of the medics providing

> care?

> What is your company's regulatory history?

> May I see your past 3 years of financial statements?

>

> While I actually do favor the free market, I recognize that there is a

> role

> and place for proper government regulation of the marketplace.

And with this I agree to a certain extent. If I was a resident of a city, I

would expect a regulatory agency to make sure that the ambulance services

allowed to operate there meet all federal, state, and local

safety/crew/medical requirements. And as such, the city should have the

right to inspect vehicles at any time, receive service information upon

request, and require that the service remains in compliance all of the time

to maintain the priviledge of operating there. In my experience, franchise

applications require documents supporting your medical direction, copies of

all of your licenses (TDH, DEA, DPS, etc.), full staffing information,

liability insurance proof, vehicle insurance, application fees, rate sheets,

and much more. The paperwork is neverending, and it becomes public record.

But three years of financial statements for non-exclusive " permission " to

operate in the city? Not agreeing 100% with that; kinda kicks the new or

small provider from ever having a chance to offer the area's patients

something better than what currently exists. Prove that you have funding to

operate (such as a sizable SBA loan) and significant management/EMS

experience? Sure. But you won't have three years of financial statements

unless you have been operating somewhere for three years, but how can you

operate somewhere for three years unless a city grants you a franchise in

the first place? In this rural area, franchises are required in any city of

any reasonable size... the remaining services are volunteer and everything

else is far and few between. Maybe things are different in more

densely-populated areas of Texas.

Sad part is, even if you meet and/or exceed all of the " city's requirements "

during the application process, your permission to operate is still

determined by a group of elected people. Not by medical professionals. Not

determined by the people who must deal with the city's medical needs on a

daily basis, and are the ones voicing a desire for change.

That's the problem.

You know I like to play the devil's advocate as well Wes. Can't make life

too easy for you ;-)

Yahoo! Groups Links

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

[Guest guest]

Just illustrating the absurdity of assuming that the free market will work

in every situation, as the core assumption that markets work is that the

consumer has all of the information needed to make an informed decision.

-Wes

In a message dated 1/30/2006 9:01:45 PM Central Standard Time,

THEDUDMAN@... writes:

Wes,

Once you get all this information from the EMS crew, how long do you wait on

scene to obtain all this on the possible ED's you could be transported to?

Or do you only care this much about the ride to the hospital and not the

hospital care itself? What about your private physician? Do you get this on

his/her office staff?

Just curious...

Dudley

Re: Re: City Ordinances

> Economists say that the free market works best when the consumer has full

> information. Do you provide consumers with full information about your

> service? In such a system, I'd ask the following:

> Who is your medical director?

> Who will be transporting me?

> What equipment do you carry?

> How much insurance do you have?

> May I see the personnel and disciplinary records of the medics providing

> care?

> What is your company's regulatory history?

> May I see your past 3 years of financial statements?

>

> While I actually do favor the free market, I recognize that there is a

> role

> and place for proper government regulation of the marketplace.

And with this I agree to a certain extent. If I was a resident of a city, I

would expect a regulatory agency to make sure that the ambulance services

allowed to operate there meet all federal, state, and local

safety/crew/medical requirements. And as such, the city should have the

right to inspect vehicles at any time, receive service information upon

request, and require that the service remains in compliance all of the time

to maintain the priviledge of operating there. In my experience, franchise

applications require documents supporting your medical direction, copies of

all of your licenses (TDH, DEA, DPS, etc.), full staffing information,

liability insurance proof, vehicle insurance, application fees, rate sheets,

and much more. The paperwork is neverending, and it becomes public record.

But three years of financial statements for non-exclusive " permission " to

operate in the city? Not agreeing 100% with that; kinda kicks the new or

small provider from ever having a chance to offer the area's patients

something better than what currently exists. Prove that you have funding to

operate (such as a sizable SBA loan) and significant management/EMS

experience? Sure. But you won't have three years of financial statements

unless you have been operating somewhere for three years, but how can you

operate somewhere for three years unless a city grants you a franchise in

the first place? In this rural area, franchises are required in any city of

any reasonable size... the remaining services are volunteer and everything

else is far and few between. Maybe things are different in more

densely-populated areas of Texas.

Sad part is, even if you meet and/or exceed all of the " city's requirements "

during the application process, your permission to operate is still

determined by a group of elected people. Not by medical professionals. Not

determined by the people who must deal with the city's medical needs on a

daily basis, and are the ones voicing a desire for change.

That's the problem.

You know I like to play the devil's advocate as well Wes. Can't make life

too easy for you ;-)

Yahoo! Groups Links

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

[Guest guest]

-- short of a court challenge, the CONCEPTS of freedom of choice and the

free market are just CONCEPTS. A city has ordinance power (commonly called the

" police power " ) to promulgate ordinances to protect the public health, welfare,

and safety. Cities enact these ordinances ostensibly to protect the public, and

perhaps for the revenue from franchise and license fees. Without showing that

state or Federal law preempts the city ordinance, the ordinance will likely be

upheld in court, absent a showing of arbitrary and capricious behavior on behalf

of the City or perhaps violation of civil rights. This is rather similar to most

cities having a taxicab ordinance regulating which taxis may operate within

their city, minimum standards, and even fares. In other words, regulation of

ambulance service is not without precedent.

Unfortunately, in some cases, unscrupulous behavior by some (not all) private

services has caused some municipalities to believe that government intervention

in the private EMS market is a necessary evil. If you wish to change these

ordinances, your best bets would be to (1) consult legal counsel to determine

whether the ordinance is legal or (2) make your views known to the relevant

officials. Many private EMS services are members of the Texas Ambulance

Association. You may wish to check with them to see what guidance they provide

their members on this issue.

I hope that I have explained the relevant legal issues in terms that a layperson

might understand.

Best regards,

-Wes Ogilvie, MPA, JD, EMT-B

Attorney at Law/Emergency Medical Technician

Austin, Texas

*NOTA BENE* *DISCLAIMER -- I am not providing legal advice, nor have I

established an attorney/client relationship. I am merely explaining principles

of law in an educational forum as provided by the Texas EMS group on Yahoo

Groups.*

Re: Re: City Ordinances

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??

[Guest guest]

-- short of a court challenge, the CONCEPTS of freedom of choice and the

free market are just CONCEPTS. A city has ordinance power (commonly called the

" police power " ) to promulgate ordinances to protect the public health, welfare,

and safety. Cities enact these ordinances ostensibly to protect the public, and

perhaps for the revenue from franchise and license fees. Without showing that

state or Federal law preempts the city ordinance, the ordinance will likely be

upheld in court, absent a showing of arbitrary and capricious behavior on behalf

of the City or perhaps violation of civil rights. This is rather similar to most

cities having a taxicab ordinance regulating which taxis may operate within

their city, minimum standards, and even fares. In other words, regulation of

ambulance service is not without precedent.

Unfortunately, in some cases, unscrupulous behavior by some (not all) private

services has caused some municipalities to believe that government intervention

in the private EMS market is a necessary evil. If you wish to change these

ordinances, your best bets would be to (1) consult legal counsel to determine

whether the ordinance is legal or (2) make your views known to the relevant

officials. Many private EMS services are members of the Texas Ambulance

Association. You may wish to check with them to see what guidance they provide

their members on this issue.

I hope that I have explained the relevant legal issues in terms that a layperson

might understand.

Best regards,

-Wes Ogilvie, MPA, JD, EMT-B

Attorney at Law/Emergency Medical Technician

Austin, Texas

*NOTA BENE* *DISCLAIMER -- I am not providing legal advice, nor have I

established an attorney/client relationship. I am merely explaining principles

of law in an educational forum as provided by the Texas EMS group on Yahoo

Groups.*

Re: Re: City Ordinances

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??

[Guest guest]

-- short of a court challenge, the CONCEPTS of freedom of choice and the

free market are just CONCEPTS. A city has ordinance power (commonly called the

" police power " ) to promulgate ordinances to protect the public health, welfare,

and safety. Cities enact these ordinances ostensibly to protect the public, and

perhaps for the revenue from franchise and license fees. Without showing that

state or Federal law preempts the city ordinance, the ordinance will likely be

upheld in court, absent a showing of arbitrary and capricious behavior on behalf

of the City or perhaps violation of civil rights. This is rather similar to most

cities having a taxicab ordinance regulating which taxis may operate within

their city, minimum standards, and even fares. In other words, regulation of

ambulance service is not without precedent.

Unfortunately, in some cases, unscrupulous behavior by some (not all) private

services has caused some municipalities to believe that government intervention

in the private EMS market is a necessary evil. If you wish to change these

ordinances, your best bets would be to (1) consult legal counsel to determine

whether the ordinance is legal or (2) make your views known to the relevant

officials. Many private EMS services are members of the Texas Ambulance

Association. You may wish to check with them to see what guidance they provide

their members on this issue.

I hope that I have explained the relevant legal issues in terms that a layperson

might understand.

Best regards,

-Wes Ogilvie, MPA, JD, EMT-B

Attorney at Law/Emergency Medical Technician

Austin, Texas

*NOTA BENE* *DISCLAIMER -- I am not providing legal advice, nor have I

established an attorney/client relationship. I am merely explaining principles

of law in an educational forum as provided by the Texas EMS group on Yahoo

Groups.*

Re: Re: City Ordinances

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??

[Guest guest]

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,

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 â

€œ

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 that’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]

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,

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 â

€œ

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 that’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]

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,

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 â

€œ

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 that’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]

If you think a city will allow you to use any plumber, try using one (or

perhaps an electrician) who isn't approved. I assure you the building permit

will be cancelled quicker than you can say " illiterate. "

In a message dated 1/30/2006 10:02:46 PM Central Standard Time,

asearch4reason@... writes:

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,

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

â

€œ

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 that’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]

If you think a city will allow you to use any plumber, try using one (or

perhaps an electrician) who isn't approved. I assure you the building permit

will be cancelled quicker than you can say " illiterate. "

In a message dated 1/30/2006 10:02:46 PM Central Standard Time,

asearch4reason@... writes:

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,

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

â

€œ

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 that’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]

If you think a city will allow you to use any plumber, try using one (or

perhaps an electrician) who isn't approved. I assure you the building permit

will be cancelled quicker than you can say " illiterate. "

In a message dated 1/30/2006 10:02:46 PM Central Standard Time,

asearch4reason@... writes:

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,

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

â

€œ

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 that’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]

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]

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]

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]

Re: Re: City Ordinances

> Economists say that the free market works best when the consumer has full

> information. Do you provide consumers with full information about your

> service? In such a system, I'd ask the following:

> Who is your medical director?

> Who will be transporting me?

> What equipment do you carry?

> How much insurance do you have?

> May I see the personnel and disciplinary records of the medics providing

> care?

> What is your company's regulatory history?

> May I see your past 3 years of financial statements?

>

> While I actually do favor the free market, I recognize that there is a

> role

> and place for proper government regulation of the marketplace.

And with this I agree to a certain extent. If I was a resident of a city, I

would expect a regulatory agency to make sure that the ambulance services

allowed to operate there meet all federal, state, and local

safety/crew/medical requirements. And as such, the city should have the

right to inspect vehicles at any time, receive service information upon

request, and require that the service remains in compliance all of the time

to maintain the priviledge of operating there. In my experience, franchise

applications require documents supporting your medical direction, copies of

all of your licenses (TDH, DEA, DPS, etc.), full staffing information,

liability insurance proof, vehicle insurance, application fees, rate sheets,

and much more. The paperwork is neverending, and it becomes public record.

But three years of financial statements for non-exclusive " permission " to

operate in the city? Not agreeing 100% with that; kinda kicks the new or

small provider from ever having a chance to offer the area's patients

something better than what currently exists. Prove that you have funding to

operate (such as a sizable SBA loan) and significant management/EMS

experience? Sure. But you won't have three years of financial statements

unless you have been operating somewhere for three years, but how can you

operate somewhere for three years unless a city grants you a franchise in

the first place? In this rural area, franchises are required in any city of

any reasonable size... the remaining services are volunteer and everything

else is far and few between. Maybe things are different in more

densely-populated areas of Texas.

Sad part is, even if you meet and/or exceed all of the " city's requirements "

during the application process, your permission to operate is still

determined by a group of elected people. Not by medical professionals. Not

determined by the people who must deal with the city's medical needs on a

daily basis, and are the ones voicing a desire for change.

That's the problem.

You know I like to play the devil's advocate as well Wes. Can't make life

too easy for you ;-)

[Guest guest]

Re: Re: City Ordinances

> Economists say that the free market works best when the consumer has full

> information. Do you provide consumers with full information about your

> service? In such a system, I'd ask the following:

> Who is your medical director?

> Who will be transporting me?

> What equipment do you carry?

> How much insurance do you have?

> May I see the personnel and disciplinary records of the medics providing

> care?

> What is your company's regulatory history?

> May I see your past 3 years of financial statements?

>

> While I actually do favor the free market, I recognize that there is a

> role

> and place for proper government regulation of the marketplace.

And with this I agree to a certain extent. If I was a resident of a city, I

would expect a regulatory agency to make sure that the ambulance services

allowed to operate there meet all federal, state, and local

safety/crew/medical requirements. And as such, the city should have the

right to inspect vehicles at any time, receive service information upon

request, and require that the service remains in compliance all of the time

to maintain the priviledge of operating there. In my experience, franchise

applications require documents supporting your medical direction, copies of

all of your licenses (TDH, DEA, DPS, etc.), full staffing information,

liability insurance proof, vehicle insurance, application fees, rate sheets,

and much more. The paperwork is neverending, and it becomes public record.

But three years of financial statements for non-exclusive " permission " to

operate in the city? Not agreeing 100% with that; kinda kicks the new or

small provider from ever having a chance to offer the area's patients

something better than what currently exists. Prove that you have funding to

operate (such as a sizable SBA loan) and significant management/EMS

experience? Sure. But you won't have three years of financial statements

unless you have been operating somewhere for three years, but how can you

operate somewhere for three years unless a city grants you a franchise in

the first place? In this rural area, franchises are required in any city of

any reasonable size... the remaining services are volunteer and everything

else is far and few between. Maybe things are different in more

densely-populated areas of Texas.

Sad part is, even if you meet and/or exceed all of the " city's requirements "

during the application process, your permission to operate is still

determined by a group of elected people. Not by medical professionals. Not

determined by the people who must deal with the city's medical needs on a

daily basis, and are the ones voicing a desire for change.

That's the problem.

You know I like to play the devil's advocate as well Wes. Can't make life

too easy for you ;-)

[Guest guest]

Re: Re: City Ordinances

> Economists say that the free market works best when the consumer has full

> information. Do you provide consumers with full information about your

> service? In such a system, I'd ask the following:

> Who is your medical director?

> Who will be transporting me?

> What equipment do you carry?

> How much insurance do you have?

> May I see the personnel and disciplinary records of the medics providing

> care?

> What is your company's regulatory history?

> May I see your past 3 years of financial statements?

>

> While I actually do favor the free market, I recognize that there is a

> role

> and place for proper government regulation of the marketplace.

And with this I agree to a certain extent. If I was a resident of a city, I

would expect a regulatory agency to make sure that the ambulance services

allowed to operate there meet all federal, state, and local

safety/crew/medical requirements. And as such, the city should have the

right to inspect vehicles at any time, receive service information upon

request, and require that the service remains in compliance all of the time

to maintain the priviledge of operating there. In my experience, franchise

applications require documents supporting your medical direction, copies of

all of your licenses (TDH, DEA, DPS, etc.), full staffing information,

liability insurance proof, vehicle insurance, application fees, rate sheets,

and much more. The paperwork is neverending, and it becomes public record.

But three years of financial statements for non-exclusive " permission " to

operate in the city? Not agreeing 100% with that; kinda kicks the new or

small provider from ever having a chance to offer the area's patients

something better than what currently exists. Prove that you have funding to

operate (such as a sizable SBA loan) and significant management/EMS

experience? Sure. But you won't have three years of financial statements

unless you have been operating somewhere for three years, but how can you

operate somewhere for three years unless a city grants you a franchise in

the first place? In this rural area, franchises are required in any city of

any reasonable size... the remaining services are volunteer and everything

else is far and few between. Maybe things are different in more

densely-populated areas of Texas.

Sad part is, even if you meet and/or exceed all of the " city's requirements "

during the application process, your permission to operate is still

determined by a group of elected people. Not by medical professionals. Not

determined by the people who must deal with the city's medical needs on a

daily basis, and are the ones voicing a desire for change.

That's the problem.

You know I like to play the devil's advocate as well Wes. Can't make life

too easy for you ;-)

[Guest guest]

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]

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]

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]

Wes,

Once you get all this information from the EMS crew, how long do you wait on

scene to obtain all this on the possible ED's you could be transported to? Or

do you only care this much about the ride to the hospital and not the hospital

care itself? What about your private physician? Do you get this on his/her

office staff?

Just curious...

Dudley

Re: Re: City Ordinances

> Economists say that the free market works best when the consumer has full

> information. Do you provide consumers with full information about your

> service? In such a system, I'd ask the following:

> Who is your medical director?

> Who will be transporting me?

> What equipment do you carry?

> How much insurance do you have?

> May I see the personnel and disciplinary records of the medics providing

> care?

> What is your company's regulatory history?

> May I see your past 3 years of financial statements?

>

> While I actually do favor the free market, I recognize that there is a

> role

> and place for proper government regulation of the marketplace.

And with this I agree to a certain extent. If I was a resident of a city, I

would expect a regulatory agency to make sure that the ambulance services

allowed to operate there meet all federal, state, and local

safety/crew/medical requirements. And as such, the city should have the

right to inspect vehicles at any time, receive service information upon

request, and require that the service remains in compliance all of the time

to maintain the priviledge of operating there. In my experience, franchise

applications require documents supporting your medical direction, copies of

all of your licenses (TDH, DEA, DPS, etc.), full staffing information,

liability insurance proof, vehicle insurance, application fees, rate sheets,

and much more. The paperwork is neverending, and it becomes public record.

But three years of financial statements for non-exclusive " permission " to

operate in the city? Not agreeing 100% with that; kinda kicks the new or

small provider from ever having a chance to offer the area's patients

something better than what currently exists. Prove that you have funding to

operate (such as a sizable SBA loan) and significant management/EMS

experience? Sure. But you won't have three years of financial statements

unless you have been operating somewhere for three years, but how can you

operate somewhere for three years unless a city grants you a franchise in

the first place? In this rural area, franchises are required in any city of

any reasonable size... the remaining services are volunteer and everything

else is far and few between. Maybe things are different in more

densely-populated areas of Texas.

Sad part is, even if you meet and/or exceed all of the " city's requirements "

during the application process, your permission to operate is still

determined by a group of elected people. Not by medical professionals. Not

determined by the people who must deal with the city's medical needs on a

daily basis, and are the ones voicing a desire for change.

That's the problem.

You know I like to play the devil's advocate as well Wes. Can't make life

too easy for you ;-)

[Guest guest]

Wes,

Once you get all this information from the EMS crew, how long do you wait on

scene to obtain all this on the possible ED's you could be transported to? Or

do you only care this much about the ride to the hospital and not the hospital

care itself? What about your private physician? Do you get this on his/her

office staff?

Just curious...

Dudley

Re: Re: City Ordinances

> Economists say that the free market works best when the consumer has full

> information. Do you provide consumers with full information about your

> service? In such a system, I'd ask the following:

> Who is your medical director?

> Who will be transporting me?

> What equipment do you carry?

> How much insurance do you have?

> May I see the personnel and disciplinary records of the medics providing

> care?

> What is your company's regulatory history?

> May I see your past 3 years of financial statements?

>

> While I actually do favor the free market, I recognize that there is a

> role

> and place for proper government regulation of the marketplace.

And with this I agree to a certain extent. If I was a resident of a city, I

would expect a regulatory agency to make sure that the ambulance services

allowed to operate there meet all federal, state, and local

safety/crew/medical requirements. And as such, the city should have the

right to inspect vehicles at any time, receive service information upon

request, and require that the service remains in compliance all of the time

to maintain the priviledge of operating there. In my experience, franchise

applications require documents supporting your medical direction, copies of

all of your licenses (TDH, DEA, DPS, etc.), full staffing information,

liability insurance proof, vehicle insurance, application fees, rate sheets,

and much more. The paperwork is neverending, and it becomes public record.

But three years of financial statements for non-exclusive " permission " to

operate in the city? Not agreeing 100% with that; kinda kicks the new or

small provider from ever having a chance to offer the area's patients

something better than what currently exists. Prove that you have funding to

operate (such as a sizable SBA loan) and significant management/EMS

experience? Sure. But you won't have three years of financial statements

unless you have been operating somewhere for three years, but how can you

operate somewhere for three years unless a city grants you a franchise in

the first place? In this rural area, franchises are required in any city of

any reasonable size... the remaining services are volunteer and everything

else is far and few between. Maybe things are different in more

densely-populated areas of Texas.

Sad part is, even if you meet and/or exceed all of the " city's requirements "

during the application process, your permission to operate is still

determined by a group of elected people. Not by medical professionals. Not

determined by the people who must deal with the city's medical needs on a

daily basis, and are the ones voicing a desire for change.

That's the problem.

You know I like to play the devil's advocate as well Wes. Can't make life

too easy for you ;-)

[Guest guest]

Wes,

Once you get all this information from the EMS crew, how long do you wait on

scene to obtain all this on the possible ED's you could be transported to? Or

do you only care this much about the ride to the hospital and not the hospital

care itself? What about your private physician? Do you get this on his/her

office staff?

Just curious...

Dudley

Re: Re: City Ordinances

> Economists say that the free market works best when the consumer has full

> information. Do you provide consumers with full information about your

> service? In such a system, I'd ask the following:

> Who is your medical director?

> Who will be transporting me?

> What equipment do you carry?

> How much insurance do you have?

> May I see the personnel and disciplinary records of the medics providing

> care?

> What is your company's regulatory history?

> May I see your past 3 years of financial statements?

>

> While I actually do favor the free market, I recognize that there is a

> role

> and place for proper government regulation of the marketplace.

And with this I agree to a certain extent. If I was a resident of a city, I

would expect a regulatory agency to make sure that the ambulance services

allowed to operate there meet all federal, state, and local

safety/crew/medical requirements. And as such, the city should have the

right to inspect vehicles at any time, receive service information upon

request, and require that the service remains in compliance all of the time

to maintain the priviledge of operating there. In my experience, franchise

applications require documents supporting your medical direction, copies of

all of your licenses (TDH, DEA, DPS, etc.), full staffing information,

liability insurance proof, vehicle insurance, application fees, rate sheets,

and much more. The paperwork is neverending, and it becomes public record.

But three years of financial statements for non-exclusive " permission " to

operate in the city? Not agreeing 100% with that; kinda kicks the new or

small provider from ever having a chance to offer the area's patients

something better than what currently exists. Prove that you have funding to

operate (such as a sizable SBA loan) and significant management/EMS

experience? Sure. But you won't have three years of financial statements

unless you have been operating somewhere for three years, but how can you

operate somewhere for three years unless a city grants you a franchise in

the first place? In this rural area, franchises are required in any city of

any reasonable size... the remaining services are volunteer and everything

else is far and few between. Maybe things are different in more

densely-populated areas of Texas.

Sad part is, even if you meet and/or exceed all of the " city's requirements "

during the application process, your permission to operate is still

determined by a group of elected people. Not by medical professionals. Not

determined by the people who must deal with the city's medical needs on a

daily basis, and are the ones voicing a desire for change.

That's the problem.

You know I like to play the devil's advocate as well Wes. Can't make life

too easy for you ;-)

[Guest guest]

Wes I see where you are going with this. However as a

taxpaying citizen, they should have thee right to

choose. Now what happens when citizens are not

pleased with the sole provider for said city/county?

Should he/she be forced to be transported by a service

they have a issue with or do not like how they are

treated. I for one know of a lot of people that are

not happy with a certain service. But because of the

county and city ordinance no one else can go in. So

now I am talking to a city commissioner who is my best

friend's brother to educate him on EMS. The 911 in

this area is suffering because of the city

county/ordinances. The EMS use FD for first

responders when a unit is not available because they

are doing transfers. Or they use the supervisor

vehicle and use his on-scene time to satisfy the

response time obligation. And they were trying to get

the transfer contract for another city. I say TDSHS

should regulate this better with a CON. Several

cities could use the help. Alot of 911 providers

refuse to use other providers in the area because of

competition.

Salvador Capuchino

EMT-P

--- 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,

> 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 that’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]

Wes I see where you are going with this. However as a

taxpaying citizen, they should have thee right to

choose. Now what happens when citizens are not

pleased with the sole provider for said city/county?

Should he/she be forced to be transported by a service

they have a issue with or do not like how they are

treated. I for one know of a lot of people that are

not happy with a certain service. But because of the

county and city ordinance no one else can go in. So

now I am talking to a city commissioner who is my best

friend's brother to educate him on EMS. The 911 in

this area is suffering because of the city

county/ordinances. The EMS use FD for first

responders when a unit is not available because they

are doing transfers. Or they use the supervisor

vehicle and use his on-scene time to satisfy the

response time obligation. And they were trying to get

the transfer contract for another city. I say TDSHS

should regulate this better with a CON. Several

cities could use the help. Alot of 911 providers

refuse to use other providers in the area because of

competition.

Salvador Capuchino

EMT-P

--- 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,

> 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 that’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]

>

>

>

>