Riverside has no business enforcing a de facto monopoly on ambulance services. City officials should drop the flimsy rationale for the status quo, and ask the pertinent question they have avoided: Would letting additional ambulance companies operate in the city improve service and cut costs to residents?

Twice in the past five months, the Riverside City Council has rejected applications by ambulance companies seeking a piece of the Riverside nonemergency ambulance business. The city denied applications from Mission Ambulance in October and Alpha Ambulance in December. Only one company, American Medical Response or AMR, provides nonemergency ambulance transport in Riverside. The city controls nonemergency ambulance transport, such as from a hospital to a long-term care facility, through a system of franchise permits which are ostensibly available to any qualified ambulance company. Riverside County oversees emergency ambulance services.

But a state agency last month said Riverside overstepped its authority in rejecting the applications from Mission and Alpha. The city denied the permits on the grounds that there was no public need for additional ambulance service. Yet the director of the state Emergency Medical Services Authority said that Riverside cannot use “need and necessity” to limit ambulance services under state law. That agency has no enforcement authority, however.

But Riverside’s approach was flawed in any case. In practice, the “need” metric consisted of city officials checking AMR’s performance record and deeming it acceptable. The city ducked the question of whether allowing additional ambulance companies into the city would be better for residents. Competition can bolster service and trim costs — no small issue when ambulance transport can easily run $1,000 or more a trip.

Yet the city never bothered to compare Riverside’s costs with prices in areas that have competitive service. Councilman Paul Davis argues that Riverside residents pay far more than in surrounding areas because of AMR’s exclusive contract. Surely that issue should be a central focus of the deliberations.

Even stranger, the city’s approach includes consideration of whether allowing additional companies into Riverside would “impair the economic viability of the existing franchisee.” But that provision creates an insurmountable obstacle for other ambulance companies. Letting another provider operate in Riverside is bound to “impair” the current monopoly holder’s finances.

But why should that be a concern at all? There is no public interest in city government protecting a private business from competitors. That mind-set only invites questions about whether other factors influenced the choice — such as the $1.4 million in paramedic training and equipment that AMR provides Riverside each year under a separate contract.

The city does not benefit from generating public suspicion about undue influence or insider dealing. The council’s only concern should be ensuring good, cost-effective ambulance service. Anything else is irrelevant.

Riverside officials don’t have the right to stop qualified ambulance companies from picking up patients in the city, according to the state agency that oversees county emergency medical service plans.

In Riverside County, all 911 ambulance calls are controlled through a county-approved contract, but county officials say non-emergency transports — such as trips to dialysis — are an open market where multiple providers compete for business.

The city of Riverside requires ambulance companies to have a franchise permit and so far has granted a permit for nonemergency calls only to American Medical Response, which also is the county’s 911 responder.

City officials contend they haven’t limited service to an exclusive provider but say that none of the other applicants met their criteria for service.

The council on Tuesday will consider an application from Los Angeles-based Alpha Ambulance. A committee has recommended denying the permit.

The city’s rejection of all other permit applicants means only AMR’s ambulances can pick up patients in Riverside. But officials with the California Emergency Medical Services Authority, or EMSA, said Riverside “does not have the authority to restrict trade for interfacility transports within their area” because the county’s emergency medical services plan doesn’t give the city that authority, according to a written statement from EMSA.

Riverside City Attorney Greg Priamos said Friday that he disagrees with EMSA’s assessment.

The issue of ambulance service is a complex and contentious one. Emergency medical services has been an organized, regulated system since only about 1980.

Because of the public interest in fast, reliable ambulance response, the state allowed local governments to create monopolies for 911 service and in some cases for nonemergency, or retail, transports. The state requires each county to have a plan for emergency medical services, and EMSA is charged with reviewing and approving those plans.

STATE STANCE

Under state law, the local EMS agency — in this case, Riverside County — is the only entity with the authority to restrict competition in ambulance service, said Daniel Smiley, EMSA’s chief deputy director. If the county’s plan was written to allow cities to regulate ambulance companies, then it would be fine — but Riverside’s plan isn’t written that way, he said.

“We do not believe (the city of Riverside has) the authority to restrict trade in that zone because the (county) plan does not contemplate that at all,” Smiley said.

Going outside the bounds of the county’s EMS plan could make the city vulnerable to antitrust litigation, Smiley said.

Riverside officials have argued they are not creating a monopoly because ambulance franchises are not exclusive; most applicants simply haven’t met the criteria set out in the city’s municipal code. One of those criteria is having a county permit, which means the ambulance company has proper equipment, employee certifications, insurance and the like; the other criteria are showing there’s a need for another provider, and that allowing more ambulance companies won’t economically harm existing providers.

“We do not share EMSA’s view in its entirety, and the city continues to believe that it may regulate nonemergency transports in the absence of any conflicting exercise of state or county authority affecting the same activity,” Priamos said Friday.

He also cited an October 2010 letter from Riverside County Emergency Medical Services Agency Director Bruce Barton. That letter says any ambulance company with a county permit can provide nonemergency transports anywhere in Riverside County, but it goes on to say any provider must operate “in conformance with applicable state, federal and local laws and regulations.”

CITY’S DEFENSE

Priamos said the county has never advised the city that it can’t regulate ambulances through franchise agreements.

Earlier this month, Barton said he wanted to speak with county counsel before responding to EMSA’s comments. He could not be reached Friday.

So far, no one has formally asked EMSA to weigh in on the issue, and Smiley said the agency doesn’t have the responsibility or a mechanism to make Riverside do anything.

If an ambulance provider believes the city is improperly restricting trade, it’s up to the provider to take the issue to court, Smiley said.

There have been numerous court cases among ambulance providers, cities and counties over who controls emergency medical services, he said, but he was not aware of case law on the issue that has been raised in the city of Riverside.

Riverside officials again will be asked to decide whether the city needs more than one ambulance service, after voting in October to stick with a single company.

American Medical Response is Riverside County’s exclusive provider of 911 ambulance service, but everywhere in the county except the city of Riverside, more than one company may take patients on non-emergency ambulance runs.

The city of Riverside allows any ambulance company to apply for a permit to run non-emergency calls, but so far AMR is the only company to receive one.

Corona-based Mission Ambulance’s application was rejected last month, and the council will soon discuss whether to give a permit to Alpha Ambulance, based in Los Angeles.

Council members turned down Mission based on Fire Chief Steve Earley’s conclusion that there is no public need for another ambulance service. The council’s public safety committee on Monday recommended Alpha be denied a permit for the same reason — a lack of public need, and to a lesser degree, the fact that splitting the ambulance calls with another company would hurt AMR’s financial viability.

Councilmen Andy Melendrez and Chris Mac Arthur, both on the public safety committee, said Tuesday they still don’t see a need for another ambulance provider. “We would need to hear that AMR was not fulfilling the service that was required by our community,” and Earley’s investigation found medical facilities are satisfied with AMR, Melendrez said.

Alpha Ambulance General Manager Wes Kingsbury could not be reached Tuesday for comment. The full council still must vote on Alpha’s application.

Ambulance service is a complex area of policy that is tightly regulated to ensure public safety, but also is largely provided by private, for-profit companies. Riverside’s rejection of every application except AMR’s has raised questions about whether the city truly has a non-exclusive system, as officials claim.

The issue is further complicated by a special contract under which AMR helps pay for the city’s Fire Department paramedic program — funding which some fear might evaporate if AMR faces competition in the more lucrative non-emergency market.

Melendrez said officials need to decide whether they will allow competition or not, and they need to more clearly spell out what constitutes a public need for additional ambulance service. Also, if AMR predicts it will suffer from having another provider in the market, he said, “We need to see numbers that show there is a financial hardship.”

AMR provides the county with overall income statements but does not separate emergency and non-emergency revenues.