Published: 11 December 2011 08:06 PM

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.


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.”


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.