Emergency Service

EMS Monopoly Ordinance Goes To Court

The issue of who has the ultimate authority to operate ambulance service, establish medical protocol and levy taxes is headed for the courts in what can be termed as a “test case.”
Ada County Commishes passed the ordinance which was strongly opposed by fire chiefs and firefighters at last week’s meeting. The passage and resulting court scrutiny may not be all bad. But the decision may not be what the county EMS folks want to hear.

Previous GUARDIAN postings have been slammed with paramedics and firefighters sniping at each other over the ordinance which we see as a power play on the part of the county to rescue an ailing agency.

Ignored by everyone–including the mainstream media–is a provision in the existing IDAHO CODE which gives cities the power to allow a county ambulance to operate within the city limits. We assume this law would apply to “incorporated fire districts as well.”

31-3905. AMBULANCE SERVICE — OPERATION DEPENDENT UPON RESOLUTION OF EACH CITY — RIGHT TO TAX UNAFFECTED BY NONSERVICE. “All cities and villages within the county, upon resolution duly passed and approved and presented to the board of county commissioners, may authorize said ambulance service to operate within the boundaries of said city or village, but the failure of any such governing body to authorize said ambulance service to operate within the limits of said village or city, shall not affect the right of the board of county commissioners to levy the tax as hereinbefore provided.”

To our layman’s mind this says the county can indeed tax, but without permission from the cities, the EMS cannot operate within the cities.

We have no objection to a MEDICAL standard for all EMS service regardless of private, fire, or EMS offering it. It will come as no surprise if the court rules the county can set the standard, but they cannot usurp the cities right to provide services to their residents.

That state–not Ada County–should take the lead in establishing medical protocols, training requirements, and general standards for paramedics.

EDITOR NOTE–Please keep comments short and try not to rehash previous comments.

Comments & Discussion

Comments are closed for this post.

  1. OK, First, I must state the below opinions are my own and not affiliated with any organizations that I may work for.

    Second, There has not been a state yet that has been able to meet the scope of practice needs of all its agencies with out subscribing to the a lower common denominator.

    Case(s) in point: Many states in the new england area try to have regional protocols and state wide protocols that are mandatory. Unfortunately when you compare those to areas that allow more individual initiative in medical care, there is really no comparison, The scope of practice just considerably more restrictive and limited.

    While Ms. Gainor (sp) is highly respected in the EMS world, why should Idaho be suddenly different? The reason is simple…the state cannot be in the business of micromanaging the QA and training process for all providers on a daily systems basis. Its too complex and expensive to do on a statewide scale. The states job is to assist locals in systems development, grants, and entry level certifications.

    Simply put, the states sets the bare minimums. In addition, in our state where the majority of EMS is underfunded rural providers, the underfunded state EMS agency has its hands full assisting those agencies who need the states help just to operate.

    A case example is also (again) King County Medic One. While the state of Washington actually has a descent scope of practice (for ILS providers, better than Idahos), Dr. Copass from the King county system was neither satisfied with this, nor the minimum standards for hiring and training the state of Washington requires (not saying anything bad about Washington.., or Idaho even….mind you).

    So they (Dr. Copass and King County) set a (much) higher standard for their area, through ordinance and other means, and hold everyone within King County (fire and third services) to that higher standard. This standard is MUCH higher than the state (WA) minimum. This concept should be familiar now.

    And the result is the best EMS system in the nation.

    Simply put, the standards for paramedics in Idaho may be consistent (or a little better in some cases) with the nation wide average, but in the EMS world those national and state standards are often not believed to be high enough. In fact, there are a lot of dangerous paramedics and dangerous EMS agencies in the US of all shapes and sizes and affiliations. I mean deadly dangerous.
    So, when you consider that in this area (Ada County as an example) Paramedic care is at a higher level than most parts of the nation (example- Central Venus Access, Standing orders for Narcotics, and Medicated assisted Intubation using paralytics..lifesaving procedures that are VERY dangerous if used incorrectly or by under-trained providers ) it is absolutely necessary for a higher standard to be set.

    Now this may seem like a rehash of previous comments, but I felt it was a reasonable reply to the suggestion that training standards should be set by the state.

    Simply put…The state sets the regulatory minimum…but professional ethics dictate we must operate at a significantly higher standard.

    To suggest that we try to change the state standard to address this local issue is both a cop out and a diversionary tactic to divert attention away from our own responsibility. In fact, the states testimony before the BOCC indicates it is looking for Ada County to be the model for what may work elsewhere in the state. That should speak for itself.

    EDITOR NOTE–So much for short replies!

  2. I’m just concerned that the same three County Commissioners that passed this resolution are the same three that spent $30,000 in taxpayer money to fight a $50 fine for an open meeting law violation. Now they will spend more to find out if their ordinance is legal. There seems to be no bottom to their (our) pocket.

  3. I didn’t hear anyone testify against high standards, or against prioritizing patient care. What I heard was a number of people who were concerned with having Ada County tell other taxing districts, each with their own elected city councils and/or fire commissioners, how to operate. The fire districts expressed a willingness to work together, just not to be subject to the rule of Ada County. I am as ardent a supporter of Ada County EMS as you will find, but this is a reasonable expectation.

    The 2004 Big Sky Paramedics v. Sagle Fire Supreme Court decision makes an interesting point: “Municipal power is a classic example of derivative power. Because a fire district is a government subdivision like a city, a fire district possesses only the powers conferred on it by the legislature or which can be derived by necessary implication.” State v. Frederic. A county is also a government subdivision, so the same ought to hold true for them as well.

    What can a fire district do? From Idaho Code: FIRE PROTECTION DISTRICT 31-1401. PURPOSE AND POLICY OF LAW — SHORT TITLE. The protection of property against fire and the preservation of life, and enforcement of any of the fire codes and other rules that are adopted by the state fire marshal pursuant to chapter 2, title 41, Idaho Code, are hereby declared to be a public benefit, use and purpose.

    What can County commissioners do with regard to ambulance service? From Idaho Code: 31-3903. AMBULANCE SERVICE — POWERS AND DUTIES OF BOARD OF COUNTY COMMISSIONERS. The board of county commissioners shall determine the manner in which said ambulance service shall be operated, and is empowered to make expenditures from the ambulance service fund for the purchase or lease of real property and the construction of buildings necessary in connection with said service, to acquire necessary equipment for the operation and maintenance of said service, and to pay necessary salaries.

    Fire districts have the explicit power to ensure “the preservation of life”. County commissioners, although allowed to form an ambulance district, levy taxes, and run a county ambulance district, do not appear to have any authority to regulate the provision of emergency medical or ambulance service by other government entities.

    I am not an attorney but I would venture to speculate that with the passage of this Ordinance, our Ada County commissioners are, once again, needlessly going to waste precious taxpayer dollars in a lengthy court battle over something that should have been worked out peacefully instead.

  4. Thomas the tank
    Dec 19, 2006, 9:29 pm

    I really think that the large picture is being missed here in regards to the most effective use of tax payer dollars. Combining all of the Fire, EMS and police departments into a metro type system would do several things.

    First it would eliminate all of the seperate fire chiefs. One would likely need to elect a chief much like a sherrif. Perhaps just one elected official to govern the three. Then appoint one sheriff or police chief, one EMS director and one Fire chief.

    EMS is already functioning on a county wide system with one chief or director as is the sheriff. The elimination of so many chiefs would surely save a significant amount of money. Making one training department for Police, EMS and Fire would save money. The combined purchasing power for fuel uniforms supplies etc. would save money.

    All Fire, EMS, and Police stations would be one in the same. Although PD does not really have stations in all locales per sey. The days of houses burning down because some one does not live in a fire district would be over. EMS and the sherrif do not have such a problem. There are no EMS districts. The county is the district. Sherrif is in the same boat as well. Property taxes would surely go down as all of the county would be incorporated into a metro or FIRE EMS PD taxing district one bill for all services for the entire county.

    When the towns and cities here in Ada Co. were several miles apart this would not have made sense. Today can you honestly tell me where Boise ends and Meridian begins? How about Kuna and Meridian? Garden city and Boise? Would the cities give up their slice of the tax pie for the greater good? Probably not. I believe in some form or another this was one of the recommendations of the Blue Ribbon task force. PD was not included in the Blue Ribbon task force but makes sense to me.

    One of the other things that I hope this would alleviate is the unpaid Fire fighters and EMTs that respond in Kuna, Star and Eagle (and perhaps other districts). The region should have enough resources to stop this practice. Some one who does this line of work, in this large of an area should be paid, and professional.

  5. OK “G” short and to the point.
    We are not in the”world of EMS” we are in the real world, like it or not.

    In one breath we want to maintain our “Idaho lifestyle” but in the next breath we want to measure up to the Seattle EMS system. I don’t see it as anything but wanting it both ways. Ain’t gonna happen! EMS can “lobby” all it wants, but the fact remains that folding the EMS system into the fire department makes the most sense for the taxpayer.

  6. Sharon are you on drugs again? You always claim that if you were there, there would have been a peaceful way to resolve all of these issues. Your term as county commissioner was the most un-peaceful and embarrassing term I have ever seen, even compared to the current three.

    As far as EMS and Fire, those two have been at each other’s throats for a long time. The same is true for BPD and the Fire Dept. I think the time for a peaceful resolve has come and gone, which is why the county is in this whole debacle. Neither side will back down from their fight and it is to the point of pure principle.

    I will keep my comments short and sweet like Nemo did and say one last thing. EMS and Fire are doing a great job at what they specialize in, but I see where Fire is coming from. They want the latest equipment, they want to keep busy, and they want paid more…….but we must run the county like a business and be cost effective and lean. I think the county made the right decision regardless of how peaceful it was.

  7. Snoop, I don’t disagree with the idea of running the County, Cities, or any taxing districts like a business. In this scenario the County is trying to do the exact opposite. Their business model in the past has failed financially. Instead of becomeing a better business, they want to legislate the rest of the providers out of business.

    Competition is what makes business models work. Yours is either better than the other guy or not. County made a really bad decision on this one. To Thomas the Tank…you make several good points about the efficiencies that could be realized with a cooperative County wide system. However, the days of a house burning down across fire district lines ended a long time ago. We call them mutual aid agreements and they work well. In fact, sometimes too well. Everyone wants to respond to everything. As for the “unpaid and unprofessional” volunteers in Star. I will keep them every day of the week. We have increased our paid staff over the years, but our volunteers have been protecting us for quite a long time. They deserve our thanks, not our ridicule.

    Frankly, being 15 miles away from this county’s closest full time paramedic station concerns me a whole lot more than the volunteer EMTs in Star. I challenge anyone to read the ordinance adopted yesterday and tell me how it made Star or any other place in Ada County a safer place to live. My take is, it just attempts to limit my options to try and increase the level of life saving service in Star. Unfortunately, Judy’s closing snipe about “we’ll see you in court” is where this will all end up. And we all know that will make us safer.

    And Guardian, sorry for the short reply….but I am a politician…what do you expect.

  8. Just moving back (home) to Idaho, I’m pleased to see that this is the debated issue in the news and blogasphere. It’s much better than state, county, and city issues that fight all the way to the U.S. Supreme Court, costing citizens large amounts of wasted money and a greater distrust in their own elected government.

    Honestly, this issue seems like one that could be resolved if the major player sat down and discussed the major issues. But from what I can tell, that’s not what anybody wants to do. At least were not talking about Bill of Rights-type issues. It’s good to be back in Idaho.

  9. Snoop – On drugs? I’ve only heard that I was crazy! 😉 Maybe it is crazy to think that adults who are elected or appointed to represent taxpaying constituents can sit down at the table when they disagree and peacefully either come to a consensus or work out compromises.

    When I was in office, I brought the issue of shared employees – people who work for the County but serve the state, such as clerks of the court, juvenile court employees, etc. – to the attention of the Idaho Association of Counties’ Justice and Public Safety Committee. There was a lot of friction surrounding the issue.

    The short version of the shared employees story is that a committee was formed that included representatives of both the state and counties. I served on that committee. We met quarterly and peacefully hashed out template agreements that could be used by the state and the counties in order to better define the roles of each with regard to shared employees.

    The EMS situation is no different. Things would be much better today, had the County worked WITH the fire districts in writing a new Ordinance.

    As for my colleagues and me when I was on the commission, I suggested mediation and they refused. It does take willingness on the part of both or all parties to actually work out differences. With the proposed EMS Ordinance, I see that willingness from the fire districts, but not from the County commissioners and EMS administration. Therein lies the problem.

  10. Thomas the tank
    Dec 20, 2006, 8:53 pm

    The remarks about volunteers was NOT meant to be a slam. It was a remark that they SHOULD be paid, shoud BE hired as full time or not at all. They provide too valuable of a service to not be compensated and protected w/ a living wage, I did not say they were not professional or needed. The county is big enough they should ALL be paid! Oh and there was a house that burned down just this year south of town. It was all over the news.

  11. There is no doubt the best solution would be a county wide public safety system. I have talked directly to the EMS director and know that he would support a move in that direction. The problem I see is too many fire chiefs not wanting to get off the top of their totem poll. It would save large amounts of taxpayer dollars and be more effective. Its too bad that greed and money control the fire Departments and not what is best for those they are to serve.

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