HLTH 88 008 PE
4-0900-2165 2
STATE OF MINNESOTA
OFFICE OF ADMINISTRATIVE HEARINGS
FOR THE MINNESOTA DEPARTMENT OF HEALTH
In the Matter of the
License Applications FINDINGS OF. FACT,
of North Ambulance, CONCLUSIONS AND
Hennepin County EMS, RECOMMENDATION
and HealthOne
The above-entitled matter Came on for hearing before Administrative Law
Judge Peter C, Erickson at 9:30 a.m. on Tuesday, April 12, 1988 at the
Minnesota department of Health Building, Minneapolis, Minnesota. The record
on this matter was closed on May 25, 1988, the date of receipt of the last
post hearing submission. All parties in this matter waived the ninety-day
report requirement contained in Minn. Stat. 144.802, subd. 3(g) (Supp. 1987).
Kent G. Harbison, from the firm of Fredrikson & Byron, Attorneys at law,
1100 International Centre, 900 Second Avenue South, Minneapolis, Minnesota
55402-3397, appeared on behalf of Applicant, North Ambulance. Marilyn
Maloney, Assistant County Attorney, A-2000 Hennepin County Government Center,
33 South Sixth Street, Minneapolis, Minnesota 55487, appeared on behalf of
Applicant, Hennepin County Ambulance Service. Mark G. Mishek, General Counsel,
HealthOne Corporation, 2810 - 57th Avenue North, Minneapolis, Minnesota
55430 2496, appeared on behalf of Applicant, HealthOne Transportation
Services. Paul A. Melchert, from the firm of Melchert, Hubert, Sjodin &
Willemssen, Attorneys at Law, First National Bank Building, Box 7, Waconia,
Minnesota 55387, appeared on behalf of Objector, Waconia Ridgeview Ambulance
Service. (The Petition to Intervene filed on behalf of Waconia Ridgeview was
withdrawn after the three Applicants amended their applications to exclude the
Objector's service area.)
This Report is a recommendation, not a final decision. The Commissioner
will Make the final decision after a
of the Minnesota Department of Health WI
review of the record which may adopt, reject or modify the Findings of Fact,
Conclusions, and Recommendations contained herein. PUrsUdnt to Minn. Stat.
5 14.61, the final decision of the Commissioner shall not be made until this
Report has been made available to the parties to the proceeding for at least
ten days. An opportunity must be afforded to each party adversely affected by
this Report to file exceptions and present argument to the Commissioner.
Parti es should c ontact Si ster Mary Madonna Asht on , Commi s si oner, Mi nne Sota
Department of Health, 717 Delaware Street S.E., Minneapolis, Minnesota 55440,
to ascertain the procedure for filing exceptions or presenting argument.
STATEMENT OF ISSUES
The issues to be determined in this proceeding are whether the Applicants
have shown, by a preponderance of the evidence, that their respective
applications for expanded and/or new ambulance service should be granted
pursuant to the standards set forth in Minn. Stat. sec. 182.802, subd. 3(g) (1987
supp.).
Based upon all of the proceedings herein, the Administrative Law Judge
makes the following:
FINDINGS OF FACT
PROCEDUR AL HISTORY
1. This case involves the applications of three licensed medical
transportation providers to expand each provider's primary service area
("PSA") within which it can provide scheduled advanced life support ("ALS")
and basic life support ("BLS") transportation services. Hennepin County
Ambulance Service ("HCAS") filed its application with the Minnesota Department
of Health on August 24, 1987 and amended that application at the hearing on
April 12, 1988. HealthOne irdnsportation Services ("HealthOne") filed its
application with the Department on September 1, 1987 and amended that
application on March 28, 1988 and at the hearing on April 12, 1988. North
Ambulance ("North") filed its application with the Department on November 18,
1987 and amended that application at the April 12, 1988 hearing.
2. On January 25, 1988, the Commissioner of Health issued a Notice and
Order for Hearing which consolidated the three above referenced applications
and set a date for a public hearing on April 12, 1988. On February 5, 1988,
the Notice of Hearing was published in the State Register at 12 S.R. l62l. On
February 8, 1988, notice of the hearing was published in the "Minneapolis Star
and Tribune".
3. After the hearing on this matter had been concluded, the Department
of Health moved copies of the amendments to all three applications to an
"interested persons" list maintained by the Department. This mailing informed
recipients that additional comments on the applications, as amended, could be
submitted to the Administrative Law Judge on or before April 29, 1988 for
consideration as part of the record.
HENNEPIN COUNTY AMBULANCE SERVICE
4. HCAS is currently licensed for both advanced life support and basic
life support transportation for both scheduled and unscheduled runs in a
primary service area generally covering the City of Minneapolis, the southwest
suburbs and some of the southern suburbs. The municipalities currently served
are Deephaven, Eden Prairie, Excelsior, Greenwood, Hopkins, Minneapolis,
Minnetonka, Richfield, St. Anthony, St. Louis Park, Shorewood, Tonka Bay and
Woodland. HCAS's license for these services was most recently renewed by the
Commissioner of Health in October of 1987.
5. In its application, HCAS seeks to expand its current PSA for
scheduled ALS and BLS services to the boundaries of Hennepin County, with the
exception of the area of Hennepin County which is in the PSA of Waconia
Ridgeview Ambulance Service.
6. The amended application sets forth the schedule of services applied
for as follows:
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Hennepin County Medical Center Ambulance Service will
provide prearranged transfer runs with basic life support
and advance life support ambulance service for any person
and/or facility from any location within Hennepin County,
except as limited in Section I above, to Hennepin County
Medical Center. "Pre-arranged transfer run" is defined
here and in Hennepin County Ambulance Ordinance, subs. 21
as, "the classification of ambulance request when the
caller requests an ambulance for transportation at some
later time or date for non emergencies. Immediate
attention or transportation is not being requested.
7. Currently, the following are licensed to provide advanced life
support services in the proposed Hennepin County PSA: Edina Fire Department,
North Memorial Medical Center Ambulance Service and HealthOne Ambulance
Service. These providers also provide BLS service in addition to Midwest
Med-Cab and medi-bus.
8. HCAS seeks to expand its PSA for scheduled transportation for the
purpose of providing greater continuity of care for certain patients being
transported to the Hennepin County Medical Center from areas outside the
current PSA. It is estimated that the proposed expanded service would result
in only approximately 40 to 50 ambulance runs per year. This number is less
than 1/10th of one percent of HCAS's current run volume for both scheduled and
unscheduled sp(.,ces.
9. A need exists for certain critical Hennepin County Medical Center
patients who would benefit by transportation to Hennepin County Medical Center
by Hennepin County Medical Center's own ambulance service rather than another
provider. Most of these patients will be critical patients with severe
injuries or burns or in need of hyperbaric medicine, renal dialysis, or
neonatal care who have arrived at the Minneapolis-St. Paul Airport for
transportation to and treatment at Hennepin County Medical Center. HCAS is
not currently able to provide ambulance transportation to patients who arrive
at the airport because it is outside of the present PSA. Additionally,
Hennepin County Medical Center geriatric service doctors will be able to
provide medical attention for the transportation of nursing home patients to
the Medical Center from areas in Hennepin County which are now outside the
current PSA.
10. HCAS is not planning to market its requested expanded scheduled
service.
11. The Metropo Ii I an Counci I Metro Hea Ith P I an and t he Community Hea Ith
Plan for Hennepin County do not provide any sections dealing with scheduled
ALS or BLS ambulance service.
12. In JanUdry of 1988, HCAS added another fully staffed ambulance to its
complement in order to curb an increase in the average response time for
unscheduled ambulance runs. All ambulances in the complement will be used for
both scheduled and unscheduled runs.
13. No recommendations or comments were received from the governing body
of Hennepin County or any of the municipalities for which the proposed
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expanded services would be provided either in support or in opposition to the
application of HCAS.
HEALTHONE TRANSPORTATION SERVICES
14. HealthOne transportdtion Services is an operating division of
HealthOne Corporation and has been providing comprehensive medical
transportation services in the Minneapolis -St. Paul metropolitan area for
approximately 15 years. Those services now include: (a) unscheduled and
scheduled ALS transportation services in Anoka County, portions of northern
Ramsey County, a Small portion of northern Hennepin County and the City of
Bloomington in Hennepin County; (b) BLS transportation services in the areas
listed in (a) and most of Hennepin County, Ramsey County including the City of
St. Paul, and portions of Dakota County; (c) scheduled ALS services between
HealthOne hospitals located within the metropolitan area; and (d) special
transportation services throughout the entire metropolitan area, which
services are not regulated by the Department of Health.
15. HealthOne's application seeks to provide scheduled ALS services to
patients originating in a PSA which includes all of Hennepin County except the
area serviced by WaConia Ridgeview Ambulance Service, all of Anoka County, and
all of Ramsey County excluding the corporate limits of the Cities of White
Bear Lake, Gem Lake, White Bear Township, North St. Paul and the City of
Maplewood.
16. The amended application sets forth the schedule of services applied
for as follows:
HealthOne Transportation Services will provide Advanced
Life Support (ALS), pre arranged transfer runs for patients
originating at any medical facility (e.g., hospitals,
nursing homes, ambulatory surgical centers, physician
clinics) within the primary service area (PSA) described
below, whose physician, acting personally or through a
Registered Nurse who is acting as a representative of the
medical facility of origin, requests transportation to any
HealthOne facility, 24 hours per day, 7 days per week.
"Pre arranged transfer run" is defined here and in the
Hennepin County Ambulance Ordinance, subs. 21 as, "the
classification of ambulance request when the caller
requests an ambulance for transportation at some later
time or date for non-emergencies. Immediate attention or
transportation is not being requested."
17. Currently, the following are licensed to provide ALS services in all
or portions of Hennepin County: Edina Fire Department, North Memorial Medical
Center Ambulance Service, HealthOne, Waconia Ridgeview Ambulance Service, Life
Link 111, and Health Last Ambulance.' Within Anoka County, Life Link III,
Health East and HealthOne provide ALS services. Within the requested new PSA
in Ramsey County, the St. Paul Fire Department, Health East Ambulance, Life
Link III , and HealthOne (only inter-facility) currently provide ALS services.
Applicants, amended PSA excludes the Waconia Ridgeview service drea-
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18. If HealthOne's application is granted, a duplication in services will
result with the providers listed above. However, HealthOne has experienced an
increasing volume of scheduled ALS ambulance runs. Additionally, the granting
of this application would provide a continuity of care for patients being
transported to HealthOne hospitals from areas outside the current PSA.
Hea lthone faci Iit i es in the metropo I i tan area are Mercy and Unity Hospit a Is in
Anoka County; United and Children's Hospitals in Ramsey County; and
Metropolitan Medical Center-Mt. Sinai Hospital in Hennepin County. There is
no estimate as to the number of additional scheduled ALS ambulance runs that
the expanded PSA will generate.
19. HealthOne has 11 ambulance "bases" scattered throughout the
metropolitan area. Thus, it does not contemplate that unscheduled, emergency
needs will go unmet while scheduled runs are being made.
20. The Metropolitan Council Metro Health Plan and the Community Health
Plan for Hennepin County do not provide any sections dealing with scheduled
ALS ambulance service
21. The Mayor and Fire Chief of the City of St. Paul submitted a joint
comment in opposition to the application of HealthOne. Their major concerns
were the lack of definition for the terms "scheduled" and "inter facility"
care. In addition, Mayor Latimer and Fire Chief Conroy are concerned about
individuals being able to "bypass" the "911" system.
NORTH AMBULANCE
22. North Ambulance is owned by North Memorial Medical Center, 3300
Oakdale Avenue North, Robbinsdale, Minnesota and has been providing ambulance
services for approximately 27 years. North Memorial Medical Center is a
licensed health care facility. North Ambulance is currently licensed by the
Minnesota Department of Health to provide ALS and BLS unscheduled and
scheduled transportation services in the northwestern portion of the
metropolitan area that lies generally west of Interstate Highway 94 and north
of State Highway 12.
23. In its application, North Ambulance seeks to expand its current PSA
for scheduled ALS and BLS services to include: all of Hennepin County with
the exception of the area of Hennepin County which is in the PSA of WdConia
Ridgeview Ambulance Service; all of Anoka County excluding the corporate
limits of the Cities of Lino Lakes, Columbus, Circle Pines, and Lexington; and
all of Ramsey County excluding the corporate limits of the Cities of White
Bear Lake, Gem Lake, White Bear Township, North St. Paul and the City of
Maplewood.
24. The amended application gets forth the schedule of servicen applied
for as follows:
North Ambulance will provide ALS and BLS pre arranged
transfer runs in the PSA described below, 24 hours a day.
The term 'pre-arranged transfer run" is defined here and in
the Hennepin County Ambulance Ordinance, subsection 21 as,
"The classification of ambulance request when the Cdller
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requests an ambulance for transportation at some later time
or date for non emergencies. Immediate attention or trans-
portation is not being requested." The only qualification
to this term and provision is that North Ambulance does not
intend to use its ALS on duty emergency fleet to respond to
proposed scheduled calls. North Ambulance will not reduce
its current complement of emergency response vehicles to
substitute for the above-scheduled transfer volume. North
Ambulance intends to restrict its pre arranged transfer
runs to calls received from physicians, their designees or
other licensed health care providers. North Ambulance does
not intend to respond to requested scheduled calls from
private residences.
25. Currently, the following are licensed to provide life support
transportation services in the proposed, expanded PSA: Hennepin County
Ambulance Service, Health East Ambulance Service, HealthOne, Medi-Bus, St.
Paul Fire Department, Edina Fire Department, Life Link III, and Falcon Heights
Fire Department.
26. North Ambulance seeks to expand its PSA for scheduled ALS and BLS
services to increase the number of available providers in the most densely
populated metropolitan areas. North Ambulance statistics show that the number
of ALS ambulance runs it has made from 1983 through 1987 has risen by
approximately 1,000 each year. In addition, the number of scheduled BLS runs
it made rose from approximately 3,000 in 1986 to approximately 6,670 in 1987.
Currently, there is a trend for medical facilities to become specialized, thus
resulting in a greater need for inter-facility transportation of patients.
Additionally, because much more out-patient medical care is being provided,
there is a greater need for patient transport to and from medical facilities
which includes a growing population of elderly individuals in nursing homes.
27. North Ambulance maintains four separate ambulance "bases" in the
metropolitan area. These are located in Brooklyn Park, Maple Grove, Crystal
and Golden Valley. Currently, North has available nine vehicles to provide
scheduled transportation services. Three of these are equipped to provide ALS
transport. No vehicles now providing unscheduled transportation services for
North Ambulance will he used to provide scheduled services if this application
is granted. The vehicles and staff for unscheduled and scheduled services
will be completely independent.
28. The Metropolitan Council Metro Health Plan and the Community Health
Plan for Hennepin County do not provide any sections dealing with scheduled
ALS or BLS ambulance service.
29. The Mayor of St. Paul, in conjunction with the Fire Chief, filed a
comment in opposition to the application of North Ambulance. The reasons for
this opposition are set forth above in Finding No. 21 .
OTHER EVIDENCE
30. At the hearing on this matter, Rod Crane, Executive Director of Life
Link 11I, testified in opposition to the three applications considered
herein. He stated that if any of these applications are granted, it would
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result in a loss of business for Life Link III which would have a detrimental
effect. Additionally, Mr. Crane argues that all three applications should be
tabled until the EMS Task Force commissioned by the Department of Health makes
its report regarding the appropriate regulation of scheduled services.
31. The Judge received approximately 20 written submissions from other
life transport services, city officials and public health organizations.
These have been thoroughly read and considered herein. All of these comments
will be submitted to the Commissioner of Health as part of the official record
in this case. !he Judge points out that the Hennepin County Community Health
Department initially commented in opposition to dll three applications.
Their concern WdS the fact that the expansion of the applicants' PSAs and the
dual use of vehicles for both scheduled and unscheduled services could result
in a significantly greater response time for emergency runs. In addition, the
Health Department is concerned that permitting individuals from private
residences to call for scheduled ambulance services will result in a general
confusion as to the proper use of the "911" system. In a second submission,
the County Health Department stated its support for the North Ambulance
application because its amendments had addressed their primary concerns.
Based upon the following Findings of Fact, the Administrative law Judge
makes the following:
CONCLUSIONS
1. The Administrative Law Judge and the Commissioner of Health have
jurisdiction over this matter pursuant to Minn. Stat. sec. 14.50 (1986) and Minn.
Stat. 144.802, subd. 3 (1987 Supp.). The Notice of Hearing WdS in all
respects proper and all procedural and substantive provisions of law or rule
have been complied with by the Department.
2. As stated in the Notice of and Order for Hearing, the issue to be
determined in thin proceeding is whether the applicants have shown that their
applications should be granted based upon the criteria set out in Minn. Stdt.
144.802, subd. 3(g) (1987 Supp.). That statutory provision reads as follows:
(g) The administrative law judge shall review and
comment upon the application and shall make written
recommendations as to its disposition to the commissioner
within 90 days of receiving notice of the application. In
making the recommendations, the administrative law judge
shall consider and make written comments as to whether the
proposed service, change in base of operations, or expansion
in primary service area is needed, based on consideration
of the following factors:
(1) the relationship of the proposed service, change
in base of operations or expansion in primary service area
to the current community health plan as approved by the
commissioner under section 145,918;
(2) the recommendations or comments of the governing
bodies of the counties and municipalities in which the
service would be provided;
(3) the deleterious effects on the public health from
duplication, if any, of life support transportation
services that would result from granting the license;
(4) the estimated effect of the proposed service,
change in base of operation or expansion in primary service
area on the public health;
(5) whether any benefit accruing to the public health
would outweigh the costs associated with the proposed
service, change in base of operations, or expansion in
primary service area.
The administrative law judge shall recommend that the
commissioner either grant or deny a license or recommend
that a modified license be granted. The reasons for the
reLommenddtion shall be set forth in detail. The
administrative law judge shall make the recommendations and
reasons avdilable to any individual requesting them.
3. After due consideration of all of the factors enumerated in the above-
quoted statute, and for the reasons set forth in the Memorandum below, the
Judge concludes that all three Applicants have met the Statutory criteria and
that their applications should be GRANTED.
Based upon the foregoing Conclusions, the Administrative taw Judge makes
the following:
RECOMMENDATION
IT IS HEREBY RECOMMENDED: That all three applications herein, as amended,
be approved by the Commissioner of Health.
Dated this..) (I day of June, 1988.
PETER C. ERICKSON
Administrative Law Judge
MEMORANDUM
All three of the Applicants in this case have applied for scheduled
services within an expanded PSA. Both HCAS and HealthOne argue that
"continuity of care" is a major reason why their applications should be
granted. North Ambulance contends, primarily, that due to the increase in the
number of scheduled ambulance runs in the urban area, there is a need for
another "competitor" in their proposed PSA.
The Judge will first point out the significant differences between the
proposed scheduled services applied for even though it has been concluded that
all three applications should be granted, HCAS proposes to provide scheduled
transportation servicen only to Hennepin County Medical Center. However, all
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of their ambulances may provide this service and a 'pick-up' may be initiated
by a private citizen and originate from a residence. HealthOne's amended
application provides for scheduled services originating only at medical
facilities and initiated by a physician or nurse. Any of the HealthOne
ambulances may provide the scheduled runs. A HealthOne facility will be on
the receiving end of all of the scheduled transportation. North Ambulance
proposes to provide scheduled ambulance services initiated by physicians or
health care providers. It does not "intend" to make 'pick-ups" from private
residences. North Ambulance will transport patients to any location in the
proposed PSA, however. No ambulances that currently provide unscheduled runs
will be used for the proposed scheduled transportation, however.
The above-provisions in the three applications raise three issues:
(1) will the "911" system be bypassed by private citizens who are aware they
can arrange for scheduled services absent the input of a medical practitioner;
(2) will the use of emergency vehicles for scheduled runs result in a greater
response time because of the unavailability of ambulances; and (3) is
increasing the competition in the scheduled transportation market consistent
with the intent of Minn. Stat. 144.802, subd. 3 (1987 Supp.). These issues
must be examined in light of the statutory criteria, or "factors", which have
been set forth above in Conclusion No. 2.
The first factor to be considered is the relationship of the proposed
change in service and PSA to the current community health plan. As is set
forth above in the Findings of Fact, neither the Metropolitan Health Plan nor
the Hennepin County Health Plan speak to the provision of scheduled ambulance
services by life support transportation providers. Consequently, this factor
is not applicable to these applications.
The second factor which must be addressed is the "recommendations or
comments of the governing bodies of the counties and municipalities" which are
included in the proposed PSAS. As the Findings above show, the Mayor of the
City of St. Paul commented in opposition to the applications of HealthOne and
North Ambulance. The reasons for the Mayor's opposition are: the lack of
definition for several of the terms the Applicants use to define the services
proposed; and a concern that the "911" system will be bypassed by the public.
The Judge has determined that the schedule of services proposed by both
HealthOne and North Ambulance is sufficiently specific regarding what can, and
cannot, be provided if the expanded licensure is granted. Additionally, both
the HealthOne application and the North Ambulance application, as amended,
require that a health facility or medical practitioner initiate the scheduled
service request. Consequently, the public at large will not be able to access
these proposed scheduled services. No increased confusion regarding the "911"
system should result.
The third factor which must be considered is whether granting the
applications would result in "deleterious effects on the public health from
duplication . . . of . . . services. . . ." Granting one, two or all three of
the application herein would result in some duplication of services. Both
HCAS and HealthOne have defined their scheduled services in terms Of a need
for "continuity of care" for patients whom they will serve. Because the HCAS
and HealthOne transports will be to only their own facilities, there will not
be a "general" duplication of services in the PSA. North Ambulance intends to
offer scheduled services to any location in its proposed PSA. Consequently,
it will be in competition with all of the other scheduled services now being
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provided. However, the record shows that the demand for scheduled services is
increasing in the metropolitan area and none of the three Applicants is
proposing to expand into an area where there is only one other ambulance
provider offering scheduled and unscheduled services. The Judge has concluded
that all three Applicants have shown that no deleterious effects on the public
health will result from a duplication of services if the applications are
granted. North Memorial Medical Center v. Minnesota Department of Health,
slip op. (Minn. App. May 24, 1988 CX 87-2166.
The fourth factor which must be addressed is the 'estimated effect" of the
expansion in PSA on the public health. Both HCAS and HealthOne contend that
the public health will be benefited because patients admitted to their
facilities by way of an ambulance will receive "continuity of care" from their
respective ambulance services. North Ambulance contends that an expanded PSA
will provide an additional, competitive scheduled ambulance service which can
only be a benefit to the consuming public. The concern raised by the Hennepin
County Community Health Department is whether using ambulances for scheduled
services will result in an unavailability of vehicles when emergency needs
arise. North Ambulance Service will not use any of its vehicles that provide
emergency services for its scheduled services operation. The other two
Applicants will have dual-use vehicles but the number of scheduled runs should
be much less than North's because patients will only be delivered to their own
facilities. Although the County Health Department has shown that the
emergency response time has been increasing over the past few years, its
concern if any of these applications are granted is only speculative. The
county ambulance ordinance regulates the response time that licensed services
must meet. Consequently, there is a control mechanism if any of the
Applicants' response times do not meet the criteria. Because the County's
concern is largely speculative, the Judge will not make an adverse
recommendation based on that consideration.
Another issue which arises in conjunction with the above factor is whether
the public's use of a scheduled service will result in the "911" ystem being
bypassed. This is a concern, however, the Judge has no way to evaluate the
seriousness or extent of the problem. Consequently, it is impossible, based
on this record, to "estimate" any negative effects on the public health due to
the possibility of "911" confusion.
The last factor which must be addressed is weighing the benefits to the
public if the applications are granted against the costs associated with the
proposed expansion of service and PSA. The "costs" contemplated in this
statutory criteria are the costs of a proposed service which will be passed on
to the consuming public. Life Star Ambulance Systems Inc. v. Ashton 363
N.W.2d 895 (Minn. App. 1985). The record in this matter does not support a
finding that any additional costs will be passed on to the public. There was
a suggestion that North Ambulance may have to establish one or more additional
ambulance "stations", but that Will only be based on the demand for its
scheduled services if the application is granted. Consequently, any increased
cost to the public is only speculative and will not be the basis for a
negative recommendation.
The Judge has concluded that all three Applicants herein have met the
statutory criteria set forth in Minn. Stdt. sec. 144.802, subd. 3(g) (1987
Supp.). As can be easily seen, these criteria are not objective but rather
very subjective and prone to policy considerations. The Judge has attempted
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to evaluate the applications herein as objectively as possible, within the
standards imposed by the statute. The Judge points out that several ambulance
services now licensed in the proposed PSAs objected to the applications
herein, primarily because they do not want any more competition in the area
being served. These objectors are, for the most part, large ambulance service
providers who should not be greatly affected by the increased competition.
The proposed PSAs herein were amended and structured specifically to
accommodate the concern for adverse competition on small providers. Sep,
North Memorial Medical Center, sugra. An argument has been made that granting
North Ambulance's application will essentially deregulate ambulance licensure.
The Judge does not agree. Rather, the Judge concludes that the Commissioner
can determine "safe" levels of competition within the meaning of "need" set
forth in the statute. See, Twin Ports Convalescent, Inc. v. Minn. Brd. of
Health, 257 N.W.2d 343, (Minn. 1977).
P.C.E.
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