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8-0913-11166-2 |
STATE OF MINNESOTA
OFFICE OF ADMINISTRATIVE HEARINGS
FOR THE MINNESOTA EMERGENCY MEDICAL SERVICES
REGULATORY BOARD
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In the Matter of the ALS License Application of the City of Red Wing, d/b/a Red Wing Fire Department Ambulance, Red Wing, Minnesota. |
FINDINGS OF FACT, CONCLUSIONS OF LAW AND ORDER |
The above-entitled matter was heard by Administrative Law Judge Jon L. Lunde commencing at 11:30 a.m. on Monday, June 30, 1997 at the Red Wing City Hall in Red Wing, Minnesota. The hearing was held pursuant to a Notice of Completed Application and Notice of and Order for Hearing dated May 19, 1997. The record closed on July 11, 1997 when documents the Judge requested at the hearing were filed.
Philip Mathiowetz, Fire Chief, Red Wing Fire Department, 420 Plum Street, Red Wing, MN 55066, appeared on behalf of the City of Red Wing (City or Applicant). No one petitioned to intervene in this proceeding or filed any written comments opposing the City’s license application, and at the hearing no one spoke in opposition to the application, as amended pursuant to an agreement between interested parties.
NOTICE
This Order is the final administrative decision in this proceeding. Any person aggrieved by this Order is entitled to judicial review in the manner provided in Minn. Stat. §§ 14.63 to 14.69 (1996).
STATEMENT OF ISSUE
The issue in this case is whether the application filed by the City of Red Wing to provide advanced life support (ALS) ambulance services in its primary service area should be approved under Minn. Stat. § 144.802, subd. 3(h) (1996).
Based upon all of the files, records and proceedings herein, the Administrative Law Judge makes the following:
FINDINGS OF FACT
1. The City of Red Wing is licensed by the Board to provide basic life support (BLS) ambulance services in a portion of Goodhue County, Minnesota. The services are provided by the City’s fire department. Its EMS number is 204.
2. On January 8, 1997, the City filed an application with the Board to upgrade its type of service from a basic life support ambulance service to an advanced life support ambulance service. Ex. 1.
3. On May 19, 1997 the Board’s executive director issued a Notice of Completed Application and Notice of and Order for Hearing ordering that a public hearing on the City’s application be held on June 30, 1997 in Red Wing, Minnesota. Ex. 4.
4. On May 27, 1997, the Notice of Completed Application and Notice of and Order for Hearing was published in the State Register. Ex. 2. It also was published in the Republican Eagle: once the week of June 2, 1997 and once the week of June 9, 1997. Ex. 3. Also, the Notice of Completed Application and Notice of and Order for Hearing was mailed to the Goodhue County Board of Commissioners, Goodhue - Wabasha Community Health Board, Public Health Service of Goodhue - Wabasha, Southeastern Minnesota EMS Joint Powers Board, Cannon Falls Ambulance Service, Kenyon Ambulance Service, Lake City Ambulance Service, Northfield Rescue Squad, West Concord Fire Department Ambulance, Zumbrota Area Ambulance Service, and the City of Red Wing.
5. The Red Wing Fire Department has provided ambulance services in and around the City of Red Wing for over 30 years. It provides ambulance services in three townships in Pierce County, Wisconsin and in portions of Goodhue County, Minnesota. It serves 25,000 residents and 15,000 visitors and has approximately 2,000 annual runs: 700 advanced runs and 1,300 basic runs.
6. Most patients utilizing the City's ambulance service are taken to St. John's Regional Health Center in Red Wing. The City has a training agreement with St. John's which has primary on-line medical control over all EMT services provided by the City.
7. The City has mutual aid agreements with the Hastings Fire Department (EMS 101), the Lake City Ambulance Service (EMS 126), the Cannon Falls Ambulance Service (EMS 044), and the Zumbrota Area Ambulance Service (EMS 278).
8. The base of operation for the City's ambulance service is at the fire department in Red Wing. There are no substations. The City employs 26 career attendants and drivers: 14 intermediate EMTs and 12 Minnesota Paramedics. Four paramedics are on duty 24 hours daily.
9. The "911" public service answering point in Goodhue County is at the Goodhue County Sheriff's Office in Red Wing. The City's ambulances are dispatched by the sheriff's office which has two dispatchers on duty at all times.[1] Ambulances are dispatched to the ambulance service serving the primary service area where the service is needed.
10. The City currently has variances which authorize it to use advanced airway management, defibrillation and intravenous fluid administration. If its license application is approved it also will be authorized to utilize intubation, including endotracheo intubation and provide pharmacology services.
11. Several years ago the City changed its method of financing ambulance services from a tax-based system to a user system. Most revenues (65%) will come from third-party payors such as Medicare, Medicaid and private insurance. The remainder come from direct patient payments or community health system subsidies. Because the City's ambulance service operates without a profit motive, its fees are lower than the fees generally charged in the State for comparable services. The average ALS charge is expected to be $450.00 and the average BLS charge is expected to be approximately $350.00.
12. In Minnesota, the City’s primary service area (PSA) is wholly within Goodhue County. At one time, the City’s PSA overlapped with the PSAs of the Lake City Ambulance Service, the Cannon Falls Ambulance Service, and the Zumbrota Area Ambulance Service. Pursuant to a written agreement between the Lake City Ambulance Service and the City of Red Wing, the overlapping sections in their PSAs were eliminated. Pursuant to the terms of that agreement, sections 25 and 35 in Haycreek Township and section 19 in Florence Township will be served exclusively by the City.[2] Sections 2, 3, 9-12, 13-17 and 20-26 in Florence Township will be served exclusively by the Lake City Ambulance Service.
13. Prior to the time of the hearing in this matter, the City's PSA overlapped the PSA of the Zumbrota Area Ambulance Service. The overlap occurred in sections 1-24 in Goodhue Township and sections 4-9 and 16-21 in Belvedere Township. At the hearing, the City and the Zumbrota Area Ambulance Association agreed to eliminate the overlaps. Under their agreement, sections 1-12 in Goodhue Township and sections 4-9 in Belvedere Township will be served exclusively by the City. Sections 13-36 in Goodhue Township and 1-3 and 10-36 in Belvedere Township will be served exclusively by the Zumbrota Area Ambulance Service.
14. Based on agreements between the City, the Lake City Fire Department, the Cannon Falls Ambulance Service and the Zumbrota Area Ambulance Service, the City's primary service area will be as follows:
|
Municipality, Township or Area |
Township Number |
Range |
Section |
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Belvedere Twp. |
111 N |
14 W |
4-9 |
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Goodhue Twp. |
111 N |
15 W |
1-12 |
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Florence Twp. |
112 N |
13 W |
4-8, 18-19 |
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Hay Creek Twp. |
112 N |
14 W |
1-35 |
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Featherstone Twp. |
112 N |
15 W |
All |
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Vasa Twp. |
112 N |
16 W |
1-3, 10-15, 23-26, & 36 |
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Wacouta Twp. |
113 N |
13 W |
All in Goodhue County |
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Red Wing & Wacouta Twp. |
113 N |
14 W |
All in Goodhue County |
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Red Wing |
113 N |
15 W |
All in Goodhue County |
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Welch Twp. |
113 N |
16 W |
All |
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Prairie Island area |
114 N |
15 W |
19, 29-32 |
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North of Welch Twp. |
114 N |
16 W |
3, 10-14, 22-27 & 34-36 |
15. The City’s application to upgrade its license has the support of the City of Red Wing, Goodhue County Board of Commissioners, Goodhue County Health Department, Director of Nursing for the Goodhue - Wabasha Public Health Service, Goodhue County Sheriff, St. John’s Regional Health Center, and the Southeastern Minnesota EMS Joint Powers Board. Exs. 1, 7.
16. The City’s license application addresses issues relating to the emergency medical components of the community health plan adopted by the Goodhue - Wabasha Community Health Board and the City’s licensure will meet or exceed the health plan components.
17. As a result of agreements with the Lake City Ambulance Service, the Cannon Falls Ambulance Service and the Zumbrota Area Ambulance Service, the City’s PSA will not overlap the PSAs of the other three ambulance services. Consequently, there will be no duplication of ambulance services within Goodhue County and no deleterious competition.
18. The Board has adopted a policy relating to ALS licensure. Its policy is as follows:
a) The Board strongly encourages the development and implementation of advanced ambulance service throughout Minnesota;
b) The Board highly recommends that all Public Safety Answering Points (PSAPs) give dispatch priority to advanced ambulance service providers licensed within primary service areas overlapping with basic ambulance services; basic ambulance services are encouraged to develop intercept agreements with advanced ambulance services where practical;
c) From a public health perspective, primary service areas are best served by advanced ambulance service; the Board recognizes that this is not practical at this time for all areas of Minnesota; however, this mode of ambulance service is highly recommended and encouraged as a goal in EMS system development throughout the state.
Exhibit 6.
19. Approval of the City’s application to upgrade its ambulance service is consistent with the Board’s policy encouraging the development of ALS services throughout the state. Furthermore, since the City’s PSA will no longer overlap that of other ambulance services, dispatch priority within the City’s PSA will necessarily be given to the City’s ambulance service.
20. Approving the City’s application will reduce mortality and morbidity because City personnel will be authorized to provide a greater variety of health care interventions. This will benefit the public health status of the population living within the City’s PSA or visiting there. Advanced life support services are able to provide a higher level of pre-hospital care. This is especially important for persons living in rural areas where maximum response times, like the City’s, can take up to 20 minutes. Also, the City’s paramedics can provide more sophisticated medical therapies and early recognition and interpretation of cardiac arrhythmias.
21. The benefits accruing to the public health will outweigh the costs associated with the higher level of ambulance services the City will be authorized to provide if its license application is approved. The proposed BLS service fees will be approximately $350.00. This is lower than most BLS fees charged by other ambulance services within the state which have a base rate ranging from $350 to $450.
22. The City has the personnel and equipment needed to provide ALS services.
Based upon the foregoing Findings of Fact, the Administrative Law Judge makes the following:
CONCLUSIONS
1. The Administrative Law Judge has authority to consider the license application filed by the City of Red Wing under Minn. Stat. § 144.802, subd. 3 (1996).
2. Proper and timely notice of the hearing and of the issues involved in this proceeding were given by the Board and this matter is, therefore, properly before the Administrative Law Judge.
3. The Board and the City have complied with all relevant substantive and procedural requirements of statute and rule.
4. Pursuant to Minn. R. 1400.7300, subp. 5 (1995) the Applicant has the burden of proof in this proceeding to establish, by a preponderance of the evidence, that its license application should be approved.
5. The Applicant has established that approval of its license is needed and will not have a deleterious effect on the public health. Matter of Rochester Ambulance Service, 500 N.W.2d 495, 498-99 (Minn. Ct. App. 1993).
6. Under Minn. Stat. § 144.802, subd. 3(h) the Administrative Law Judge must consider the following factors in determining whether the City’s license application should be approved:
(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 of health under section 145A.12, subdivision 4;
(2) the recommendations or comments of the governing bodies of the counties, municipalities, and regional emergency medical services system designated under section 144.8093 in which the service would be provided;
(3) the deleterious effects on the public health from duplication, if any, of ambulance 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.
7. The City has shown that its licensure is consistent with the local community health plan; that granting the license will enhance the public health to residents and visitors in the primary service area; that there will be no duplication of ambulance services or unnecessary and harmful competition within the Applicant’s proposed primary service area; that the benefits accruing to the public health of citizens in Goodhue County served by the City outweigh the costs associated with the proposed upgrading of the City’s license to an ALS level.
8. ALS ambulance service is needed in the Applicant’s proposed PSA in order to maximize the public health and reduce mortality and morbidity.
Based upon the foregoing Conclusions, the Administrative Law Judge makes the following:
ORDER
IT IS HEREBY ORDERED: That the City’s application for a license to provide advanced life support ambulance services be and it is hereby GRANTED upon the Board’s approval of changes in the primary service agreed to by the City and the Zumbrota Area Ambulance Service.
Dated this 14th day of July, 1997.
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JON L. LUNDE |
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Administrative Law Judge |
Reported: Taped (1 Tape)