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Health Services Department recommending the Board take action to designate County Service Area 7 an exclusive operating area, "grandfather" the County as the provider of ambulance transport services under Health and Safety Code section 1797.224, and identify which service components are included in the exclusivity designation. (Refer 7/19/11, File 11-0785, Item 43) (Est. Time: 30 min.)
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Background: On July 19, 2011, the Health Services Department reviewed the structure of ambulance transport services in County Service Area (CSA) #7 with the County of El Dorado Board of Supervisors. The presentation included the history of ambulance services in CSA #7, background on exclusive operating areas, and options for the Board's consideration pertaining to future ambulance transport service system design in CSA #7.
Following Board discussion and input from the public, the Board voted unanimously to have the Department return on August 16, 2011 with an action item to create an exclusive operating area (EOA) for CSA #7, and to include recommendations on what components would be included within the EOA.
Subsequent to the July 19, 2011 Board meeting, the Department met with representatives from Marshall Medical Center (MMC) and Gold Country Retirement Community to discuss each of their respective facility's needs in terms of establishing an EOA for inter-facility transport services on the Western Slope of the County. Representatives from MMC expressed concern with the cost of inter-facility transports to within-County and out-of-County destinations. Both MMC and Gold Country require these inter-facility transports on a frequent basis. With the assistance of the consultant from the Polaris Group, we continued to meet and discuss the needs of these important partners to ensure that the EMS system design provides response time reliability, clinical competence and is financially cost-effective for the County's contractor as well as those served by the system.
The provision of Health and Safety Code section 1797.224 that allows the County to "grandfather" a provider requires that the provider has been providing continuous service without interruption since January 1, 1981, in the same manner and scope as the services to be provided under the EMS Plan. The Health Services Department recommends that the Board include both 911 and within-County inter-facility transports (i.e., those transfers that begin and end in the County of El Dorado) as exclusive services since these are the services currently provided by the County through its contractor.
Inter-facility transports that do not begin and end in the County (e.g. transfers of patients originating in County facilities to out-of-County facilities; transports through the county, and transfers originating out-of-County to a facility in-County) will not be included within the EOA. However, it is important to note that under the EMS Act, the County is responsible for regulation and oversight of all EMS services originating in the County. Currently, Section 8.74.050 of the County's Ambulance Ordinance states that "Emergency and non-emergency services (ambulances) subject to this ordinance will be governed by a contract with the County to provide ambulance services within the primary response areas." Since inter-facility transports originating within the County but not included within the EOA are not covered by the ordinance, the Department recommends the establishment of a permit process for non-contracted ambulance companies that run calls originating in the County, but terminating elsewhere. This is necessary for the County to assure that ambulance companies whose calls originate in the County have appropriate insurance, record keeping practices, training, equipment, staffing standards, a quality improvement process and a 24/7 contact person if problems are encountered. These ambulance companies will also need to agree to participate in disaster and mutual aid efforts.
The Department believes that establishing CSA #7 as an EOA, designating 911 and within-County inter-facility transport services as exclusive services, and instituting a permit process for ambulance companies that transfer patients originating in County facilities to out-of-County facilities, is the best system design to ensure the continuation of an organized and efficient EMS response system in CSA #7. It is also the most cost-effective model for serving both the populated and the rural areas of CSA #7.
Recommendation: To create the EOA, staff recommends that the Board take action to designate CSA #7 as an exclusive operating area and to grandfather the County as the provider of ambulance services for 911 and within-County inter-facility transfers.
Action to be taken by the Department:
The Department will take the following steps to complete the process:
1. Update the EMS Plan to reflect the Board's decision to establish CSA #7 as an EOA and provide information on the transport components that are included under exclusivity.
2. Update the current Ambulance Ordinance to reflect changes that have occurred in the EMS system over the past 10 years, including the establishment of CSA #7 as an EOA and requiring permits for ambulance companies that transfer patients originating in El Dorado County to out-of-County facilities.
3. Amend the current contract with the El Dorado County Emergency Services Authority (JPA) to reflect the establishment of the EOA and define the transport components the JPA will need to provide.
4. Return to the Board with the Amended EMS Plan, Amended Ambulance Ordinance, and the Amended JPA contract for Board approval.
Contact: Kathy Lang
Concurrences: County Counsel