Tuesday, March 8, 2005 • Closest ambulance must respond regardless of patient’s membership in Life Support Association

Publisher’s note: This story originally appeared in the Tuesday, March 8, 2005 edition of the Lassen County Times.

The closest ambulance will respond to emergency medical calls, even if the patient requests service from a subscription program guaranteeing no out-of-pocket costs.

Nor-Cal EMS, the agency responsible for regulating ambulance service in Lassen County, developed the policy requiring the closest ambulance to respond after a question from a reporter at this newspaper. Nor-Cal CEO Dan Spiess said the agency was not concerned about how patients on fixed incomes would pay their bills for ambulance service.

In response to two phone calls from members of the public, a reporter asked whether South Lassen Ambulance could send an ambulance to Susanville if a member of its Life Support Association subscription program requested service.

“The inquiry prompted follow-up calls and resulted in the need to issue an interim clarifying policy,” according to a memo Spiess sent to the Lassen County Board of Supervisors. “The response to the reporter was that patient care was the primary issue.”

Since South Lassen provides ambulance service in Janesville and Westwood and REMSA provides service in Susanville, Spiess wrote, if South Lassen responded to Susanville “a delay in care and transport would result” because the ambulance would probably be coming from Janesville.

At the same time, Janesville would be without immediate ambulance coverage, according to the memo.

The memo said Nor-Cal officials spoke with the manager of South Lassen, who said subscriber calls from Susanville are given to the closest ambulance.

“The manager informed us that on only one occasion has South Lassen Ambulance responded to a subscriber request in Susanville,” the memo said, “and that was when South Lassen happened to have a second vehicle staffed and at that particular time, happened to be located in Susanville.”

The memo said South Lassen’s policy of giving the call to the closest ambulance “serves the best interest of the emergency patient and needs to continue.”

Supervisor Jim Chapman said the memo addresses a question he raised in December.

“I think it is an issue of great interest to local residents who have paid their subscription with the ambulance company,” Chapman said at the board’s Feb. 22 meeting. “As I told several who asked me about it, maybe the people that took the money can give it back if they’re not able to provide the service.”

However, Chapman said he was concerned about the process Nor-Cal EMS used to issue the policy.

“For them to take this action on this particular issue two months after we had the discussion in this room and they had an opportunity to weigh in on it then I just found was really amazing,” he said. “It’s like the left hand’s not talking to the right hand.”

He said Nor-Cal should not have issued the policy because it gives the ambulance providers   exclusive operating areas.

“This action on their part basically declares a de facto exclusive operating area for these various operators,” Chapman said, adding he wondered what Nor-Cal was up to, “especially operating without any communication to us until after the fact.”

He said the board should ask Nor-Cal to consult with it before issuing policies about which the public will complain to the board.

The memo said Lassen Ambulance, South Lassen and Mountain Lifeflight maintained a joint subscription service providing patients with ground and air transportation for an annual fee. The companies then accepted whatever the patient’s insurance paid for ambulance transportation and patients had no out-of-pocket costs.

Lassen Ambulance, which provided service in the Susanville area, went out of business in December. A declaration of emergency allowed the board to contract with REMSA out of Reno for ambulance service in the Susanville area.  The board is currently in the process of selecting a company which will have an exclusive operating area covering most of the county.

Nor-Cal’s interim policy requires the closest ambulance to respond to calls for service, even if the call originates through a seven-digit phone number.

“Unless requested for mutual aid, REMSA’s response area is the Susanville zone only,” it said. “Unless requested for mutual aid, South Lassen’s response areas are the Westwood and Janesville zones only. All subscription calls in the Susanville area are to be reported to Nor-Cal EMS on a patient care report form within 24 hours of the response.”