February 18, 1999
ASSIGNING AND REVOKING AMBULANCE SERVICE AREAS
By: Matt Ranelli, Associate Attorney
You asked if the Department of Public Health (DPH) can revoke assigned service areas for emergency medical service (EMS) providers.
DPH regulations establish two methods of revoking or taking-away assigned EMS service areas. The department may revoke an assigned service area from one provider and assign it to another if (1) the department, after investigation, determines that it is in the best interest of the affected town or towns to do so or (2) a local chief elected official petitions the department to do so and can demonstrate that an emergency situation exists.
PRIMARY SERVICE AREAS
The state's emergency medical service delivery system coordinates emergency services to minimize the time between the occurrence of a sudden injury or illness and the delivery of care at the scene. It establishes three tiers of care in order of increasing life-saving skills (i.e. first responder, basic ambulance, advanced life support) and assigns geographic areas, called primary service areas (PSAs), to specific EMS providers for each tier of service available in that area. PSAs may cover all or portions of several towns (Ct. Regs. ∋ 19a-179-1).
Every EMS service must be available to respond to emergency calls in its PSA 24 hours a day, seven days a week, or must arrange with other certified or licensed response services to cover its PSA during non-operational hours with no reduction in level of service (Ct. Regs. § 19a-179-11). Every Connecticut town is part of a PSA for first responder and basic ambulance service and most have either a paramedic or paramedic intercept service.
DPH assigns PSAs at each service level. It must assign a PSA basic for every town in the state. DPH must consider the following factors before assigning a PSA to a provider:
1. size of population to be served,
2. effect of proposed PSA assignment on other emergency medical service providers in the area,
3. geographic locations of the proposed PSA provider,
4. the proposed PSA's record of response time,
5. the proposed PSA's record of activation time,
6. the proposed PSA's level of licensure or certification, and
7. other factors which DPH determines are relevant to providing efficient and effective emergency medical services to the population.
DPH must also seek the advice and recommendations of the appropriate regional council and the chief administrative official of the affected town.
According to Warren Wollschlager, chief of DPH regulatory services, the department does not require PSAs to be renewed; the assignments are indefinite unless revoked. DPH regulations allow the department to revoke or take away a PSA under two circumstances:
1. DPH determines (on its own initiative or by request) that it is in the best interests of patient care in the PSA to do so (Ct. Regs. ∋19a-179-4(d)) or
2. a local chief administrative official petitions DPH in writing to take away the PSA assignment and can demonstrate that the provider's performance has created an emergency that jeopardizes the safety, health and welfare of the citizens of the affected area (Ct. Reg. ∋ 19a-179-4(e)).
A possible third way to remove a provider from a PSA is to reject its license renewal application or otherwise suspend or revoke its license. By law, providers must renew their licenses annually (CGS ∋ 19a-180). The statutes and the regulations do not specifically provide for the effect of denying a license renewal on the PSA assignment, except that PSA-providers must have a DPH license. It appears that a provider whose license is revoked would be disqualified from holding a PSA. The drawback of this alternative is that it could be lengthy. By law, providers must have opportunity to show compliance and may appeal the decision (CGS ∋ 19a-181a and Ct. Regs. ∋ 19a-179-15). In addition, this alternative may be impractical in some instances because it would prevent the provider from serving its other PSAs.