Pass a law allowing private EMS to operate in all jurisdictions duly licensed.

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Many cities, counties and other jurisdictions of the State of Texas have extremely restrictive regulations against private EMS agencies in the State of Texas. While the purpose of some local jurisdictions is to provide reasonable regulations in addition to the Department of State Health Services, many are over-bearing, burdensome and exclude the rights of agencies to practice in their jurisdiction altogether. These types of exclusions limit the rights of Texans to choose their EMS healthcare provider, causes delays of care and creates a monopoly that drives down the quality and efficiency of care by limiting, or eliminating, competition.

Below is a letter sent to State Representative Cecil Bell, Jr. Representative Bell is currently assisting in a proposed bill restricting the ability of local jurisdictions from prohibiting private EMS agencies from providing services across the State, if they are duly licensed and abiding by regulations set forth by those same jurisdictions. 


Letter to Representative Bell:

     I am writing this email to request that your office draft a proposed bill. As we spoke about last month, I have noted an issue that many of my colleagues and I find concerning regarding EMS regulation in the State of Texas. Currently, EMS is regulated by the Texas Department of State Health Services. As such, all EMS agencies, whether privately or publicly owned, must pay the appropriate fees and abide by all laws set forth by the State of Texas to remain a licensed provider. The Department of State Health Services then regulates all EMS agencies during the period of their license with surprise inspections and audits, while requiring a necessary paper trail of documents to notify the State of any accidents, changes in operations, changes in the company, etc... 

     Understandably, Cities and County Commissioners around the State of Texas have concern regarding the regulations of ambulances. By the laws and Government Code of the State of Texas, these Cities and County Commissioners are granted the authority to further regulate EMS agencies doing business within their jurisdiction. While many Cities offer nominal fee schedules and requirements that meet, or only slightly exceed, the expectations set forth by the Department of State Health Services, some entities have practices that are far more stringent and invasive than the intention of the laws in Texas. As such, some entities have began to practice exclusion of certain private EMS agencies from doing business in their cities. These exclusions are often carried out by way of exclusive bidding processes, a lack of application for licensure or certification within the City, or denials of applications based on the city or counties belief that a specified number of providers is sufficient and that no more than an allotted number of agencies should be allowed to exist. The agencies allowed to do business in these jurisdictions are afforded all of the business, while every other ambulance provider in the State is excluded. 

     Recently, in Austin, a company was denied a "franchise license" to do business within Austin/Travis County because they would "be a threat to the market for EMS and could cause the three other allowed private agencies to suffer with regards to the amount of business available within the City".  It could be reasonably perceived that a private business was denied the opportunity to participate in a free market, because the City wants to protect other private entities doing business within their jurisdiction. Of course, the concern was noted that a disruption in the market could cause all private agencies to lose business and exit the market in that region, leaving citizens with no choice in providers, something we have not seen in other markets.


     Why is this bill important? Our society is built on the idea that a free market creates competition and leads to lower prices and better service. In some of these markets, prices are already controlled. However, certain jurisdictions have limited these private EMS contracts to only one private EMS provider. As a citizen, or someone with family that is a citizen in one of these jurisdictions, we are declining all rights of choosing which EMS agency we want to be transferred by. This takes the choice of who to give our money to, away. Furthermore, Fire and EMS agencies across the State rely on mutual aid agreements with other agencies to successfully provide coverage to 100% of their calls. No EMS system is capable of taking 100% of their calls in a timely manner, meaning more agencies being available can equal faster and better service. Without a choice in providers, we have acutely ill patients waiting hours for transport, even during major events such as heart attacks and strokes. As a State that prides itself on Regional Advisory Councils and other committees put in place to improve patient care, we are not giving our citizens access to the best care available. It should be noted that private EMS agencies are not a threat to 911 providers, generally. The type of calls taken by private EMS agencies are many times a niche market, not usually handled by the local 911 agency. In many cases, private EMS agencies are just as well stocked and protocolled as local 911 services. Additionally, the State licenses for these companies, and their providers, are the exact same license issued to all EMS personnel in the State. Many private EMS agencies employ 911 Firefighters and EMS personnel that are simply off duty from their 911 job.


     This is why I write you today, requesting a proposed bill that will restrict the rights of Cities, Counties and other local regional authorities to exclude EMS agencies from doing business within their jurisdiction, so long as they are a duly licensed EMS provider in The State of Texas and fall within reasonable guidelines of the jurisdiction which they wish to practice. Should you or your staff require any further explanation of this idea, I would love to meet with y'all any time. I can make myself available to help answer any questions, or clarify any points made in this request. Upon your request, I can also provide additional evidence of the practices mentioned and the relevance of such a law. I will also be providing you with a list of petition signatures and the support of associations, emergency rooms, hospitals, providers and cities across our State. I appreciate your time.

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