Regulators grant limited ambulance license to Children's Minnesota

A regulatory board voted Friday to give Children's Minnesota a license to transfer patients between its hospitals with two new quad-cab ambulances but opted against licensure that designates a statewide service area for the rigs.

At the conclusion of a Friday hearing, the chairman of the state's Emergency Medical Services Regulatory Board said the license would allow Children's to continue operating the new ambulances as it's been doing for the past several months, including across the state under restrictions established in "primary service area" rules.

But Children's said it would review its options in the wake of the Friday decision, which can be appealed to the Minnesota Court of Appeals. Last month, an administrative law judge recommended that the EMS board grant Children's a statewide license due to concerns that local ambulance services might otherwise block Children's from performing runs deemed necessary by doctors.

"In reference to the geographic restrictions, we made a pretty good case with the [judge] … why we felt that it was not adequate," said Dr. David Hirschman, medical director of the critical-care transport program at Children's Minnesota, in an interview. The license approved on Friday "imposes a potential intrusion of the medical decisionmaking," Hirschman said.

Currently in Minnesota, the license for ground ambulance services specifies the care it can provide within a geographic area. The license effectively reserves for the ambulance service 911 call response plus patient transfers from hospitals in the service area unless that service or a physician wants an outside ambulance due to special patient needs.

Children's doesn't want to answer 911 calls, but sought a license with a statewide service area. Critics argued the statewide service would deprive local EMS providers of interfacility runs that generate critical revenue.

The vote Friday came at the conclusion of a five-hour hearing in Brooklyn Park and will be codified with an order and findings from the board expected by mid-January.

Children's said it planned only limited operations, and Ebeling said he believed that that's the goal of the current administration. But hospital administrations change, Ebeling said, plus the board's decision would be "precedent setting" for other services that might subsequently seek a statewide license — ultimately dooming the primary service area rules that have been credited with protecting rural EMS providers.

"Once they would have a statewide [primary service area], they could put ambulances anywhere and do transfers," Ebeling said. "If you don't have the group that can respond to the 911 calls, especially in the rural areas, you have problems."

During the hearing, Gregory Merz, an attorney representing Children's, said critics had doubled down on extreme rhetoric in response to the administrative law judge's advisory opinion that supported Children's. Merz said the judge's ruling should provide a clear road map for the board.

"The objectors are acting, I think understandably, out of a desire to protect their turf," Merz told the board. "The idea that you're going to be setting precedent here is a complete red herring."

In 2016, Children's purchased two quad-cab ambulances at an overall cost of $1.3 million including the expense for onboard technology. Merz told board members that the quality of the service "is something that children in other states have, that children in Minnesota don't have."

"When Children's says in its application that there's a gap in service … that there's something that needs to be rectified, that's wrong," Dan Falknor, an attorney representing the Mayo Clinic, told the board before the vote.