COUNTY OF SAN BERNARDINO v. Apple Valley Fire Protection District, et al., Interveners and Respondents.

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Court of Appeal, Fourth District, Division 2, California.

COUNTY OF SAN BERNARDINO, et al., Plaintiffs and Appellants. v. CITY OF SAN BERNARDINO, Defendant and Respondent; Courtesy Services of San Bernardino, Inc. et al., Interveners and Appellants; Apple Valley Fire Protection District, et al., Interveners and Respondents.

No. E012673.

Decided: October 17, 1995

Alan K. Marks, County Counsel, and Alan L. Green, Deputy County Counsel, for plaintiffs and appellants. Richards, Watson & Gershon, Harry L. Gershon, Steven H. Kaufmann, Los Angeles, Daniel E. Lungren, Attorney General, Charlton G. Holland, III, Senior Assistant Attorney General, Dennis Eckhart and Michael V. Hammang, Deputy Attorneys General, for interveners and appellants. Hanson, Bridgett, Marcus, Vlahos & Rudy, Craig J. Cannizzo and Robert L. Rusky, San Francisco, as amici curiae on behalf of appellants. James F. Penman, City Attorney, and Robert L. Simmons, Senior Deputy City Attorney, for defendant and respondent. Stream & Stream, Kenneth B. Stream, Theodore K. Stream, Theresa Han Savage, Riverside, Rutan & Tucker, Elizabeth Hanna Dixon, Matthew K. Ross and Scott R. Santagata, Costa Mesa, for interveners and respondents. Kronick, Moskovitz, Tiedemann & Girard and Ruthann G. Ziegler, Sacramento, as amici curiae on behalf of interveners and respondents.

This case requires us to interpret the Emergency Medical Services System and the Prehospital Emergency Medical Care Personnel Act.  (Health & Saf. Code, § 1797 et seq.1  Herein, the “EMS Act.”)

The parties view the EMS Act from very different perspectives.   The plaintiffs, County of San Bernardino (herein “County”) and the Inland Counties Emergency Medical Agency (herein “ICEMA”), together with plaintiffs in intervention Courtesy Services of San Bernardino (herein “Courtesy”) and the California Emergency Medical Services Authority (herein “Authority”), view the EMS Act as preempting the field of prehospital emergency medical services regulation by delegating the control of local emergency medical services systems to the County or its local emergency services systems agency, ICEMA.

Amicus California Ambulance Association agrees with plaintiffs that the County has the exclusive authority under the EMS Act to regulate the provision of all prehospital emergency medical services in the County, including emergency ambulance services.

Defendants, the City of San Bernardino (herein, “City”) together with defendant intervenors Apple Valley Fire Protection District, Barstow Fire Protection District, Chino Valley Independent Fire District, City of Victorville and City of Rialto, rely on section 1797.201 of the EMS Act as an affirmation of their historic right to provide prehospital emergency medical services to their respective cities and districts.   They thus argue that County administration is limited to areas in which they do not provide services.   While acknowledging they are subject to the medical control provisions of the EMS Act, they argue that they retain the right to administer the provision of prehospital emergency medical services within their respective geographic jurisdictions.

Amici, California Fire Chiefs Association, et al.,2 agree with defendants that the EMS Act does not preempt the field of provision of prehospital emergency medical services, and that section 1797.201 authorizes certain cities and fire districts to continue to provide prehospital emergency medical services within their boundaries.

The trial court agreed with the City and defendants in intervention and granted their motion for summary judgment.   The trial court specifically agreed with the City's interpretation of section 1797.201 and found that the County's jurisdiction over the City is limited to medical control, as specified in section 1798, et seq.   The trial court also found that, since the City retains management and control over prehospital emergency medical services within its boundaries, the County has no authority to dispatch, regulate or authorize providers to operate within the City.

We agree with the trial court and affirm this portion of the judgment.

The trial court also held that section 1797.201 grandfathers certain cities and fire districts by authorizing them to continue to provide services at not less than the levels existing at the time of enactment of the EMS Act.   However, it found that, if a city or fire district wants to contract for services in excess of existing levels, it may only do so by agreement with the County agency.   This latter finding is the subject of the City's cross-appeal.

We agree with the City that this latter finding is improper and we order the judgment modified to strike it.

THE EMS ACT

The EMS Act is found in Division 2.5 of the code at section 1797 et seq.   Five of its eleven chapters are relevant to the issues presented here.   These are the chapters containing general provisions and definitions, and the chapters on state administration, local administration, and medical control.

The state administration chapter establishes the Emergency Medical Services Authority in the Health and Welfare Agency.  (§ 1797.100.)   The Authority is responsible for the coordination and integration of all state activities concerning emergency medical services.  (§ 1797.1.)  “The authority, utilizing regional and local information, shall assess each EMS area or the system's service area for the purpose of determining the need for additional emergency medical services, coordination of emergency medical services, and the effectiveness of emergency medical services.”  (§ 1797.102.)   It also develops guidelines for emergency medical services systems (§ 1797.103) and provides technical assistance to “existing agencies, counties and cities for the purpose of developing the components of emergency medical services systems.”  (§ 1797.104.)   It also reviews the plans of local agencies for the implementation of emergency medical services and trauma care systems.  (§ 1797.105.)   A large part of the technical assistance provided by the Authority consists of setting standards for the training of emergency care providers.3  (§ 1797.160 et seq.;   §  1797.208.)

Pursuant to the statute, the Authority has promulgated detailed regulations for training and certification of emergency medical technicians and paramedics, as well as hospital trauma care systems.  (22 Cal.Code Regs., Div. 9.)

The local administration chapter is the chapter primarily at issue here.   It provides that counties may develop an emergency medical services program.  (§ 1797.200.)   If a county elects to develop such a program, it designates a local EMS agency, including a joint powers agency “created for the administration of emergency medical services by agreement between counties or cities and counties․”  (§ 1797.200, emphasis added.)

The County has elected to participate in the emergency medical services program and has delegated a portion of its authority to plaintiff ICEMA, an entity formed under a joint powers agreement between San Bernardino, Inyo and Mono counties.4

The balance of the local administration chapter sets forth the powers and duties of the local EMS agency.   These include the planning, implementation and evaluation of an emergency medical services system (§ 1797.204), the certification of emergency medical personnel (§§ 1797.208–1797.218), and medical control of the EMS system (§ 1797.220).

In particular, section 1797.204 provides that “[t]he local EMS agency shall plan, implement, and evaluate an emergency medical services system, in accordance with the provisions of this part, consisting of an organized pattern of readiness and response services based on public and private agreements and operational procedures.”  (Emphasis added.)

The local administration chapter also provides for the creation of exclusive operating areas for the providers of emergency medical system services.   No competitive selection process is needed “if the local EMS agency develops or implements a local plan that continues the use of existing providers operating within a local EMS area in the manner and scope in which the services have been provided without interruption since January 1, 1981.”   (§ 1797.224.)   This power to create exclusive operating areas for service providers in section 1797.224 is expressly subject to the provisions of section 1797.201, the statute relied on by defendants in this case.

Section 1797.201 provides:  “Upon the request of a city or fire district that contracted for or provided, as of June 1, 1980, prehospital emergency medical services, a county shall enter into a written agreement with the city or fire district regarding the provision of prehospital emergency medical services for that city or fire district.   Until such time that an agreement is reached, prehospital emergency medical services shall be continued at not less than the existing level, and the administration of prehospital EMS by cities and fire districts presently providing such services shall be retained by those cities and fire districts, except the level of prehospital EMS may be reduced where the city council, or the governing body of a fire district, pursuant to a public hearing, determines that the reduction is necessary.  [¶] Notwithstanding any provision of this section, the provisions of Chapter 5 (commencing with Section 1798) shall apply.”

It is undisputed that defendants here (1) provided prehospital emergency medical services on June 1, 1980;  and (2) have not requested or entered into any written agreements with the County regarding the provision of such services.

Defendants therefore contend they are grandfathered under section 1797.201 into the emergency medical services system, and may continue to provide prehospital emergency medical services within their territorial jurisdictions, subject only to the provisions for medical control of the services provided.   (§ 1798 et seq.)

Although section 1797.201 is expressly made subject to the chapter on medical control (§ 1798 et seq.), the scope of the term “medical control” is also an issue in this case.

Section 1798, subdivisions (a) and (b) states:  “(a) The medical direction and management of an emergency medical services system shall be under the medical control of the medical director of the local EMS agency.   This medical control shall be maintained in accordance with standards for medical control established by the [state] authority.  [¶] (b) Medical control shall be within an EMS system which complies with the minimum standards adopted by the authority, and which is established and implemented by the local EMS agency.”

As discussed below, section 1797.201 allows a city or fire district which provided prehospital emergency medical services prior to June 1, 1980, to continue to administer such services.   The scope of the term “administration” is also at issue here.

The primary issue in this case, therefore, is the proper meaning and interpretation of section 1797.201, and, specifically, whether cities and fire districts have the authority to control the provision of prehospital emergency medical services within their territorial jurisdictions.

PREEMPTION

 The County and the Authority contend that the EMS Act preempts the field of prehospital emergency medical services regulation, citing sections 1797.1, 1797.2 and 1797.5.

Section 1797.1 declares that the intent of the EMS Act is to “provide the state with a statewide system for emergency medical services” by establishing the Authority.   However, the Authority is not given the power to administer such a system.   Instead, its role is to set standards, particularly standards for certification and training of emergency medical services personnel.   Thus, the only way in which the Legislature intended to establish a statewide system was to create the Authority, with limited powers to coordinate and integrate all state activities concerning emergency medical services.  (§ 1797.1.)   There is no suggestion that the Legislature intended the State to itself provide or mandate others to provide certain services.

Section 1797.2 declares that the intent of the Legislature is to “maintain and promote the development of EMT–P paramedic programs where appropriate throughout the state․”  This section is again concerned with certification and training programs for emergency medical services personnel.   The Legislature found that differing local training and certification standards were impeding the movement of personnel between jurisdictions, and that all emergency services personnel should have the same training and qualifications.  (§ 1797.7.)   Thus a person designated as a paramedic has the same qualifications and training as other paramedics, even though one may be employed by a city fire department and other paramedics may be employed by private ambulance companies or other emergency care providers.

Section 1797.5 states the Legislative intent to “promote the development, accessibility, and provision of emergency medical services to the people of the State of California.”   Neither this general statement, or any of the other legislative intent sections, declare an intent to preempt the field of prehospital emergency medical services regulation by excluding the historic providers of such services, the cities and fire districts, from further participation in the system.   Instead, the EMS Act imposes a structure, consisting of the Authority, the County and the county emergency services agency, on the existing public and providers of emergency medical services.   The structure consists primarily of standards for training and certification of personnel and the provisions for uniform medical control of services.

In addition, as the City points out, section 1797.6, was specifically enacted to give state action immunity under the antitrust laws to local government agencies “for activities undertaken by local governmental entities in carrying out their prescribed functions under this division.”   The City argues that this section demonstrates that the Legislature recognized that local government entities do have functions under the EMS Act, and that those functions are not totally preempted by the EMS Act.   We agree.

We therefore find nothing in the declarations of legislative intent to support the argument that the EMS Act preempts the field of prehospital emergency medical services.

The County and the Authority also argue that the provision of prehospital emergency medical services is a matter of statewide concern.

While we agree that the regulation of prehospital emergency medical services is a matter of statewide concern (Northern Cal. Psychiatric Society v. City of Berkeley (1986) 178 Cal.App.3d 90, 108, 223 Cal.Rptr. 609), subject to state legislative authority, we find that the Legislature has not taken over the field by providing such services itself, at state expense, nor has it mandated that the counties take over and control all aspects of prehospital emergency medical services, at County expense.

First of all, the system is voluntary.   Under section 1797.200, counties may elect to develop an emergency medical services program, but they are not required to do so.   Section 1797.200 provides that the program is to be carried out by agreements between counties or cities and counties pursuant to the joint powers provisions of the Government Code.   (Gov.Code, § 6500 et seq.)   As the Authority notes, if section 1797.200 had been made mandatory, it is at least arguable that a state mandated program would have been created which would require the state to fund it.   If the Legislature had intended to occupy the field and create a single statewide prehospital emergency medical services system, it would not have made county participation in the system optional.

Secondly, the concept of “statewide concern” is different from preemption.   “In those cases where the preliminary conditions are satisfied, that is, where the matter implicates a ‘municipal affair’ and poses a genuine conflict with state law, the question of statewide concern is the bedrock inquiry through which the conflict between state and local interests is adjusted․  [¶] The phrase ‘statewide concern’ is thus nothing more than a conceptual formula employed in aid of the judicial mediation of jurisdictional disputes between charter cities and the Legislature․”  (California Fed. Savings & Loan Assn. v. City of Los Angeles (1991) 54 Cal.3d 1, 17, 283 Cal.Rptr. 569, 812 P.2d 916.)

Here, even though the matter of prehospital emergency medical services is a matter of statewide concern, there is no local ordinance to be preempted by the application of state law.   Only the interpretation of state statutes is involved, and thus there is no conflict between state and local law to be resolved by application of the preemption doctrine.  (Northern Cal. Psychiatric Society v. City of Berkeley, supra, 178 Cal.App.3d 90, 106–108, 223 Cal.Rptr. 609.)

Thirdly, as discussed below, section 1797.201 preserves some role for the cities and fire districts within the emergency medical services system.   The issue here is the nature and scope of that role.   The Authority concedes that one purpose of the EMS Act “was to bring structure to a disorganized, but existing, collection of both public and private EMS providers․”  The role of the Authority under the EMS Act is thus a coordinating and standard setting role.  (§ 1797.1.)   In fact, the Authority is specifically required to give technical assistance to “existing agencies, counties, and cities for the purpose of developing the components of emergency medical services systems.”   (§ 1797.104.)   This section would have no meaning if cities were not part of the emergency medical services system.   Similarly, the Legislature has strongly stated its intent that local fire districts be responsible for emergency medical services and ambulance services by subsequently enacting section 13801, part of the Fire Protection District Law of 1987.

While we agree with the County that its authority is defined on a countywide basis by the provisions defining an “EMS area” (§§ 1797.74, 1797.78), the fact remains that the County's emergency medical services system consists of “an organized pattern of readiness and response services based on public and private agreements and operational procedures.”  (§ 1797.204.)   Except for medical control and personnel certification standards, the authority of the County/ICEMA over the cities and fire districts in the County thus depends upon consent of the governed.

Counties and local emergency medical services agencies were not mandated to take over the existing local providers, public or private.   Thus the Legislature did not preempt the field of prehospital emergency medical services.

FACTS AND PROCEDURAL HISTORY

In 1975, the San Bernardino City Council rejected a request from Courtesy to provide a paramedic program for the City and decided that the City fire department would provide paramedic services in the City.   Nevertheless, Courtesy staffed its ambulances with paramedics and has continued to be the exclusive provider of ambulance transport services in the City.

The EMS Act was enacted in 1980, ICEMA was re-formed in 1984 and 1988, and the County's emergency medical services plan (“EMS Plan”) was adopted in 1985.   (Stats.1980, ch. 1260, § 7.)   Courtesy asserts that, under the EMS Plan, it was designated as the exclusive provider of emergency medical system services in the City.5

In 1988, the County adopted a detailed ordinance requiring a permit for the operation of ambulance services in the unincorporated areas of the County.   The ordinance also contemplates the issuance of permits for operations in exclusive operating areas of the County, including the exclusive operating area comprising the City of San Bernardino.  (See County of Sacramento v. American River Fire Protection Dist. (Sacramento Sup.Ct. No. 535767, discussed at fn. 13, post.)

The current controversy began in August 1991.   At that time, both Courtesy and the City's fire department were providing paramedic services to ill or injured persons, and Courtesy was the only provider of ambulance transportation services in the City.6

In their first amended complaint filed April 2, 1992, plaintiffs County and ICEMA sought declaratory and injunctive relief.   The County alleged that (1) it has the sole power and authority under the EMS Act to adopt local regulations and ordinances pertaining to emergency medical services within the County;  (2) the EMS Act preempts the regulation of emergency medical services by any local entities, such as defendant City of San Bernardino;  and (3) the City must comply with all County and ICEMA protocols, policies and procedures pertaining to all aspects of emergency medical services.

Specifically, the County alleged that it had promulgated two protocols that the City was refusing to follow.   The first, called the Patient Management Protocol, was issued on November 1, 1991.   It provided that, “in the event that both public and private emergency medical personnel arrive on the scene with the same qualifications, patient management responsibility will rest with the first to arrive.”

The second, called the Dispatch Protocol, concerned the method of dispatching emergency medical vehicles.   The Dispatch Protocol forbids the City's alleged practice of delaying the arrival of ambulances at the scene of medical emergencies.7

The County further alleged that the City was refusing to comply with either protocol, and that it was manipulating its dispatch procedures to assure that paramedics on City fire engines arrived first at the scene of an emergency.8  Courtesy argued that the City was attempting to drive it out of business in San Bernardino, despite its designation by the County as the exclusive provider of ambulance transportation services in the City.

The City responded that the County and ICEMA did not have any “authority to dispatch, regulate or authorize ambulance or other emergency medical care providers to operate within the CITY limits of the CITY OF SAN BERNARDINO.”

ISSUES

As a fire department captain stated in his deposition, “[t]he controversy is over who's in charge of patient care at the scene [of a medical emergency].”   The County agrees that “the action's roots are based upon a power struggle for control of [emergency medical services] at the local level.”

The County contends that the trial court erred in finding that section 1797.201 allows an eligible city or fire district to remain outside the control of the local emergency services agency.

Secondly, the County argues that the trial court improperly and broadly construed the term “administration” in section 1797.201 and narrowly construed the term “medical control” in section 1798 et seq.

Thirdly, the County argues that, even if the local emergency services agency cannot regulate the city or fire district directly because of section 1797.201, the agency may regulate other emergency services providers, such as Courtesy, within the city or fire district, and the city or fire district may not regulate such other providers.

There being no factual issues, the question is whether the City was entitled to summary judgment as a matter of law.  (Code Civ.Proc., § 437c, subd. (c).)  Accordingly, we consider the County's legal arguments in the order stated above.9

SECTION 1797.201

 As noted above, the City defends the action by contending that section 1797.201 preserves its historic role as a provider of prehospital emergency medical services to the community, subject only to the medical control provisions of section 1798 et seq., and the personnel training and certification standards.

The first sentence of section 1797.201 reads:  “Upon the request of a city or fire district that contracted for or provided, as of June 1, 1980, prehospital emergency medical services, a county shall enter into a written agreement with the city or fire district regarding the provision of prehospital emergency medical services for that city or fire district.”

This sentence merely requires a county to enter into a written agreement for the provision of emergency medical services upon request of a city or fire district.  (Cal. Const., art. 11, § 8, subd. (a).)  It thus preserves the right of an eligible city or fire district to cease providing prehospital emergency medical services and to contract with the county to provide such services for the city or fire district.   Contrary to the County's contention, it does not require the city or fire district to request such an agreement within any particular time, or at all.

The second sentence reads:  “Until such time that an agreement is reached, prehospital emergency medical services shall be continued at not less than the existing level, and the administration of prehospital EMS by cities and fire districts presently providing such services shall be retained by those cities and fire districts, except the level of prehospital EMS may be reduced where the city council, or the governing body of a fire district, pursuant to a public hearing, determines that the reduction is necessary.”

This sentence requires a city or fire district to continue to provide prehospital emergency medical services at not less than the existing level until an agreement is reached for the county to provide such services.   If no agreement is requested or reached, the city or fire district that historically provided prehospital emergency medical services may continue to provide and administer such services.   The use of the word “retain” also indicates a continuation of the administration of prehospital emergency medical services by the cities and fire districts that historically provided such services.   The exception merely provides for the possible reduction of service levels when the governing body determines that such a reduction is necessary.

The third sentence reads:  “Notwithstanding any provision of this section the provisions of Chapter 5 (commencing with Section 1798) shall apply.”

This sentence makes it clear that the local emergency services agency has medical control of the entire prehospital emergency services system, including the portions of the system administered by a city or fire district.   The City and fire districts here concede that they are under the medical control of ICEMA, although they disagree with the County as to the meaning of the term.   As discussed below, we find that the County's medical control authority must be found in section 1798 et seq., and that the “notwithstanding” clause prevents reliance on the medical control provisions of section 1797.220 as authority for the protocols issued by the County.

“Where the statute is clear, the ‘plain meaning’ rule applies.   The Legislature is presumed to have meant what it said, and the plain meaning of the language governs.”  (Sutco Construction Co. v. Modesto High School Dist. (1989) 208 Cal.App.3d 1220, 1228, 208 Cal.App.3d 1220, 256 Cal.Rptr. 671;  People v. Hansel (1992) 1 Cal.4th 1211, 1217, 4 Cal.Rptr.2d 888, 824 P.2d 694.)

While we find the plain-meaning rule applicable because section 1797.201 is clear in its terms, we note that the parties have cited a letter from the League of California Cities dated June 2, 1980, to show the legislative intent of the section.   The letter expresses concerns with SB 125, the pending bill to enact the EMS Act.   The letter states the view that “staffing levels of city paramedic programs, the transportation and system organization which we would assume means where paramedics are stationed, how they are dispatched with engine companies and the utilization of their time, whether they are otherwise full-time firemen or not, etc., are fundamentally management decisions of the city fire department and ultimately the city council.   We believe this because city taxpayers are financially supporting this program and city management is responsible for their efficient utilization.   The city council is responsible for the level of service and the cost of the program, wholly unrelated to medical questions.”

The League also opposed “those aspects of SB 125 which remove from cities the authority to establish service levels, types of transportation, location and system organization to the extent that those components of the emergency medical services system are not, strictly speaking, medical questions.   Cities are required to pay for this type of service and to remove the ability to establish service levels according to community needs and the community's ability to pay for them would have the same effect as if the state were to mandate levels of service without providing adequate financial support.”

Shortly after the letter was received by Senator Garamendi, the bill's sponsor, section 1797.201 was inserted into the bill.   Thus, the City argues that the subsequent amendments were clearly a response to the concerns articulated in the letter, and that the section should be interpreted in the light of those concerns.   The City also traces the amendment history of section 1797.201 and concludes that the Legislature intended to allow cities and fire districts to continue to administer all emergency medical services within their geographic boundaries.

City of Petaluma v. County of Sonoma (1993) 12 Cal.App.4th 1239, 15 Cal.Rptr.2d 617, is the only appellate case to interpret section 1797.201.   In that case, the City of Petaluma had historically provided prehospital emergency services to areas outside its municipal borders.   After the EMS Act was passed, the county emergency medical services agency assumed control over the unincorporated areas and authorized a private ambulance service to operate in those areas.   The City of Petaluma objected.

The trial court had found that section 1797.201 was a transitional provision, allowing time for an agreement between the city and county for the transfer or coordination of prehospital emergency service administration and regulation.   It also had found that a city or fire district qualifying under section 1797.201 could only continue to administer prehospital emergency medical services within its city or fire district boundaries, not outside those boundaries.  (City of Petaluma v. County of Sonoma, supra, 12 Cal.App.4th 1239, 1243, 15 Cal.Rptr.2d 617.)

With regard to these findings, the appellate court said:  “The plain meaning of section 1797.201 supports the trial court's findings.   It allows qualified cities to continue providing EMS services and retain administration thereof in the interim between its request for a written agreement with the county and the reaching of such an agreement.   There is no evidence City has ever made such a request.”  (City of Petaluma v. County of Sonoma, supra, 12 Cal.App.4th 1239, 1244, 15 Cal.Rptr.2d 617.)   At oral argument, Courtesy contended that our tentative opinion conflicted with Petaluma because the Petaluma case found section 1797.201 to be merely transitional.   However, a close reading of the Petaluma opinion discloses no such conflict.

In a footnote accompanying the text quoted above, the court made it clear that it was not deciding whether the provision was transitional or not:  “The statute does not say how long a city has to request a written agreement nor what happens if it does not.   The validity of the trial court's finding herein, that ‘a city or fire district qualified to assert Section 1797.201 may indefinitely forbear from executing an agreement with the local EMS Agency,’ is not before this court on appeal.”  (City of Petaluma v. County of Sonoma, supra, 12 Cal.App.4th 1239, 1244, fn. 3, 15 Cal.Rptr.2d 617.)

Thus, a close reading of the opinion does not support Courtesy's position at oral argument that this opinion conflicts with the Petaluma opinion because the Petaluma opinion finds section 1797.201 to be transitional.

The appellate court in Petaluma agreed that section 1797.201 did not allow the City of Petaluma to continue providing exclusive services in the unincorporated areas.   The court found that the City of Petaluma was misinterpreting the term “the existing level” of services in section 1797.201 to refer to historic services provided outside the city's geographical area.   The court interpreted the word “level” to refer “to such matters as the quantity of available staff, vehicles, equipment, etc., and/or to the type and character of available EMS services as constituting basic, advanced, or limited advanced life support ․, not to a particular geographical area in which such services are offered.”  (City of Petaluma v. County of Sonoma, supra, 12 Cal.App.4th 1239, 1245, 15 Cal.Rptr.2d 617.)   This issue is not present in this case.

The court also considered the letter from the League of California Cities quoted above and finds that it “only confirms that cities continuing to provide EMS services under county EMS plans wish to retain control over certain aspects of the program.   The letter does not assert any city's right to be the only EMS provider in any particular geographical area;  it does not mention exclusivity or historical service areas.”  (City of Petaluma v. County of Sonoma, supra, 12 Cal.App.4th 1239, 1245, 15 Cal.Rptr.2d 617.)

We find the plain meaning of section 1797.201 supports the position of the City that the cities and fire districts that provided prehospital emergency services on June 1, 1980, may continue to do so indefinitely, and may expand such services.   Administration of those services is by the city and fire districts because it is the taxpayers in the city and fire districts that must pay to maintain the chosen level of services.   However, the administrative power of the cities and fire districts is subject to the medical control of the County and ICEMA, as discussed below.

We thus agree with the trial court that “[a]bsent a contract pursuant to Health & Safety Code § 1797.201, the County of San Bernardino—ICEMA's jurisdiction over the City of San Bernardino and the intervenors is limited to the provisions of Health and Safety Code § 1798, et seq.”

ADMINISTRATION/MEDICAL CONTROL

The County next contends that the trial court erred in interpreting the term “administration” broadly (§ 1797.201) and in interpreting the term “medical control” (§ 1798 et seq.) narrowly.

1. Medical Control.

Section 1797.90 defines “medical control” to mean “the medical management of the emergency medical services system pursuant to the provisions of Chapter 5 (commencing with Section 1798).”

Section 1798 provides, in relevant part:  “(a) The medical direction and management of an emergency medical services system shall be under the medical control of the medical director of the local EMS agency.   This medical control shall be maintained in accordance with standards for medical control established by the [state] authority.  [¶] (b) Medical control shall be within an EMS system which complies with the minimum standards adopted by the authority, and which is established and implemented by the local EMS agency.”

 More specifically, section 1798.6, subdivision (b), provides that, if the County desires to establish a unified command structure for patient management at the scene of an emergency, it may do so by a committee formed pursuant to a joint powers agreement.   The committee is established by a joint powers agreement and includes representatives of the “public prehospital-care provider agencies serving the county, and public fire, police, and other affected emergency service agencies within the county.”   Thus, if the County wishes to establish a unified command structure, it must do so by agreement with the cities and fire districts, not by fiat.   The County has not followed this procedure here.

This provision is consistent with section 1797.204, which provides that:  “The local EMS agency shall plan, implement, and evaluate an emergency medical services system, in accordance with the provisions of this part, consisting of an organized pattern of readiness and response services based on public and private agreements and operational procedures.”  (Emphasis added.)

Section 1798.6 also answers the question of who is in charge of patient care at the scene of a medical emergency.   Subsection (c) provides that “Notwithstanding subdivision (a), authority for the management of the scene of an emergency shall be vested in the appropriate public safety agency having primary investigative authority.” 10

The regulations of the Authority also provide guidance on the meaning of the term “medical control.”   The regulations concern first-aid training of public safety personnel as well as extensive regulations regarding the certification of emergency medical personnel.  (22 Cal.Code Regs., Div. 9, § 100001 et seq.)

The regulations also provide that a local EMS agency which has implemented or plans to implement a trauma care system must establish policies and procedures to assure compliance with specified minimum standards for trauma care systems.  (22 Cal.Code Regs., § 100254.)   Those policies include policies which address service areas, EMS dispatching, and communication system usage.   (22 Cal.Code Regs., § 100256.)

However, consistent with the Authority's preemption position here, the regulations do not address the integration of cities and fire districts into a trauma care system.   Specifically, they do not require that counties recognize that cities and fire districts that historically provided prehospital emergency medical services are part of the trauma care system unless they agree to have the counties take over emergency medical services by agreement.   The regulations also do not directly address the question of whether dispatching is an administrative or medical-control decision.

2. Section 1797.220 and Related Sections.

 The County specifically argues that section 1797.220 establishes “the parameters under which a local EMS agency exercises the medical control necessary to carry out its regulatory task under Section 1798.”

Section 1797.220 provides:  “The local EMS agency, using state minimum standards, shall establish policies and procedures approved by the medical director of the local EMS agency to assure medical control of the EMS system.   The policies and procedures approved by the medical director may require basic life support emergency medical transportation services to meet any medical control requirements including dispatch, patient destination policies, patient care guidelines, and quality assurance requirements.”  (Emphasis added.)

The City argues that section 1797.220 is inapplicable here because it is not part of the chapter on medical control commencing with section 1798.

We agree.   Section 1797.220 is part of the article dealing with the local emergency medical services agency.   It authorizes the agency to establish policies and procedures to assure medical control of the emergency medical services system.   By its terms, it allows the agency to direct medical transportation providers, such as Courtesy, to comply with medical control requirements, including dispatch requirements.   It does not authorize ICEMA to impose requirements, including dispatch requirements on other service providers, including the City.

In addition, section 1797.220 does not apply to cities and fire districts that qualify under section 1797.201 because section 1797.201 expressly provides that cities and fire districts are subject only to the medical control provisions of section 1798 et seq.

 Some parties also cite section 1797.178 as authority for the proposition that cities and fire districts can only provide prehospital emergency medical services as part of the county's emergency medical services system.   That section provides, in relevant part, that “[n]o person or organization shall provide advanced life support or limited advanced life support unless that person or organization is an authorized part of the emergency medical services system․”

One side contends that cities and fire districts are not “persons or organizations” within the meaning of this section, relying on section 19, Vedder v. County of Imperial (1974) 36 Cal.App.3d 654, 662, 111 Cal.Rptr. 728, and the placement of the section within the personnel article.   Other parties argue that the section applies to cities and fire districts and that cities and fire districts are therefore within the regulatory control of the County and ICEMA.

The trial court found the controversy moot, apparently because it found that the cities and fire districts are part of the emergency medical services system under section 1797.201.   We agree that the cities and fire districts are an authorized part of the emergency medical services system by virtue of the grandfathering effect of section 1797.201.   There is thus no violation of section 1797.178.

3. Administration.

Turning to the question of the definition of administration, we find statutes and precedent which help us define the nature of administration.

 Historically, fire fighting, police, and ambulance services have been considered to be municipal services or functions, administered by the local municipality.  (Gov.Code, § 54980.)   The legislative body of a city therefore has the power to contract for ambulance service for the residents of the city.  (Gov.Code, § 38794.)   These sections, enacted in 1978 and 1971, respectively, were not amended by the EMS Act.   Similarly, a city has the power to contract for paramedic services.  (Saathoff v. City of San Diego (1995) 35 Cal.App.4th 697, 41 Cal.Rptr.2d 352.)

The Fire Protection District Law of 1987 clearly states a legislative intent to preserve local fire district control over emergency medical services and specifically authorizes fire districts to provide emergency medical services and ambulance services pursuant to the EMS Act.  (§ 13862.)   The legislative intent is stated as follows:  “The Legislature finds and declares that the local provision of fire protection services, rescue services, emergency medical services, hazardous material emergency response services, ambulance services, and other services relating to the protection of lives and property is critical to the public peace, health, and safety of the state.   Among the ways that local communities have provided for those services has been the creation of fire protection districts.   Local control over the types, levels, and availability of these services is a long-standing tradition in California which the Legislature intends to retain.   Recognizing that the state's communities have diverse needs and resources, it is the intent of the Legislature in enacting this part to provide a broad statutory authority for local officials.   The Legislature encourages local communities and their officials to adapt the powers and procedures in this part to meet their own circumstances and responsibilities.”  (§ 13801.)

 The Authority “agrees that providing emergency services, including medical, is a traditional municipal service.”   However, it seeks to differentiate between administration and regulation, arguing that this case concerns regulation, and that regulation has never been a municipal function.

In our view, the Legislature has not explicitly subjected the prehospital emergency medical services traditionally controlled by the cities and fire districts to county control or regulation except in the areas specifically stated in the EMS Act, most notably medical control and training and certification standards for emergency care system personnel.   Without such legislative authorization, the cities and fire districts that were historically providing such services remain free to administer prehospital emergency medical services in their territorial areas.

A county, on the other hand, has historically had the duty to pay for emergency ambulance services for all county residents, including indigent persons in a city.  (City of Lomita v. Superior Court (1986) 186 Cal.App.3d 479, 230 Cal.Rptr. 790;  City of Lomita v. County of Los Angeles (1983) 148 Cal.App.3d 671, 196 Cal.Rptr. 221.)   At oral argument, counsel for Courtesy contended that our tentative opinion conflicted with the Lomita cases.   If, he asks, a county has the duty and responsibility to provide emergency medical services to all county residents, how can it carry out that duty if a city or fire district within the county is able, because of our conclusions, to refuse to provide such services?   The first Lomita case answers the question as follows:  “[A] County, obligated to provide emergency ambulance service to indigents, is free to select, for itself, the particular mode of compliance:  it may operate its own services with its own ambulances;  it may assign day-to-day operation to a sheriff, to a fire district, or setup some other department;  or in lieu of providing ambulance service by its own employees, it may hire a city or other local agency or a private company to provide the service.”  (City of Lomita v. County of Los Angeles, supra, 148 Cal.App.3d 671, 673–674, 196 Cal.Rptr. 221.)   In the second Lomita case, the court again addressed the issue, saying:  “The county's duty to [persons in the county in need of emergency medical care] may be fulfilled in any one of four different ways or by any combination of such services.”  (City of Lomita v. Superior Court, supra, 186 Cal.App.3d 479, 481, 230 Cal.Rptr. 790.)   The four methods are to assign the duty to an existing county department, to create a separate county department, to contract with private ambulance companies, or to “contract with the cities or local agencies located within the county to provide necessary emergency ambulance service to the residents of the county found within such city or cities․”  (Id., at p. 482, 230 Cal.Rptr. 790.)   If the latter method does not work because the city does not wish to enter into such a contract, the other three methods remain available to the county to satisfy its obligation.   Thus, the county here has elected to contract with private ambulance companies.   If, as here, the cities and fire districts provide, or may wish to provide, emergency medical services for their residents, the provision of such services only lessens the county's obligations, including its obligations under the Lomita cases to pay for such services.   What the county may not do is order a city or fire district to provide such services in the absence of a contractual agreement.   The Lomita cases also provide no support for the theory that, in the absence of an agreement with a city or fire district, the county may administer or regulate the services provided by cities and fire districts.   We therefore find no conflict between the Lomita cases and our opinion in this case.

Similar issues have arisen in an antitrust context.   In Springs Ambulance Service v. City of Rancho Mirage (9th Cir.1984) 745 F.2d 1270, the court held that a private ambulance company could not maintain an antitrust action against a city that elected to provide emergency ambulance services through another provider.   The court held that Government Code section 38794 was “a sufficiently clear expression of state policy to permit California municipalities to provide exclusive, free emergency municipal ambulance service.”  (Id., at p. 1273.)   Accordingly, the city was immune from antitrust liability.  (Id., at p. 1272.)

Similarly, in Mercy–Peninsula Ambulance v. San Mateo County (9th Cir.1986) 791 F.2d 755, a company providing ambulance services in a county challenged the county's decision to contract with others for paramedic services.   The court considered the EMS Act and held that the exclusion of the company was “the foreseeable consequence of state policy as adopted in the EMS Act.”  (Id., at p. 756.)   Accordingly, the county was immune from antitrust liability.  (Ibid.;  see, also, Mercy–Peninsula Ambulance v. County of San Mateo (N.D.Cal.1984) 592 F.Supp. 956.)

In addition, section 1797.6 expresses the legislative intent to direct and supervise emergency medical services to the extent necessary to provide for local government immunity under the antitrust laws.   As this section states, it was a response to the United States Supreme Court decision in Community Communications Co. v. City of Boulder, Colo. (1982) 455 U.S. 40, 102 S.Ct. 835, 70 L.Ed.2d 810.   In that case, a municipal ordinance prohibiting expansion of a cable operator's franchise was held not to be state action.   The ordinance was therefore not eligible for exemption from federal antitrust laws.   We need not determine whether section 1797.6 is a sufficient statement of policy to confer antitrust immunity on the local government agencies.   We only note that section 1797.6 applies to all “activities undertaken by local governmental entities in carrying out their prescribed functions under this division.”   It is not limited to activities undertaken by counties.

4. Conclusion.

 Taken together, we discern a legislative intent in section 1797.201 to allow cities and fire districts that were providing prehospital emergency medical services on June 1, 1980, to continue to administer prehospital emergency medical services within their territorial jurisdictions until a written agreement with the county and its emergency services agency is executed.   We agree with our colleagues in the First District that the level of services refers “to such matters as the quantity of available staff, vehicles, equipment, etc., and/or to the type and character of available EMS services as constituting basic, advanced, or limited advanced life support․”  (City of Petaluma v. County of Sonoma, supra, 12 Cal.App.4th 1239, 1245, 15 Cal.Rptr.2d 617.)

 Thus, the County can only impose medical control on the City.   The County cannot require the City to provide equipment or personnel, and cannot intrude in such matters as the staffing levels, the manner in which fire equipment, including fire equipment carrying paramedics, is deployed, and police or fire scene management.   These matters relate to the amount, or level, of service to be provided, and they are entrusted to the city or fire districts as the historic providers of those services because it is the city or fire district taxpayers who must pay for them.   These levels of service may be increased or decreased by the city council or fire district governing body as described in section 1797.201.   In addition, if the County wishes to “establish a unified command structure for patient management at the scene of an emergency” it must do so by a committee which is formed by a joint powers agreement and which includes City and fire district representatives.  (§ 1798.6, subd. (b).)

 While decisions by the City relating to the level of service obviously can have a significant effect on the quality of patient care, the broad definition of medical control urged by the County focuses solely on the quality of patient care and disregards the fiscal implications of such decisions.   For example, a very high level of patient care would be achieved if an ambulance and paramedic were stationed on every City block.   However, the costs to the City's taxpayers would be prohibitive.   If the County were able to mandate such a level of service under the guise of exercising medical control, it would be able to impose excessive costs on the City and it would not be accountable to the City's taxpayers for its decisions.   We find no such legislative intent and reject the County's argument that it can impose dispatch standards on a city which would require the City to provide sufficient equipment to reduce response time to a time prescribed by the County.

 We therefore conclude that medical control relates to the quality of service to be provided by responding personnel.   The Authority's regulations confirm this by providing detailed standards for the training and qualification of emergency medical technicians and paramedics.   The regulations also relate to the development of policies and procedures for the coordination of efforts between emergency personnel and base hospitals.   Thus, all emergency technicians and paramedics, whether employed by the City or Courtesy, are subject to the same training and certification standards, and they coordinate with the base hospital in the same manner.

The regulations thus specifically provide that medical control is established and maintained (1) prospectively, by the development of written medical policies and procedures;  (2) immediately, by providing for direct voice control by a base hospital physician or authorized nurse;  and (3) retrospectively, by evaluation and training of EMT–II personnel.  (22 Cal.Code Regs., §§ 100128, 100170.)

The County advances the spurious arguments that the trial court's decision conflicts with (1) section 1798.100, dealing with base hospitals, and (2) certification standards.

 While these issues are not directly presented for decision, we observe that the entire county is the area of jurisdiction for purposes of medical control under section 1798 et seq.   Thus the agency may contract with base hospitals and require them to provide medical direction of prehospital emergency medical care in areas designated by the agency.   We thus perceive no conflict between the trial court's interpretation of section 1797.201, which preserved this right of medical control, and the base hospital statute.  (§ 1798.100.)

The County also argues that it will not be able to accredit emergency medical services system personnel to the City if the trial court's view prevails.   It contends that a paramedic, for example, must be trained and certified in accordance with state standards and must then be accredited to an authorized emergency medical services system provider within the local emergency medical system.  (§ 1797.192, 1797.194, subd. (f).)  If therefore the City is found to be outside the local emergency medical system, the County argues that it cannot certify paramedics or emergency medical technicians to the City.11

 Of course, as we have found, cities and fire districts are part of the local emergency medical services system insofar as they are under the medical control of the County and ICEMA.  (§ 1798 et seq.)   Cities and fire districts are authorized emergency medical services system providers under section 1797.201.   The statute thus provides no obstacle to the training and certification of emergency medical services personnel by the Authority and the County, no matter who employs the paramedic or emergency medical technician.   In fact, a purpose of the EMS Act was to eliminate artificial barriers to the movement of certified personnel between jurisdictions.  (§§ 1797.7, 1797.185.)   The County's argument flies in the face of that purpose.   Accordingly, the Authority and the County continue to have the power and duty to train and certify emergency medical services system personnel who are employed by the City or fire districts.

Nothing in the trial court's decision, or this opinion, lessens the role of the Authority and the County/ICEMA in training and certification of emergency medical personnel, no matter what public or private entity is the employer of the personnel.   We find no conflict between the trial court's interpretation of section 1797.201 and the training and certification standards of the EMS Act.

We agree with the trial court that medical control involves patient care or medical management within the emergency services system.  (§ 1797.90.)   The term “medical control” thus includes control over the base hospital system pursuant to section 1798.100, and all other matters specified in section 1798 et seq.   Training and certification standards are also under the control of the Authority, the County, and ICEMA.

 The term “administration” refers to all other aspects of the emergency services system historically within the jurisdiction of a city or fire district, including the selection and retention of emergency health care providers.   If the City does not act in these areas, the County may designate providers as stated in section 1797.224.   However, “[n]othing in [that] section supersedes Section 1797.201.”  (§ 1797.224.)

Accordingly, the trial court correctly determined that the City was not obligated to comply with either the Patient Management Protocol or the Dispatch Protocol promulgated by the County/ICEMA.

REGULATION OF OTHER PROVIDERS WITHIN THE CITY

 The County also contends that, even if the County cannot regulate the City, it can regulate or control the activities of other emergency services providers, such as Courtesy, within the City, and, conversely, that the City has no power to regulate such providers.

The County specifically attacks the trial court's finding that “[b]ecause the City of San Bernardino and intervenors retain management and control over the pre-hospital EMS within their jurisdictional boundaries, the County of San Bernardino–ICEMA have no jurisdiction to dispatch, regulate, or authorize providers to operate within said city or fire district, except as otherwise agreed by the County of San Bernardino–ICEMA and the City of San Bernardino or intervenors.”

The County argues that the trial court erred because section 1797.201 should be interpreted to refer only to the administration of services actually provided by the City, and not the administration of all prehospital emergency services in the City.   Thus, it concludes that it has the authority to continue to regulate Courtesy and other private providers within the City.

The County also argues that the trial court's interpretation defeats the statutory scheme of section 1797.224.   Under that section a local EMS agency may create exclusive operating areas in the development of a local plan, and may select providers to provide services within those exclusive operating areas.   Since the County has selected Courtesy to provide ambulance transportation services within an exclusive operating area consisting of the City, it finds that City regulation of Courtesy conflicts with section 1797.224.

We disagree.   Section 1797.224 acts primarily to grandfather historic private providers by protecting them from competitive bidding requirements:  “No competitive process is required if the local EMS agency develops or implements a local plan that continues the use of existing providers operating within a local EMS area in the manner and scope in which the services have been provided without interruption since January 1, 1981.”

Although section 1797.224 was enacted four years after section 1797.201, it expressly states that nothing in the section supersedes section 1797.201.   Accordingly, if the City may regulate other providers under section 1797.201, we find no conflict with section 1797.224.12

We thus return to section 1797.201.   The second sentence of that section states:  “Until such time that an agreement is reached, prehospital emergency medical services shall be continued at not less than the existing level, and the administration of prehospital EMS by cities and fire districts presently providing such services shall be retained by those cities and fire districts, except the level of prehospital EMS may be reduced where the city council, or the governing body of a fire district, pursuant to a public hearing, determines that the reduction is necessary.”  (Emphasis added.)

The term “emergency medical services” is defined by section 1797.72 to mean “the services utilized in responding to a medical emergency.”

As discussed above, these services have historically included the provision of prehospital emergency medical services, including ambulance and paramedic services by cities and fire districts.   We think that section 1797.201 confirms the historic right of cities and fire districts to continue to provide all prehospital emergency medical services until agreement is reached with the County.   Accordingly, the method of provision of those services by a city or fire district, whether directly or by contract, is within the authority of the city or fire district that was providing those services on June 1, 1980, and is not limited to services actually provided at that time.   In other words, the cities and fire districts retain authority to administer the services they were historically providing and administering until the county takes over the providing of such services by written agreement.

Several trial court decisions interpreting section 1797.201 agree with this interpretation.13  In the declaratory judgment in City of Sonoma, et al., v. County of Sonoma, et al. (Solano Sup.Ct. No. 111910, filed March 16, 1993) the trial court found that plaintiffs city and fire protection districts “have the exclusive right to administer, operate and provide [prehospital emergency medical services] within their respective jurisdictions subject only to medical control by the County of Sonoma as that term is defined in Sections 1798.2 through 1798.6 inclusive․”

Similarly, in an order on motions for preliminary injunction in County of Sacramento v. American River Fire Protection Dist. (Sacramento Sup.Ct. No. 535767, filed November 10, 1993), the court enjoined a county ordinance that purported to require the cities and fire districts to obtain a license in order to provide prehospital emergency services.   The court said:  “Viewed in its entirety, the EMS Act contemplates many entities, both public and private, providing [prehospital emergency medical services].   Applicable law authorizes cities and fire districts to provide [prehospital emergency medical services] and, indeed, Section [1797.201] requires certain cities and fire districts to provide [prehospital emergency medical services] at no less than a minimum level of service.   The EMS Act vests counties with a supervisory role to coordinate and monitor the service that is provided.   Counties have no authority to stop, control, or take over [prehospital emergency medical services] provided by cities and fire districts․  Counties may also ‘fill in the gaps' by providing services not provided by cities and fire districts.” 14

 We agree, and conclude that qualifying cities and fire districts may administer prehospital emergency medical services within their geographical areas.   The county's coordinating role is to “fill in the gaps” by providing services not provided by the cities or fire districts, by providing services in nonqualifying cities and fire districts, and by providing services in the unincorporated areas of the county.

 Applying the general principle here, the City has not historically provided significant ambulance transport services.   Thus, the County properly allowed Courtesy to provide such services within an exclusive operating area consisting of the City.   However, if the City chooses to provide its own ambulance transport services, directly or through contract with other providers, including Courtesy, the City has the authority to provide and administer those services.

We therefore disagree to some extent with the trial court decision in County of San Bernardino, et al. v. City of Colton, et al. (Riv.Sup.Ct. Case No. 242968, filed July 21, 1994) which the parties have requested that we judicially notice.15  The trial court granted summary judgment for the County, finding that section 1797.201 authorizes the City “to add to and expand the types of emergency medical services it was providing on June 1, 1980, without first obtaining COUNTY authorization therefore [sic ].”   However, the trial court held that the section does not authorize the City to include a type of service not previously provided without obtaining County approval.   Thus, since Colton did not provide ambulance transport services on June 1, 1980, it could not decide to provide such services without obtaining County/ICEMA approval.   In other words, the trial court found that, if Colton provided ambulance transportation services on June 1, 1980, it could upgrade or improve those services.   If it did not, it could not add those services without County/ICEMA approval.

While we disagree with the principles stated by the trial court in the Colton case, the application of our reasoning would lead to the same result if the trial court found, as a factual matter, that the City was providing some limited ambulance transport services on June 1, 1980.   If so found, the providing of full ambulance transport services by the City would be considered an extension of that historic level of service.16

We also disagree with similar statements in the notice of intended decision in Winter v. City of Ukiah (Mendocino Sup.Ct. No. 65575, consolidated with No. 65248, filed July 18, 1994).   In that case, the City of Ukiah decided to enter the ambulance business.   The former provider, Mr. Winter, sued, contending that the action was inconsistent with the EMS Act.   The court found that the EMS Act required County approval for the new service.   It also seems to have held the opinion that dispatching services were within the County's control, despite the provisions of the Warren–911–Emergency Assistance Act.17  (Gov.Code, § 53100 et seq.)

 We disagree with these conclusions for the reasons stated above.   Section 1797.201 refers to the City's right to continue administration of emergency medical services.   We interpret this as a right to retain administration of all such services if the city or fire district was providing any such services on June 1, 1980.   Historically, administration of emergency medical services included the right to select and regulate ambulance services operating within the city or fire district.   We find nothing in the EMS Act that mandates a change in this historical administrative practice, particularly since the EMS Act did not amend or repeal Government Code sections 38794, 54980 or 53100 et seq.18

CITY'S CROSS–APPEAL

 The City's cross-appeal is directed at the ruling of the trial court that states:  “A city or fire district may continue to provide services ‘at not less than the existing level.’   Thus, a city or fire district is grandfathered into the EMS system by supplying services at not less than the existing level unless it agrees to contract with the local EMS agency.   Thus, if a city or fire district wants to contract for ambulance transport services in excess of existing levels, a city or fire district may only do so by agreement with local EMS agencies.”

The cross-appeal attacks the final sentence of that ruling.   The City argues that the imposition of a requirement that it obtain County/ICEMA approval to contract for ambulance transport services in excess of existing levels is contrary to section 1797.201.

 We agree.   As discussed above, we interpret section 1797.201, second sentence, to mean that the city or fire district that historically provided prehospital emergency medical services retains the power to administer all prehospital emergency medical services in the city or fire district until a written agreement is made with the county.  (§ 1797.72.)   As we also discussed above, the power to provide ambulance services, directly or through provider contracts, is an historic municipal function.  (Gov.Code, §§ 38794, 54980.)   The power to administer all prehospital emergency medical services includes the power of a city or fire district to enter the ambulance transport business.  (Springs Ambulance Service v. City of Rancho Mirage, supra, 745 F.2d 1270, 1273–1274;  Mercy–Peninsula Ambulance v. San Mateo County, supra, 791 F.2d 755.)

The trial court erred in holding otherwise.19

DISPOSITION

The judgment is modified by striking (1) the phrase “except as to the CITY OF SAN BERNARDINO's right to enter into contracts for ambulance transport” at lines 15–17 of page 2 of the judgment and (2) the last sentence of numbered paragraph 4 on page 6 of the statement of decision and order which is incorporated into numbered paragraph 1 of the judgment.   As so modified, the judgment is affirmed.20

FOOTNOTES

1.   Unless otherwise indicated, all further statutory references are to the Health and Safety Code.

2.   Their amici brief is filed on behalf of the California Fire Chiefs Association (consisting of over 500 fire chiefs), the California Fire Districts Association (consisting of approximately 425 fire districts), 9 specifically named fire districts, and 112 specifically named cities.

3.   “It is the intent of the Legislature to maintain and promote the development of EMT–P paramedic programs where appropriate throughout the state and to initiate EMT–II limited advanced life support programs only where geography, population density, and resources would not make the establishment of a paramedic program feasible.”  (§ 1797.2.)

4.   According to the County's medical director, responsibilities are divided between the County and ICEMA by the joint powers agreement.   The County establishes, designates and administers the exclusive operating areas within the County.   It also designates exclusive providers of prehospital emergency medical services within those areas, and regulates fees charged by the providers for their services.   ICEMA is responsible for certification of emergency medical personnel, supervision and regulation of their activities, and the adoption of protocols governing all aspects of EMS services.

5.   This designation was made pursuant to section 1797.224.   That section expressly provides that it does not supersede section 1797.201.   The role of the city's fire department or other cities and fire districts in providing prehospital emergency medical services was not mentioned in the plan.

6.   The evidence is in conflict as to whether the County or ICEMA has authorized Courtesy to provide paramedic services.   The County health director stated in his deposition that Courtesy was not authorized to provide any services other than emergency medical transportation services.   However, the ICEMA administrator testified that the agency had also licensed Courtesy to provide paramedic services in the City.

7.   Dispatch of emergency vehicles is handled by the fire department's dispatch center.   It was alleged that the dispatch center was dispatching fire department paramedics at a higher response level (code 3—red light and siren) than Courtesy's ambulances (code 2—normal driving procedures), and that the dispatchers were “staging,” or intentionally delaying, the arrival of ambulances at the scene until after fire department paramedics arrived.  (See, generally, the Warren–911–Emergency Assistance Act, Gov.Code, § 53100 et seq.)

8.   The City's fire chief admitted that the City fire department had begun selling a subscription plan for paramedic services to City residents, and that operation of the plan could be frustrated if Courtesy arrived first at the scene and billed for its own paramedic services.

9.   The City properly cites the rule that intervenors may not enlarge the issues in the action:  “The person seeking intervention must ordinarily show an interest under the existing pleadings and issues, and will not be allowed to come in on a claim which enlarges the issues and changes the nature of the main proceeding.”  (4 Witkin, Cal. Procedure (3d ed. 1985) Pleading, § 254, p. 308;  Fireman's Fund Ins. Co. v. Gerlach (1976) 56 Cal.App.3d 299, 303, 128 Cal.Rptr. 396 [“The issues of the action may not be enlarged by the proposed intervention.”];  Kuperstein v. Superior Court (1988) 204 Cal.App.3d 598, 600–601, 251 Cal.Rptr. 385.)We therefore respond to the issues raised by the County, and not to other issues raised by the intervenors and amici.

10.   At oral argument, County Counsel contended that subdivision (a) overrides subdivision (c), so that the most medically qualified paramedic at the scene has the authority to render medical care.   The position is untenable in light of the fact that the statute specifically provides that subdivision (c) overrides subdivision (a), thus vesting scene management authority in the appropriate public safety agency.In view of the language of the subdivisions, we find no difference between patient management and scene management in this context.   After all, an emergency is defined as “a condition or situation in which an individual has a need for immediate medical attention, or where the potential for such need is perceived by emergency medical personnel or a public safety agency.”  (§ 1797.70.)

11.   The state recently took over the certification of paramedics.   (§§ 1797.172, 1797.194.)   However, the County's argument would still apply to the EMT–I and EMT–II categories, since they are still certified locally.

12.   We note that, in 1986, the Legislature adopted section 1797.226, a special section relating only to exclusive operating areas in San Bernardino County.   The special provisions of that section are not in issue here.

13.   On March 25, 1994, defendants in intervention filed a request that we take judicial notice of certain documents in three California trial court cases:  (1) declaratory judgment in City of Sonoma, et al., v. County of Sonoma et al. (Solano Sup.Ct. No. 111910, filed March 16, 1993);  (2) order on motions for preliminary injunction in County of Sacramento v. American River Fire Protection Dist. (Sacramento Sup.Ct. No. 535767, filed November 10, 1993);  and a ruling granting a motion for preliminary injunction in City of Ukiah v. County of Mendocino (Mendocino Sup.Ct. No. 65248, filed September 29, 1992).   Defendants in intervention also requested that we take judicial notice of S.B. 125, as amended June 17, 1980.By an order filed April 22, 1994, we reserved decision on the request.On August 1, 1994, Courtesy requested that we take judicial notice of a notice of intended decision in the consolidated Mendocino case, under the name Winter v. City of Ukiah (Mendocino Sup.Ct. No. 65575, consolidated with No. 65248, filed July 18, 1994).   Our order of August 22, 1994, reserved ruling on that request.These requests for judicial notice of these documents are now granted, although we are unaware of the current trial court or appellate status of these cases.

14.   See also the City of Ukiah case discussed below at footnote 16.

15.   On June 24, 1994, the City filed a request that we take judicial notice of the transcript of a hearing on June 15, 1994, in the subject case.   Ruling was reserved on the request by our order of July 14, 1994.On August 1, 1994, Courtesy requested that we take judicial notice of the summary judgment in that case and a notice of intended decision in a Mendocino case.   Our order of August 22, 1994, reserved ruling on that request.We now grant both requests for judicial notice of the specified document in the Colton case.

16.   There was some evidence that the City had one transport ambulance in use on June 1, 1980.   Accordingly, if the City decided to provide ambulances for transport purposes, that would involve an increase in an existing level of service, rather than a new service.   However, the evidence was disputed, and a decision on this issue is not necessary in this case.

17.   In the trial court's decision granting a motion for a preliminary injunction in the Ukiah case, a different judge found that the EMS agency has no authority to impose a dispatch policy on the city because a contrary finding would render section 1797.201 meaningless.   We agree.

18.   Amicus California Ambulance Association has called our attention to the recent case of Memorial Hospitals Association v. Randol, 38 Cal.App.4th 1300, 45 Cal.Rptr.2d 547 ( [5th Dist.].)   That case concerned a county referendum measure requiring the County of Merced to rescind certain actions approving the establishment of an exclusive operating area under section 1797.224 of the EMS Act.   Since section 1797.224 specifically provides that it does not supersede section 1797.201, the discussion in that case is not helpful here.

19.   We reverse the trial court on the broad ground that the City retains the power to administer all prehospital emergency medical services in the City under section 1797.201.The parties also argue the cross-appeal on a narrower ground based on the level of services provisions of section 1797.201.   The City argues those provisions either (1) allow it to expand the level of service because it previously provided ambulance transport services (see footnote 16, supra ) or (2) level of service includes the power to provide a type of service it did not previously provide.Courtesy argues that (1) the City did not previously provide ambulance transport services and (2) the level of service does not include types of service not previously provided.Resolution of the first argument depends on a factual issue of whether the City previously provided ambulance transport services.   Accordingly, we cannot resolve the issue on summary judgment.On the second argument, we agree that the level of service provision authorizes the City to provide a type of service, ambulance transport, that it did not historically provide.  (City of Petaluma v. County of Sonoma, supra, 12 Cal.App.4th 1239, 1245, 15 Cal.Rptr.2d 617.)

20.   The statement of decision and order was incorporated by reference into the summary judgment.   Our decision affirming the judgment as modified should not be taken as an approval of all of the statement of decision and all of its reasoning.   We have only discussed the portions of the statement of decision and order which were challenged by the County.

HOLLENHORST, Acting Presiding Justice.

RICHLI and McDANIEL *, JJ., concur.