Mercy-Peninsula Ambulance, Inc. v. County of San Mateo

592 F. Supp. 956, 1984 U.S. Dist. LEXIS 24456
CourtDistrict Court, N.D. California
DecidedAugust 8, 1984
DocketC-84-1184-WWS
StatusPublished
Cited by6 cases

This text of 592 F. Supp. 956 (Mercy-Peninsula Ambulance, Inc. v. County of San Mateo) is published on Counsel Stack Legal Research, covering District Court, N.D. California primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Mercy-Peninsula Ambulance, Inc. v. County of San Mateo, 592 F. Supp. 956, 1984 U.S. Dist. LEXIS 24456 (N.D. Cal. 1984).

Opinion

MEMORANDUM OF OPINION AND ORDER

SCHWARZER, District Judge.

This antitrust action concerns the provision by ambulance personnel of paramedic *958 service, the highest level of pre-hospital emergency medical care, in the defendant County of San Mateo (“the County”). Defendants Medevac, Inc. (“Medevac”) and 911 Emergency Services, Inc. (“911”) provide primary emergency ambulance service for the County and defendant hospitals 1 through the County’s public dispatch lines; plaintiff provides “back-up” service when the primary providers cannot respond to a call. The gravamen of plaintiff’s complaint is that the County, in conspiracy with the other defendants, has refused to certify as paramedics any ambulance personnel other than that employed by the primary providers Medevac and 911. Plaintiff alleges that defendants’ actions constitute a concerted refusal to deal in violation of § 1 of the Sherman Act and an exercise of monopoly power in violation of § 2; it seeks damages and injunctive relief.

. Each of the defendants has moved to dismiss under Rule 12(b)(6). They contend that they are immune from antitrust liability under the “state action” doctrine of Parker v. Brown, 317 U.S. 341, 63 S.Ct. 307, 87 L.Ed. 315 (1943), arguing that the actions challenged by plaintiff were taken by the County pursuant to an express state policy to displace competition with regulation of paramedic care. They also argue that they are immune under the Noerr-Pennington doctrine which shields from antitrust scrutiny attempts to influence government officials’ decision-making. Finally, the County claims that it is protected by the Tenth Amendment from antitrust liability for the conduct alleged.

Plaintiff responds that defendants have failed to identify an express state policy to displace competition in the paramedic service market in the manner employed by the County. It also argues that Noerr-Pennington does not apply where government officials are alleged to have conspired with private defendants and that imposing liability on the County would not regulate the “state as state” in violation of the Tenth Amendment.

A. Statutory Background.

A complex web of statutory provisions governs emergency medical and paramedic services in California since 1980, the period in which plaintiff alleges the anticompetitive acts to have taken place.

The earliest act is the Wedworth-Townsend Paramedic Act (“WTPA”), Cal.Health & Saf.Code §§ 1480-1485, enacted in 1970, which authorized counties to “conduct a pilot program” for use of mobile intensive care paramedics to deliver pre-hospital emergency care, id. § 1480. The Act provided for county training and certification of paramedics, id. §§ 1481(a), 1481.3, as well as county establishment of recertification criteria, id. § 1484.2, and enumerated minimum training standards for paramedics, § 1482. It also authorized counties to “contract with a general acute care hospital which has the approval of the county health officer to participate in the pilot program,” id. § 1482. Although the WTPA was originally to expire by its terms in 1979, id. § 1484, it was extended by amendment until 1982, Cal.Stats.1979, C. 555, p. 1764, § 1.

In 1980, the Emergency Medical Services and Emergency Medical Care Personnel Act (“EMS Act”), id. §§ 1797 et seq., was adopted to replace the repealed Emergency Medical Care Services Act, id. 1750 et seq. The EMS Act, which took effect in 1981, seeks to “provide the state with a statewide system for emergency medical services by establishing within the Health and Welfare Agency the Emergency Medical Authority which is responsible for the coordination and integration of all state activities concerning emergency medical services,” id. § 1797.1. That state Authority is empowered to, among other things, review the emergency requirements of local “EMS areas,” id. § 1797.102, and to establish standards for paramedics (EMT-P’s) and *959 lower level emergency personnel (EMT-I’s and EMT-II’s), id. §§ 1797.80-84, 1797.-170-172, 1797.176.

The Act also envisions local regulation. It authorizes counties to designate a local “EMS agency” which may “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,” id. § 1797.204. With regard to the certification of paramedical and other personnel in counties which create such systems, the Act provided until 1983: 2

1797.206. The county is responsible for implementation of advanced life support systems and limited advanced life support systems and for the monitoring of training programs.
1797.208. The county shall be responsible for determining that the operation of training programs at the EMT-I, EMT-II, and EMT-P levels are in compliance with this part, and shall approve the training programs if they are found to be in compliance with this part. The training program at the California Highway Patrol Academy shall be exempt from the provisions of this section.
1797.210. The county health officer or county designated physician shall issue a certificate to an individual upon proof of satisfactory completion of an approved training program and passage of the examination for competence. The certificate shall be proof of the individual’s initial competence to perform at the designated level. The county health officer or county designated physician shall re-certify EMT-I’s, EMT-II’s, and EMT-P’s through passage of an examination for competency at least every two years.
1797.212. The county may establish a schedule of fees for certification in an amount sufficient to cover the reasonable cost of administering the certification provisions of this part.

The Act also provides that:

No 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 of the local EMS agency or of a pilot program operated pursuant to the Wed-worth-Townsend Paramedic Act.

Id. § 1797.178 (citation omitted).

Finally, § 1797.250 authorizes local EMS agencies to develop an emergency medical services plan which must be submitted for approval by the state Authority:

After July 1, 1982, a local EMS agency may implement a local plan developed pursuant to Section 1797.250 unless the authority determines such plan does not effectively meet the needs of residents and is not consistent with coordinating activities in the geographical area served.

Id. § 1797.105(b).

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Bluebook (online)
592 F. Supp. 956, 1984 U.S. Dist. LEXIS 24456, Counsel Stack Legal Research, https://law.counselstack.com/opinion/mercy-peninsula-ambulance-inc-v-county-of-san-mateo-cand-1984.