HCAPE’s False Statements About Local Control, PSAs, and the Minnesota Fire Service

Established in the 1980’s, Minnesota is one of the only states in the entire country to have such a restrictive PSA structure with no local control or oversight. The only other state with a similar PSA law is Connecticut (estimated population 3.6M). Connecticut’s laws and state oversight is, however, much more robust compared to Minnesota, despite a significantly less population and arguably less EMS demand. There is no data to substantiate HCAPE’s assertion that Minnesota’s PSA laws “keep Minnesotans safe or “enshrine health equity through state oversight.”

The 2022 report by the Office of the Legislative Auditor titled, Emergency Ambulance Services Evaluation Report, actually paints a much different – and very troubling picture – than what HCAPE has tried to swindle. Among their findings:

• “The law regarding primary service areas places substantial limits on EMSRB’s authority to define, administer, or alter primary service areas once they are created.” – Page 17
• “EMSRB does not draw primary service area boundaries; primary service areas are defined by the ambulance services themselves.” – Page 17
• “There was no formal process for determining whether the size or shape of a primary service area was appropriate or if it accurately reflected where ambulance services were providing coverage.” – Page 17
• “EMSRB has little authority to alter primary service area boundaries without the cooperation of the ambulance services that hold the corresponding licenses.” – Page 19
• “Once an ambulance service obtains a license with a corresponding primary service area, it retains the right to provide service in that area as long as it maintains its license. There are no clear provisions in state law for EMSRB to alter primary service area boundaries, even if EMSRB finds a public health benefit to doing so.” – Page 19

Conclusion: FICTION. HCAPE’s statement is without data or qualitative information, and does not align with the independent report published by the Office of the Legislative Auditor.

Under current Minnesota law and regulations, once an ambulance provider is granted a primary service area (PSA) – which is essentially in perpetuity – that provider must ensure 24-hour coverage. What that coverage means, how it is measured, what level of care and service is provided, and even requirements on how long it takes to have an ambulance arrive when someone calls 911, is largely left up to the provider. In most instances, there is almost little or no local oversight by elected officials (unless that city or town owns the PSA). The reality is that current Minnesota law mostly protects the provider by ensuring they never lose their PSA. And yes, it is true that they have to provide an ambulance… at some point. This is really a far cry from equitable.

The Minnesota State Fire Chiefs Association (MSFCA) and its allied partners completely agree that no city or town should ever face the real or possible scenario that they would be abandoned by their ambulance provider. Frankly, we would never stand for it and completely condemn that notion.

It is equally important for our rural communities to have a say in their emergency medical care just as much as the larger, metro cities. Local control will actually provide for greater oversight and accountability.

The sad reality is that many cities and towns today feel abandoned by their ambulance providers, even in the “metro” region. The inability to have local control, lack of state oversight and accountability, and lack of investments into our EMS systems (including pay equity and fair treatment of EMTs and paramedics), has created a crisis throughout the state. Hennepin Healthcare EMS, for instance, has struggled to keep-up with the demand in their own primary service area. In some cases, patients are waiting for an hour or more to have an ambulance arrive. Hennepin Healthcare EMS is regularly requesting ambulances from other providers to cover their calls which creates a downward impact on other communities. Fire departments, who are often the primary emergency medical first responder, are having to take units out of service for extended periods of time while they care for a patient until Hennepin EMS (or another provider) arrives on-scene to assume patient care.

While this may not fit the text book or legal definition of “abandonment,” it sure feels like it to the cities, towns, and highly trained medical first responders that are often left asking, “where is the ambulance?”

Conclusion: FICTION. This is truly a click-bate statement designed to instill fear in Minnesotans that they will be abandoned. Local control will only strengthen oversight and accountability.

Today, there is frankly very little state oversight, accountability, and transparency over Primary Service Areas (PSAs); we encourage you to read the 2022 report by the Office of the Legislative Auditor titled, Emergency Ambulance Services Evaluation Report.

We certainly don’t believe in or condone creating fiefdoms, monopolies, or anything of the like. There simply is no basis to believe that municipalities will build “fiefdoms.” As we all have learned in our early academic years, elected officials are accountable to the people that duly elected them to that office. Local control provisions would ensure that ambulance providers are accountable to the local bodies of government to which they provide services.

To be abundantly clear, we do not condone the notion that any entity – public or private – create a system that favors an “affluent (largely white)” community over another. To suggest this to be a motivating factor for establishing local control is despicable and shameful. This statement and belief alone is all the more reason for much greater accountability, oversight, and transparency for Minnesota’s ambulance system.

Conclusion: FICTION. Current Minnesota PSA law lacks any accountability or local control. The assertion that municipalities will create “tiny fiefdoms for affluent (largely white) Minnesotans is preposterous.

The Minnesota STATE Fire Chiefs Association (MSFCA) is proud to represent Minnesota fire service leaders and the public safety interests of the communities we serve. We are a volunteer, member-driven organization that is comprised of elected chief-officer level representatives from across the entire state. There are approximately 20,000 firefighters in the state, the majority are volunteer or on-call. As is the case in most fire departments, our members often live and work in the communities they serve and protect, and we take great pride in what we do. We are joined by other fire service organizations, elected officials, and community leaders who share a common goal of improving pre-hospital emergency medical care. We want to do this collaboratively and in a manner that is professional, transparent, and in the best interest of those we serve.

To be blunt, the system is already broken – very broken; and we (the MSFCA) didn’t break it. There are countless datasets, reports, and first-hand experiences that highlight the fractured nature of Minnesota’s ambulance system. HCAPE, Hennepin EMS leaders, the Minnesota Ambulance Association, and healthcare lobbyists have already stated the case quite well. The 2022 report by the Office of the Legislative Auditor titled, Emergency Ambulance Services Evaluation Report, provides a great insight into the broken Minnesota ambulance service, including PSAs.

Unfortunately, HCAPE and other Minnesota ambulance industry leaders are choosing to only focus on certain issues. There is a clear and obvious avoidance of strengthening accountability, providing for local control, increasing transparency, and working collaboratively with local elected and public safety officials to fix a broken system. Any threat to changing the “status quo” – especially highly coveted ambulance PSAs – is met with strong resistance and special interest lobbying.

Minnesota is one of the only states in the country to have such an antiquated model of establishing timeless ambulance primary service areas. There is no oversight or accountability at a state level; and, unless the PSA is owned by a local governing body, almost no local control.

The MSFCA and our allied partners are committed to FIXING a broken system. We are advocating for local control, greater oversight and accountability, transparency, and actionable steps to putting patients first. To do this, the PSA law needs to be changed and the voices of our communities – those we all have taken an oath to serve – need to be heard and recognized.

Contrary to the opinion of HCAPE, cities and towns will not be left to “fend for themselves.” If anything, it will empower local officials to work collaboratively with their ambulance provider to ensure the needs of their community is being met. From a small, rural town in Minnesota to the larger cities in the metro region.

Conclusion: FICTION. This is truly a click-bate statement designed to instill fear in Minnesotans that they will be abandoned.

Absolutely not.

Allowing local units of government to have local control over who provides ambulance service to their community will benefit all of Minnesota. A small, rural township should have the same rights and privileges to represent their community’s interests just as much as larger “metro” communities.

Local elected officials are trusted by their constituents to represent their interests – above all, public safety. Local elected leaders currently have the policy-making authority over local governmental operations, such as police, fire protection, public works, trash collection, golf courses, liquor stores (in some areas), and even cable franchising agreements.

There is no reason why they can’t be trusted to make decisions about their ambulance services – an essential, core, and vital public service.

It is sad that local elected leaders have more oversight and authority of cable franchising agreements than they do their ambulance services. This just isn’t right.

We trust our local elected leaders to represent the interests of their community.

It is disheartening that HCAPE leaders, who mainly serve a large, metropolitan area, believes in such nonsense.

Conclusion: FICTION. This is truly an emotional ploy to scare Minnesotans, and an attempt to pit greater Minnesota against metro communities. We simply won’t stand that it. We are ONE Minnesota.

Please, HCAPE, provide factual data to support this outlandish and frivolous claim.

Please read “Fact or Fiction #5.”

Ensuring that marginalized and disadvantaged communities have access to healthcare (and all public safety services) is of utmost concern. We have seen this need grow exponentially, especially over the past two-years; this simply cannot be ignored, and we need to invest into our communities. This is certainly not just a metro issue, it is a statewide issue that requires collaboration, thoughtful discussion, and action. We need to do this with the communities we serve.

In fact, local control will allow for just that. Local elected leaders were put into office to represent the needs of their constituents. By its very nature, ambulances are providing direct contact to people in local communities. Local bodies of government are in an exceptional position to represent their community’s needs, and to ensure they are getting the services they most valuably need.

This is in stark contrast to large, healthcare corporations that are making decisions from afar – sometimes even hundreds of miles away – with little to no input from or accountability to local elected leaders.

The only people that should be benefiting by the ambulance system are the patients.

The patient comes first.

Period.

Conclusion: FICTION. There is no data to support this claim. We completely support ensuring that everyone has access to the healthcare they need.

We are not sure what “plan” HCAPE is referring to and would appreciate them sharing it with us. Because we – the Minnesota State Fire Chiefs Association (MSFCA) and our allied partners – certainly aren’t aware of any “plan” like this. Unfortunately, HCAPE and other ambulance service leaders have created a false narrative that implies fire departments across the state are working to take over ambulance services through local control provisions. This simply is not true. Please see “Fact or Fiction #8” below for additional clarity on this matter.

We also invite you to read our Local Control and PSAs FAQ.

If a local unit of government – through local control – does decide they want to provide ambulance services to their community (or in partnership with other cities/towns through a JPA or special taxing district), this should be done with careful planning and consideration by the local elected officials and staff. Whether or not it is operated by the fire department is up to the local unit of government – not the fire chief.

If the local governmental body does decide it wants the local fire department to assume ambulance service responsibilities, they should carefully and methodically consider the potential impact (positive and negative) it could have on existing public safety operations. It simply cannot be a “rob Peter to pay Paul” approach.

As stated in “Fact or Fiction #2,” fire departments are already experiencing significant delays from ambulance service providers. This is a frequent occurrence across the state (metro and rural alike). These delays, including instances of ambulances showing up with only one certified EMS attendant (requiring a firefighter to drive the ambulance as the second attendant), are most certainly having a negative impact on the fire service. This ties up a valuable fire (or police) resource for an extended period, preventing them from responding to other calls.

Contrary to the belief of some, there is no “cash grab.” It is almost certain in many circumstances that a local unit of government would need to subsidize the capital and operating costs of a full-time ambulance service on their own, especially when the service is combined with other services (such a fire and rescue). Insurance reimbursements hardly ever cover the full cost of providing ambulance services.

That said, there are many considerations factored into whether a local municipality should provide an ambulance service. Among them is the level of service that they want to provide to their community.

Conclusion: FICTION. There is no statewide plan that includes fire service agencies taking over ambulance responsibilities.

HCAPE and other ambulance service leaders have created a false narrative that local control means that fire departments across the state will automatically take on providing ambulance services for their city, town, or fire protection area.

The intent on overhauling Minnesota’s primary service area (PSA) law and to allow for local control is to legally empower local elected officials to make decisions regarding ambulance service to the communities they were elected to serve. It is not a mandate that their fire department (or any other governmental body) automatically take on providing ambulance services.

Click here to learn specifically what our recommendations are. There isn’t any mention of a fire department or fire chief in our recommendations!

The decision of a local unit of government (whether a city or town) to provide ambulance services (whether through the fire department or another governmental body) is something that should rest with the elected body of that local unit of government. The Minnesota State Fire Chiefs Association (MSFCA) and our allied partners has not, and is not, advocating that this decision be the local fire chief’s – it is truly something that should be left up to the local unit of government (who were elected by their constituents to represent them).

The fire service was built on a foundation of trust and integrity. HCAPE’s accusations that fire chiefs are attempting a “bait and switch tactic” is extremely disrespectful, disingenuous, distasteful, and false. We are completely disheartened that our EMS partners are accusing their public safety peers of such behavior.

We know that HCAPE’s statements are an outlier to the otherwise professional conduct we witness every day by our ambulance providers in the field – the hard working EMTs and paramedics that are literally there to save our lives. We frankly expect better from HCAPE and its leadership.

Conclusion: FICTION. Fire chiefs are not attempting a “bait and switch tactic.”

Please refer to our prior statements in “Fact or Fiction #1-8”.

We appreciate your support of the Minnesota fire service, and the brave men and women that respond day and night to serve their local communities – whether they are volunteer, paid on-call, part-time, or career. We also support the continued investments into public safety in Minnesota, including ambulance services. We don’t, however, support giving ambulance providers a blank check without any accountability, oversight, metrics, or local control provisions.

This isn’t a “cash grab” by municipal fire chiefs or a backdoor method to create fiefdoms (see “Fact or Fiction #8).

Conclusion: LET THE LOCAL ELECTED OFFICIALS DECIDE.

Thank you HCAPE for sharing your views and opinions. Hopefully this helps clarify a few things.

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