CEO 88-56 -- September 8, 1988

CONFLICT OF INTEREST

CITY FIRE DEPARTMENT PARAMEDICS

EMPLOYED BY PRIVATE AMBULANCE COMPANY

To: Mr. G. R. McClelland, City Attorney, City of Largo; Lt. Earl J. Milne, Largo Fire Department

SUMMARY:

No prohibited conflict of interest exists under Section 112.313(7), Florida Statutes, where a city fire department paramedic also is employed by the only private ambulance company providing emergency ambulance transportation within the city. Unlike the situations presented in CEO's 88-26, 87-48, 86-34, 84-19, and 81-76, the paramedic's employment relationship with the private ambulance company would not present a continuing or frequently recurring conflict of interest and would not impede the full and faithful discharge of his public duties. Here the paramedics are to advise patients to be transported by ambulance, and may transport patients themselves only under very limited circumstances.

QUESTION:

Does a prohibited conflict of interest exist where city fire department paramedics also are employed by a private ambulance company which provides emergency medical transport services within the city?

Under the circumstances presented, your question is answered in the negative.

We have been advised that the City of Largo is under contract with Pinellas County to provide emergency medical services (EMS) and is compensated from funds collected for EMS services by the County. In addition, we have been advised that currently 13 paramedics with the City Fire Department, including Lt. Earl J. Milne, are employed on a part-time basis with a private ambulance company which is the sole provider for EMS transport services in the County. Of the 13, five perform duties in the company's dispatch center, and the remaining eight perform duties as responding EMS personnel on company vehicles. City Fire Department rules prohibit the performing of any part-time employment for the ambulance company 12 hours prior to reporting for duty with the City.

Through subsequent correspondence and a telephone conversation with our staff, the City Fire Chief has advised that a City unit and a company ambulance always are dispatched to an EMS call. As the City unit usually arrives at the scene first, the senior paramedic is authorized to tell the ambulance to slow down or to return, if there is no need to transport the patient. The City Fire Department does have the capability of transporting patients, but this is done only when the patient is a City employee or when there is an extreme delay in the arrival of the private ambulance and the senior paramedic is of the opinion that any further delay in transport would jeopardize the life of the patient. The Fire Chief advised that the City has eight units capable of responding to EMS calls. Five of these units are fire engines, one is an aerial truck, and the other two are rescue units. Of the two units which are capable of transporting, one of them rarely is in service, he advised.

The Fire Chief also stated that it is rare for the City to transport a patient. Usually, the City paramedic handles the primary stabilization treatment of the patient and the private ambulance company transports the patient. During 1986, he advised, out of 5,156 calls the City transported in 72 cases. In 1987, the City transported patients in 26 out of 5,386 calls. During the first half of 1988, the City transported 14 patients in responding to 2,853 calls. According to the EMS Director for the City, the majority of the cases in which the City transported patients involved City employees, where the City transported the patients rather than have them pay the fee for private ambulance service.

Chapter 80-585, Laws of Florida, authorizes the County Commission to contract for first responder services with municipal fire departments, under which the fire departments are paid to provide treatment and care at the scene of an emergency and to transport patients in the limited circumstances described above. The County also is authorized to contract with a private ambulance company to provide for emergency and nonemergency medical transportation in the County. Under the existing contract the County pays a flat monthly fee to the ambulance company, which does not depend directly on the number of patients transported by the company, although adjustments are made based upon other factors such as outside work, late runs, and inflation. However, the contract does provide for compensation on a per transport basis in the form of "stop loss payments" where the combined number of emergency and nonemergency transports exceeds the annual volume projected by the County. Patients who are transported by the ambulance company or by the Fire Department are billed, and payments are collected directly by the County.

It is the policy of the County that all persons who are seen by fire department or ambulance paramedics as the result of an emergency request for medical assistance be transported by ambulance to a hospital for diagnosis and treatment by a physician. Established protocols require that transport be recommended; if the patient refuses transportation or treatment the paramedic is to have the patient sign a release form.

The Code of Ethics for Public Officers and Employees provides in relevant part:

CONFLICTING EMPLOYMENT OR CONTRACTUAL RELATIONSHIP. -- No public officer or employee of an agency shall have or hold any employment or contractual relationship with any business entity or any agency which is subject to the regulation of, or is doing business with, an agency of which he is an officer or employee . . . ; nor shall an officer or employee of an agency have or hold any employment or contractual relationship that will create a continuing or frequently recurring conflict between his private interests and the performance of his public duties or that would impede the full and faithful discharge of his public duties. [Section 112.313(7)(a), Florida Statutes (1987).]

This provision prohibits a public employee from having any employment or contractual relationship which would create a continuing or frequently recurring conflict of interest or which would impede the full and faithful discharge of his public duties.

In previous opinions we have found that this provision would prohibit paramedics employed with governmental agencies from being employed by private ambulance companies doing business in the jurisdiction of their agencies, where the paramedics were in a position to make referrals to the private ambulance company or to obtain business for their private employer in determining whether the services of that company were necessary in a particular situation. See CEO 88-26, CEO 86-34, CEO 84-19, and CEO 81-76. Our concern is that the decision made by a paramedic of whether to allow the private ambulance company to transport a patient not be influenced by regard for the interests of the paramedic's private employer. Section 112.313(7)(a) requires us to examine the nature and extent of a public employee's duties and his private employment "to determine whether the two are compatible, separate and distinct or whether they coincide to create a situation which 'tempts dishonor.'" Zerweck v. State Commission on Ethics, 409 So.2d 57, 61 (Fla. 4th DCA 1982). We are especially concerned here with the potential that a paramedic's outside employment may tempt him to dishonor his duties to the public, because his decisions may affect irrevocably the life and health of patients.

Under established protocols, City paramedics on emergency calls are to recommend that the patient be transported by ambulance to a hospital for diagnosis and treatment by a physician. Therefore, in this respect we find that any temptation a City paramedic may face to benefit his private employer, the ambulance company, would not be inconsistent with the proper performance of his public duties. We also do not find, under the circumstances presented, that the City paramedics' authority to transport patients would be impeded significantly by the interests of their private employer. The primary responsibility of the City Fire Department is to provide treatment and care at the scene -- first responder services -- and not to transport patients. Fire Department paramedics are authorized to transport when delay in transport by a private ambulance would jeopardize the life of the patient. However, here the Fire Department has a very limited ability to transport, consisting of only two of the eight units which may respond to an EMS call. The statistics provided by the Department also indicate that the City transports patients only on relatively few occasions. Finally, as the private ambulance company generally is not in a position to be paid on a per call basis, we see little incentive for the company to encourage its part-time employees to wait for its vehicles to arrive in situations where delay in transport might jeopardize the patient.

Accordingly, we find that no prohibited conflict of interest exists where Largo Fire Department paramedics also are employed by a private ambulance company providing emergency medical transport services within the City.