Decisions on ambulance fees may hinge on paramedic suit

Claim over death challenges immunity

March 11, 2000|By Andrea F. Siegel | Andrea F. Siegel,SUN STAFF

Localities across Maryland are closely watching a malpractice case involving Baltimore paramedics that could pave the way for more local governments to bill for emergency ambulance trips.

In a case triggered by the death of Carlean Burley in 1995, the state's highest court will decide whether Baltimore can escape a lawsuit against its paramedics despite the fact that the city charges for ambulance service.

Some localities, fearful of such lawsuits, have decided not to charge for ambulance service, though local officials have long considered adding the fees and tapping into insurance dollars.

"One of the things that has motivated the charging is that people are covered by insurance," said David Bliden, executive director of the Maryland Association of Counties. "So if they are already covered, why shouldn't there be access to those dollars to be compensated for ambulance service?"

Debbie Rosen McKerrow, spokeswoman for CareFirst BlueCross BlueShield, said, "It's not like insurance companies print money in the basement. If we have to pay more, that becomes a cost that will probably have to be passed on to members."

State laws have been interpreted to say that charging for ambulance service is a trade-off: Governments can either charge and lose most of their immunity from lawsuits, or they can figure ambulance costs are covered by taxes and retain the legal shield.

State law permits civil lawsuits in cases of severe negligence, but that is extremely difficult to prove. Two immunity laws blunt general malpractice-type lawsuits, lawyers for Baltimore have argued.

That provision probably persuades some municipalities not to bill for ambulance service, a Court of Appeals judge said when the court heard arguments in the Baltimore case in January.

"If we go your way, we're going to have 24 subdivisions charging a fee. Taxes should pay for some services," Judge John C. Eldridge told John Amato IV, during arguments in January. Amato is the lawyer for the family of Burley, which has alleged that a Baltimore paramedic made a mistake that caused Burley's death.

"Is it that bad if they charge fees? I don't think it is. But that is a policy decision," Timothy L. Mullin Jr., a lawyer for Baltimore and its paramedic, said in a later interview.

In 1997, Burley's family sued the city and paramedic Kevin Williams for $400,000. The lawsuit contends that in 1995 Williams caused Burley's death by inserting a breathing tube into her esophagus, which leads to the stomach, instead of her windpipe, which leads to the lungs. Burley had been suffering shortness of breath when relatives called for an ambulance.

Baltimore Circuit Judge David B. Mitchell blunted the lawsuit in 1998, saying the city and paramedic were immune from suit unless Burley's family showed the paramedic and city were grossly negligent, which he said they had not done.

The family challenged that ruling in the Court of Special Appeals last year and won when the state's second-highest court ruled that, by charging for ambulance service, the city forfeited immunity.

Baltimore officials asked the state's highest court to hear the case.

Thousands of cities and counties around the country charge for ambulance service to recoup some costs. Maryland counties charging for ambulance service include Prince George's and Carroll.

Annapolis and Anne Arundel, Baltimore and Howard counties have considered charging for ambulance service.

"We looked at it a couple of years ago. But we would lose our immunity from lawsuits," said Paul G. Goetzke, Annapolis city attorney. "It wasn't worth it, because you don't get the money all the time, and we decided that what we might make could be wiped out with one good lawsuit."

If the city did not have to make a choice, the proposal might be attractive again, he said.

In Annapolis, a move to charge for ambulance service began in 1994, when the city estimated that, with a 40 percent collection rate and a billing company getting 25 percent of the take, it could net nearly $100,000 a year on some 3,000 patient trips, city documents show.

The plan began to wither after a 1995 opinion by the state attorney general that charging fees would jeopardize immunity from malpractice-type claims against paramedics. Efforts to change state law the next year, with the Maryland Municipal League and the Maryland Association of Counties behind it, failed.

The collection rate for ambulance charges is low. Baltimore averaged a 17 percent collection rate, and Washington, D.C., 40 percent, according to a 1994 Annapolis study. Baltimore's collection rate is approaching 30 percent now, said Battalion Chief Hector L. Torres of the Fire Department, which operates the city's ambulance service.

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