CEO 86-34 -- May 15, 1986

CONFLICT OF INTEREST

CITY DEPARTMENT OF PUBLIC SAFETY EMPLOYEES' INVOLVEMENT WITH PRIVATE AMBULANCE COMPANIES

To: (Name withheld at the person's request.)

SUMMARY:

A prohibited conflict of interest would be created were paramedics or EMT's assigned to either rescue units or combat units within a city department of public safety to have any employment or contractual relationships with a private ambulance company doing business within the city. However, Section 112.313(7), Florida Statutes, would not prohibit involvement with a private ambulance company if the responsibilities of an employee of the public safety department do not involve contact with patients. In addition, based on the exemption of Section 112.313(12)(a), Florida Statutes, where business is transacted under a rotation system, no prohibited conflict of interest would be created were paramedics with the department to be employed privately as paramedics for air transport units operated in the city, where requests for air transport services are handled on a rotation basis. Previous opinions CEO 81-76, CEO 84-19, and CEO 84-47 are referenced.

In your letter of inquiry you question whether a number of employees of the City of Jacksonville Department of Public Safety have a prohibited conflict of interest by virtue of their involvement with private ambulance companies doing business within the City. In CEO 81-76 we found that a captain employed by the City Fire Protection Division as a member of a rescue unit could not own and be an officer of a private ambulance service operating within the City. We concluded that his employment and contractual relationship with the ambulance service would present a continuing or frequently recurring conflict of interest and would impede the full and faithful discharge of his public duties as an emergency medical technician, in violation of Section 112.313(7), Florida Statutes. Our conclusion was based on the fact that as an employee in a rescue unit, the captain was in a position to make referrals to his private ambulance service on a frequently recurring basis and to obtain additional business for his company during the course of his duties in determining whether a patient was an emergency case or a nonemergency case. Following that rationale, in CEO 84-19 we advised that Section 112.313(7) prohibited a firefighter engineer or lieutenant employed by the City Fire Protection Division as a member of a rescue unit from owning a private ambulance service operating within the City. However, in CEO 84-47 we advised that a firefighter engineer employed as a combat fireman was not prohibited from owning a private ambulance service operating within the City. In that opinion we found a significant distinction between the duties of a firefighter in a rescue unit, who was authorized to decide whether the patient's condition required transportation by the rescue unit or by ambulance, and the duties of a firefighter in a combat unit, who at that time was authorized only to perform whatever medical services might be necessary or to allow a rescue unit to evaluate the condition of the patient and decide what transportation was appropriate.

You now advise that each call for medical assistance is handled by dispatching both the closest combat company and an advanced life support (ALS) transport unit (a rescue unit). Combat companies will provide one of two levels of response. First, most companies will have an EMT or paramedic aboard, but will not have any equipment except for oxygen and that needed for basic trauma. Secondly, two units will be advanced life support, nontransport units, with all ALS equipment and a paramedic and EMT on board.

There will be fifteen units designated as basic life support (BLS) units which will be combat units with EMT's assigned to every shift. These units are to have additional equipment for handling extreme emergency cases, as well as for triaging patients for referral to commercial ambulance companies. The capability of these combat units will allow them to turn back ALS transport units and to allow commercial ambulances to be used for transportation.

In our view, this change in the procedures of the Department and in the responsibilities of combat firefighters is significant. Now, unlike previously, both combat firefighters and rescue unit firefighters will be in a position to make referrals to a private ambulance service and to obtain additional business for an ambulance company during the course of their duties in determining whether a patient is an emergency case requiring ALS transportation by a rescue unit or a nonemergency case, in which situation the patient is responsible for arranging his transportation to the hospital by a private ambulance.

QUESTION 1:

Would a prohibited conflict of interest be created where a paramedic with a rescue unit is employed as a paramedic on a flight crew for one of two private air transport units operating in the county?

This question is answered in the negative, under the circumstances presented.

In your letter of inquiry you advise that Paramedic Louie Iturra, Captain C. R. Sealey, and Paramedic Hugh Chancey are assigned as paramedics to provide ALS patient care on a 24 hours-on/48 hours-off basis. They provide ALS care to critically injured and ill patients and transport these patients directly to a hospital. On their off- duty hours, they also are employed as paramedics on a flight crew for one of two private air transport units operating in the City and surrounding counties. However, a flight crew member is denied the ability to refer a patient for transportation to a hospital, as the Department maintains a top-of-the-list rotation of the two air transport providers.

Section 112.313(12)(a), Florida Statutes, creates an exemption to the prohibition of Section 112.313(7) where:

Within a city or county the business is transacted under a rotation system whereby the business transactions are rotated among all qualified suppliers of the goods or services within the city or county.

This provision indicates that no prohibited conflict of interest would be created by virtue of an officer's or employee's involvement with a private entity where the services provided by the private entity are rotated among the suppliers of the service within the City or County. As you have advised that the City maintains a rotation system for referrals to air transport providers, we are of the opinion that this exemption is applicable here.

Accordingly, we find that no prohibited conflict of interest would be created where paramedics with the Department of Public Safety are employed privately as paramedics for air transport units operated in the City, so long as requests for air transport services are handled on a rotation basis.

QUESTION 2:

Does a prohibited conflict of interest exist where paramedics employed by the department of public safety to provide ALS patient care are employed as paramedics for a private ambulance company?

This question is answered in the affirmative.

In your letter of inquiry you advise that Paramedic John Wright and Paramedic Jamie McNair are assigned as paramedics within the fire/rescue directorate and provide ALS patient care on a 24 hours-on/48 hours-off basis. In this capacity, they triage ill and injured patients who request assistance. Patients who are considered to be stable and not to require expedient transportation to a medical facility are referred to a commercial BLS provider (an ambulance company). You also advise that these individuals are employed privately as paramedics for a local ambulance company.

In accordance with the rationale of CEO 81-76 and CEO 84-19, we find that a continuing or frequently recurring conflict of interest would be created by virtue of these paramedics' private employment with an ambulance company. Accordingly, we find that a prohibited conflict of interest exists by virtue of the employment of these paramedics with the private ambulance company.

QUESTION 3:

Does a prohibited conflict of interest exist where a shift officer on an ALS transport unit with the Department of Public Safety holds a position with a local ambulance company?

In your letter of inquiry you advise that Lieutenant U. Sharp is assigned as a shift officer aboard an ALS transport unit (rescue unit) for the Department of Public Safety. He is responsible for providing ALS patient care on a 24 hours-on/48 hours-off basis. While on duty, he triages and treats patients. Critically ill and injured patients are transported by an ALS unit, while patients who are stable and do not require expedient transportation to a medical facility are referred to a private ambulance company.

You feel that the Lieutenant may hold a position with a local ambulance company. He states that he "does not take any money from the company and only fills in once in a while." According to the Lieutenant, his mother is the owner of the company and recently received an operating permit for a wheelchair company. You have received information that the Lieutenant has solicited business for these companies and has introduced himself as the president of the ambulance company.

We are authorized to issue an advisory opinion to a public officer or employee who has the power to hire or terminate employees and who submits in writing the facts of the situation. Section 112.322(3)(a), Florida Statutes. Our responsibility, then, is to determine whether a conflict of interest exists under the Code of Ethics based on the particular factual situation presented. As the facts of this situation apparently are in dispute, we therefore are unable to provide a conclusion as to whether the Lieutenant's relationship with the private ambulance company is prohibited.

However, we would note that Section 112.313(7) addresses "any employment or contractual relationship." Further, we would note that any use of the Lieutenant's position to refer patients to the ambulance company could constitute a misuse of public position in violation of Section 112.313(6), Florida Statutes.

QUESTION 4:

Does a prohibited conflict of interest exist where an EMT assigned to a combat unit is the president of a private ambulance company within the city?

This question is answered in the affirmative.

In your letter of inquiry you advise that Firefighter/Engineer Robert Assaf is assigned to a fire combat unit as an EMT. EMT's assigned to these units are responsible for triaging and treating ill or injured patients. Referral to a commercial BLS provider is suggested for patients who do not require emergency treatment, but who require hospitalization, further evaluation, or additional care. In these cases, the EMT or paramedic aboard these units has the prerogative to cancel the responding fire/rescue ALS unit and to refer the patient to a private ambulance company. You also advise that the Firefighter/Engineer is president of a local ambulance company.

As stated at the beginning of this opinion, the present authority of firefighter/engineers in combat units is such that we find no basis to distinguish their responsibilities from those of firefighter/engineers in rescue units. Therefore, in accordance with the rationale of CEO 81-76 and CEO 84-19, we find that the Firefighter/Engineer's employment as president of a private ambulance company within the City presents him with a continuing or frequently recurring conflict of interest in violation of Section 112.313(7), Florida Statutes.

Accordingly, we find that a prohibited conflict of interest exists where a firefighter/engineer assigned to a combat unit as an EMT is the president of a private ambulance company.

QUESTION 5:

Does a prohibited conflict of interest exist where a firefighter/engineer assigned to a combat unit as an EMT is employed by a private ambulance company during his off- duty hours?

This question is answered in the affirmative.

In your letter of inquiry you advise that Firefighter/Engineer George Blackwell is assigned to a fire combat unit as an EMT and provides the same triage and treatment services as were outlined in Question 4, above. You also advise that the Firefighter/Engineer is an employee of a private ambulance company during his off-duty hours.

Based on the rationale of our response to your fourth question, we find that a prohibited conflict of interest exists where a firefighter/engineer assigned to a combat unit as an EMT is employed by a private ambulance company during his off-duty hours.

QUESTION 6:

Does a prohibited conflict of interest exist where a captain with the department of public safety assigned to the department's training academy is the owner of a private ambulance company doing business within the city?

This question is answered in the negative.

In your letter of inquiry you advised that Captain H. S. Sellers is assigned to the Department's training academy and trains combat firefighters in BLS techniques. In this position he has no contact with patients. You also advise that the Captain owns an ambulance company operating within the City. Finally, you advise that the Fire Protection Division is a part of the Department of Public Safety, which is the regulatory agency for private ambulance companies in the City. You question whether the Captain is prohibited from owning the ambulance company because of the Department's regulatory authority.

Based on the rationale of CEO 84-47, we are of the opinion that the Captain's ownership of a private ambulance company while being assigned to a position which has no contact with patients does not present him with a continuing or frequently recurring conflict of interest. However, Section 112.313(7) also prohibits a public employee from having any employment or contractual relationship with a business entity which is subject to the regulation of his agency.

In a telephone conversation with our staff, you advised that the Department of Public Safety basically is divided into the administrative and regulatory services directorate and the fire/rescue directorate. The fire/rescue directorate is divided into five divisions: the Operations Division (combat); the Rescue Division (emergency medical transportation); the Training Division, within which the Captain is employed; the Services Division; and the Fire Prevention Division. Both you and a member of your staff advised that one individual within the Department has been responsible for seeing that State rules, regulations, and standards are met for ALS and BLS vehicles and for handling complaints. That individual currently is assigned to the Services Division. This individual works with State inspectors who are responsible for licensing private ambulance companies. If significant violations are found, the Director can suspend a company's certificate of convenience and necessity and the City can revoke the company's certificate, in conjunction with State regulatory activities.

Section 112.316, Florida Statutes, provides:

Construction. -- It is not the intent of this part, nor shall it be construed, to prevent any officer or employee of a state agency or county, city, or other political subdivision of the state or any legislator or legislative employee from accepting other employment or following any pursuit which does not interfere with the full and faithful discharge by such officer, employee, legislator, or legislative employee of his duties to the state or the county, city, or other political subdivision of the state involved. [Section 112.316, Florida Statutes (1985).]

In our view, as the Captain has no regulatory responsibilities over his private ambulance company and is employed within a different division of the fire/rescue directorate, the Captain's interest in the company does not interfere with the full and faithful discharge of his public duties. Accordingly, we find that no prohibited conflict of interest exists where a captain assigned to the Department's training academy owns a private ambulance company which operates within the City.

QUESTION 7:

Does a prohibited conflict of interest exist where a dispatch supervisor in the emergency operations center of the fire/rescue directorate is the spouse of the owner of a private ambulance company?

This question is answered in the negative.

In your letter of inquiry you advise that Ms. Kathy Wallace is a Dispatch Supervisor in the Emergency Operations Center for the fire/rescue directorate. You are concerned that the Dispatch Supervisor's availability to screen a call in the geographic location of her spouse's business and to suggest that a commercial ambulance be used may constitute a possible conflict of interest.

Section 112.313(7) prohibits public employees from having certain types of conflicting employment or contractual relationships. You have provided no indication that the Dispatch Supervisor has any employment or contractual relationship with her spouse's business. Accordingly, we find that no prohibited conflict of interest exists by virtue of her employment as a Dispatch Supervisor while remaining married to the owner of a private ambulance company. However, as we noted above in our response to your third question, any use of position to refer patients to that ambulance company could constitute a misuse of public position in violation of Section 112.313(6), Florida Statutes.