Local governments that charge for ambulance service keep their immunity from most malpractice-type lawsuits against paramedics, the state's highest court ruled yesterday in a Baltimore case closely watched by area municipalities.
In a split decision, the majority of the Court of Appeals held that rescue workers are immune from the lawsuits. The possibility that governments might lose their immunity by making patients pay for paramedics has been a key factor in keeping many jurisdictions from charging for ambulance service.
The ruling stemmed from a city case in which the family of 62-year-old Carlean Burley alleged that a city paramedic's action in 1995 cost the woman her life.
City officials said yesterday that they had not seen the ruling.
Even with the decision, it is unclear how attractive charging for ambulance runs will become, said David Bliden, executive director of the Maryland Association of Counties.
"Obviously, this takes the lawyers out of the mix, in that with increasing liability not being an issue, the question of charging a fee for service becomes a pure policy decision to be made by the local officials," he said.
Also figuring into the decision are such issues as the cost of a billing program, whether charging would be politically costly, how to bill so that only insurance fees would be expected as payment, the fiscal landscape of the jurisdiction and whether officials could realistically expect to bring in enough money to make it worthwhile.
Jurisdictions that bill for services generally do so to tap into insurance dollars. If more localities bill, insurers can expect to pay out more ambulance charges.
Area governments that charge have a low collection rate. Baltimore's collection rate is nearly 30 percent, and Washington's is about 40 percent.
In 1994, Annapolis considered ambulance fees. The danger of losing immunity to make $100,000 a year - a sum that could be more than wiped out with one lawsuit - was one reason the plan withered. The politics and mechanics of billing were others.
Annapolis City Attorney Paul G. Goetzke, who had lobbied the General Assembly to extend "good Samaritan" protection to rescue workers employed by governments that charge for ambulance runs, praised the ruling and said he will alert city officials to it.
"I think that this decision is extremely important to all local governments," he said. "Local governments may now decide to charge for paramedic services, thereby shifting the cost of those services from the general tax base to the user."
Last year, the Anne Arundel County Council voted to start charging but reversed that position, because of fears about losing lawsuit immunity and because of billing and cost issues.
The ruling "changes the picture somewhat," said Daniel Klosterman, chairman of the council. "But don't forget, there were other issues."
A 4-3 majority of the Court of Appeals held that one of two state laws grants immunity to fire and rescue departments, paid and volunteer, though the minority rejected that view. The majority said it did not need to get into the "good Samaritan" law, which protects volunteers, and overturned a Court of Special Appeals ruling.
"I just can't see this as the end, even though it can very well be," said Sharon E. Chase, the youngest of Burley's daughters. She said she and her sisters want to know whether he had the skills necessary for the emergency.
In 1997, Burley's family sued the city and paramedic Kevin Williams for $400,000. The lawsuit contends that Williams inserted a breathing tube into Burley's esophagus, which leads to the stomach, instead of into her windpipe, which leads to the lungs. Burley had been suffering shortness of breath when relatives called for an ambulance.