Opinion
NOT TO BE PUBLISHED
APPEAL from the Superior Court of San Bernardino County. No. CIVSS813505 Janet M. Frangie, Judge.
Ruth E. Stringer, County Counsel, and Alan L. Green, Deputy County Counsel, for Defendants and Appellants.
Elbert W. Muncy, Jr. for Plaintiff and Respondent.
OPINION
Codrington J.
I
INTRODUCTION
Appellants and defendants are Inland Counties Emergency Medical Agency (ICEMA), the County of San Bernardino, and Virginia Hastings (Hastings), ICEMA’s executive director. ICEMA is the joint powers EMS (emergency medical services) agency (Health & Saf. Code, § 1797.200) for the Counties of San Bernardino, Inyo, and Mono under Health and Safety Code section 1797 et seq., the Emergency Medical Services System and the Prehospital Emergency Medical Care Personnel Act.
Respondent and plaintiff Desert Ambulance Service, Inc. (Desert Ambulance) is the sole provider of ambulance services in the Barstow area under its contract with ICEMA. The City of Barstow was briefly included as a defendant below but it was dismissed and it is not a party to this appeal.
This case concerns Desert Ambulance’s contractual obligation to transport persons who have been detained under Welfare and Institutions Code section 5150 (section 5150) from an acute care hospital to a county mental health facility. In September 2008, ICEMA issued a directive to Desert Ambulance to transport “[b]ehavioral patients, regardless of whether or not they are on 5150 hold....”
The trial court granted Desert Ambulance’s motion for summary judgment and issued a permanent injunction, in which it enjoined defendants from directing Desert Ambulance to transport section 5150 detainees without an individual specifically authorized by section 5150 accompanying the transport. Defendants appeal from the court’s judgment.
We requested supplemental briefing on the issue of justiciability and ripeness. After independently reviewing the record, we conclude the trial court abused its discretion in granting summary judgment and a permanent injunction even though it based its decision on a set of undisputed, albeit limited, facts. In our view, the present dispute cannot and should not be resolved based on the record submitted to this court.
II
FACTUAL AND PROCEDURAL BACKGROUND
Although the material facts, as identified by the parties, appear to be largely undisputed, one difficulty with resolving the appeal is that the facts changed during the course of litigation in the trial court.
Under the 2004 contract between ICEMA and Desert Ambulance, the scope of service for the City of Barstow and surrounding areas includes 24-hour emergency ambulance services; critical care transport (CCT) services, as approved by ICEMA; and indigent transport services. The contract does not make any express provision for the transport of 5150 detainees.
Section 5150 et seq. governs involuntary civil commitment of persons who are dangerous or gravely disabled as a result of a mental disorder. Included are provisions relating to evaluation and screening of persons who are believed to be in need of involuntary civil commitment, one part of which is focused on those law enforcement and related persons who may be involved in that process. Welfare and Institutions Code section 5278 (section 5278) affords civil and criminal immunity to individuals authorized to perform section 5150 detentions. Those individuals include: “... a peace officer, member of the attending staff, as defined by regulation, of an evaluation facility designated by the county, designated members of a mobile crisis team provided by Section 5651.7, or other professional person designated by the county....” (§ 5150.)
In September 2008, ICEMA issued a directive that Desert Ambulance be required to transport “[b]ehavioral patients, regardless of whether or not they are on 5150 hold... [T]he EMS prehospital provider [Desert Ambulance] must respond, treat, and transport as needed.” Desert Ambulance’s CEO, Elbert W. Muncy, Jr. (Muncy), responded that Desert Ambulance “did not have legal authority to transport 5150s unless a Police Officer accompanied the ambulance.”
A. The Complaint
Originally, Desert Ambulance sued for an injunction against being compelled to provide transport of section 5150 detainees unaccompanied by a police officer. In particular, Desert Ambulance alleged the Barstow Police Department refused to transport persons subject to a section 5150 hold. Desert Ambulance alleged it could have potential legal liability for false imprisonment, assault, battery, and punitive damages. It asserted “a current dispute exists between DESERT and ICEMA whether DESERT has the legal authority to transport persons in custody under [section] 5150 and DESERT’s obligations... and who should pay for the ambulance bills in the event the person transported is unwilling or able to pay.” Desert Ambulance asked for a declaration by the superior court that Desert Ambulance “does not have the legal authority to transport a person who is in custody pursuant to [section 5150] unless accompanied by a law enforcement officer.” Desert Ambulance also asked the court to determine responsibility for ambulance bills incurred by a detainee “unwilling or unable to pay.”
B. Motion for Preliminary Injunction
In its motion for a preliminary injunction Desert Ambulance asserted it is a common practice for the Barstow police to bring potential 5150 detainees to the Barstow Community Hospital for a medical evaluation. If the hospital determines the person is subject to section 5150, it requests the police to transport him or her to a County mental health facility. Although police officers have the legal authority to detain such persons, the hospital and Desert Ambulance do not. (§ 5150.)
Desert Ambulance objected to transporting section 5150 detainees because of potential tort liability and because often it is not reimbursed. The county will not pay for nonemergency services and the detainees are often indigent. In 2001, Muncy, the owner of Desert Ambulance, decided that Desert Ambulance had no legal authority to perform section 5150 transports unless accompanied by a police officer. In 2001 and 2002, Desert Ambulance and Barstow entered into a settlement agreement, making the city responsible for transporting section 5150 detainees or paying Desert Ambulance for transport. Desert Ambulance has ceased to perform transports since that time.
According to a declaration submitted in December 2008 by Albert Ramirez, Jr., a lieutenant with the City of Barstow Police Department, the Barstow police were not refusing to transport section 5150 detainees. In fact, Barstow police were regularly transporting section 5150 detainees without the assistance of Desert Ambulance because Desert Ambulance refused to make any section 5150 transports at all.
The trial court denied Desert Ambulance’s motion for a preliminary injunction.
C. Motion for Summary Judgment
Defendants also filed a motion for summary judgment but it is not the subject of this appeal.
In support of its motion for summary judgment seeking a permanent injunction, Desert Ambulance filed a separate statement of 15 facts. ICEMA did not dispute any of the facts, except it offered clarification that it had previously understood that the Barstow police were refusing to accompany the transport of section 5150 detainees. Both parties now concede the Barstow police have not adopted a policy of refusing to transport section 5150 detainees.
Desert Ambulance also submitted Muncy’s declaration, in which he stated that, in September 2008, he was contacted by county employees, Randolph Brown and Diane Fischer, about problems transporting section 5150 detainees from Barstow Hospital’s emergency room. Muncy told Brown that Desert Ambulance would not transport such persons unless accompanied by a police officer because Desert Ambulance lacked “legal authority to detain someone against their will.” Muncy asserted his belief that ICEMA “intends to utilize mobile crisis teams [not law enforcement] to evaluate persons in the high desert.” It is unclear from the record whether mobile crisis teams are being used to transport section 5150 detainees or having difficulty doing so. Nevertheless, Hastings subsequently issued her written directive ordering Desert Ambulance to transport 5150 detainees.
Muncy speculated that “the driving factor in ICEMA issuing the directive, is to provide a means by which the San Bernardino County Mental Health Department will not have to transport 5150s they have taken into custody. This will shift the responsibility from COUNTY to the private sector ambulances.” Furthermore, “[i]n the last 30 years DESERT [h]as rarely been used to transport patients taken into custody pursuant to W&I C 5150. The exception was Barstow Police Department (BPD). [Sic.] Prior to 2001 BPD would utilize[] DESERT for 5150 transports. In 2001 DESERT determined that it was illegal to transport 5150s. Since 2001, BPD has transported the 5150s their police officers took into custody. Since 2001 I am not aware that DESERT transported any person on a 5150 hold unless accompanied by a police officer (including the time since this litigation was filed).” In other words, Barstow police were not refusing to perform section 5150 transports and Desert Ambulance had not performed section 5150 transports since 2001.
Hastings submitted her February 2009 declaration, in which she asserted that ICEMA considers section 5150 transports to be emergency transports, often involving medical emergencies. She also explained that her directive to transport section 5150 detainees had been prompted by Desert Ambulance telling her that the Barstow police were refusing to accompany section 5150 transports. She gave her opinion that “an order restraining enforcement of ICEMA’s 5150 directive to DESERT AMBULANCE can result in the imminent threat of irreparable harm to 5150 Detainees and the public in general.”
The trial court prepared a lengthy order granting summary judgment. It began by incorrectly stating that the Barstow police were refusing to transport section 5150 individuals. All the parties agree that the Barstow police are not actually refusing to transport section 5150 detainees. But the trial court concluded that, because Desert Ambulance is not authorized by law to detain a person under section 5150, it cannot be directed to transport a section 5150 detainee without “an individual specifically authorized by [Welfare and Institutions Code section] 5150 accompanying the transport.”
The trial court also noted that many other counties handle the issue of section 5150 transports differently. For example, in Kern County ambulance transport is not used for nonmedical section 5150 detainees except when restraints are used. In El Dorado County, a police officer must accompany a medical section 5150 detainee. Contra Costa County provides that the law enforcement officer and the ambulance provider should decide mutually whether the person should be transported by ambulance except where restraints are used in which case an ambulance is appropriate. Orange County suggests the ambulance provider should seek police assistance if a detainee tries to resist. Riverside County has contracted to reimburse ambulance providers for the cost of section 5150 transports.
The trial court noted that people other than law enforcement personnel can detain an individual under section 5150. The trial court further reasoned that, because the statute does not specifically identify ambulance personnel, it is “ambiguous.” The court decided that an ambulance provider is not authorized to make a detention under section 5150 and that an authorized person cannot delegate transportation of a detainee to an ambulance provider. Therefore, ICEMA could not order Desert Ambulance to transport a detainee without being accompanied by an authorized person. Hence, the trial court granted the injunction barring ICMEA from ordering Desert Ambulance to perform unaccompanied transports. The trial court did not order that a police officer accompany the transports, only an authorized person.
III
DISCUSSION
A. Standard of Review
“A trial court’s decision to grant a permanent injunction rests within its sound discretion and will not be disturbed without a showing of a clear abuse of discretion. (Shapiro v. San Diego City Council (2002) 96 Cal.App.4th 904, 912.) ‘The exercise of discretion must be supported by the evidence and, “to the extent the trial court had to review the evidence to resolve disputed factual issues, and draw inferences from the presented facts, [we] review such factual findings under a substantial evidence standard.” [Citation.] We resolve all factual conflicts and questions of credibility in favor of the prevailing party and indulge all reasonable inferences to support the trial court’s order. [Citation.]’ (Horsford v. Board of Trustees of California State University (2005) 132 Cal.App.4th 359, 390.)” (City of Claremont v. Kruse (2009) 177 Cal.App.4th 1153, 1180.)
“If the trial court misunderstands or misapplies the applicable legal standard, it has not properly exercised its discretion.” (People v. Millard (2009) 175 Cal.App.4th 7, 31, citing Horsford v. Board of Trustees of California State University, supra, 132 Cal.App.4th at p. 393.) “An exercise of discretion cannot be upheld when it is founded on incorrect legal premises. As the court said in Horsford[, at p.] 393: “‘But a reasoned decision based on the reasonable view of the scope of discretion is still an abuse of judicial discretion when it starts from a mistaken premise, even though nothing about the exercise of discretion is, in ordinary-language use of the phrase, “beyond the bounds of reason.”’ (Italics added.)” (Great West Contractors, Inc. v. Irvine Unified School District (2010) 187 Cal.App.4th 1425, 1459.)
B. Preliminary Considerations of Justiciability and Ripeness
We first consider whether the issues raised are sufficiently concrete to allow judicial resolution, even in the absence of a precise factual context:
“The ripeness requirement, a branch of the doctrine of justiciability, prevents courts from issuing purely advisory opinions. [Citation.] It is rooted in the fundamental concept that the proper role of the judiciary does not extend to the resolution of abstract differences of legal opinion. It is in part designed to regulate the workload of courts by preventing judicial consideration of lawsuits that seek only to obtain general guidance, rather than to resolve specific legal disputes. However, the ripeness doctrine is primarily bottomed on the recognition that judicial decisionmaking is best conducted in the context of an actual set of facts so that the issues will be framed with sufficient definiteness to enable the court to make a decree finally disposing of the controversy. On the other hand, the requirement should not prevent courts from resolving concrete disputes if the consequence of a deferred decision will be lingering uncertainty in the law, especially when there is widespread public interest in the answer to a particular legal question. [Citations.]
“A logical starting point for a discussion of the concept of ripeness is the following general statement from Aetna Life Ins. Co. v. Haworth (1937) 300 U.S. 227, 240-241: ‘The controversy must be definite and concrete, touching the legal relations of parties having adverse legal interests. [Citation.] It must be a real and substantial controversy admitting of specific relief through a decree of a conclusive character, as distinguished from an opinion advising what the law would be upon a hypothetical state of facts.’ A similar statement is found in Selby Realty Co. v. City of San Buenaventura (1973) 10 Cal.3d 110, 117, in which we discussed the availability of declaratory relief under Code of Civil Procedure section 1060: ‘The “actual controversy” referred to in this statute is one which admits of definitive and conclusive relief by judgment within the field of judicial administration, as distinguished from an advisory opinion upon a particular or hypothetical state of facts. The judgment must decree, not suggest, what the parties may or may not do.’ [Citation.] In the same vein, the Court of Appeal has observed: ‘The principle that courts will not entertain an action which is not founded on an actual controversy is a tenet of common law jurisprudence, the precise content of which is difficult to define and hard to apply.... A controversy is “ripe” when it has reached, but has not passed, the point that the facts have sufficiently congealed to permit an intelligent and useful decision to be made.’ (California Water & Telephone Co. v. County of Los Angeles (1967) 253 Cal.App.2d 16, 22.)” (Pacific Legal Foundation v. California Coastal Com. (1982) 33 Cal.3d 158, 170-171; Consumer Cause, Inc. v. Johnson & Johnson (2005) 132 Cal.App.4th 1175; Ebensteiner Co., Inc. v. Chadmar Group (2006) 143 Cal.App.4th 1174.)
Put most simply, Desert Ambulance does not want the responsibility of transporting section 5150 detainees unless it is compensated for the cost of transportation and for potential tort liability. The foundation for Desert Ambulance’s position is its assertion that it does not have legal authority to detain under section 5150 and it is not immune from tort liability to detainees under section 5278. Therefore, Desert Ambulance contends ICEMA cannot order it to transport the detainees without being accompanied by a person authorized under section 5150.
Desert Ambulance derives its argument from Hernandez v. KWPH Enterprises (2004)116 Cal.App.4th 170, 180-181. In discussing the liability of emergency service providers, Hernandez notedthat they could face a “Hobson’s choice” between conflicting liabilities because they are not authorized to detain pursuant to section 5150 and “‘“an involuntary detention... without consent would arguably constitute kidnapping, false imprisonment, or battery.”’” (Hernandez, at p. 181, citing Gonzalez v. Paradise Valley Hospital (2003) 111 Cal.App.4th 735, 741, citing Jacobs v. Grossmont Hospital (2003) 108 Cal.App.4th 69, 78.) Desert Ambulance echoes Hernandez, claiming that, if ICEMA requires it to transport section 5150 detainees, “... it could encourage the detention of individuals by persons not qualified or authorized by statute, and thereby contravene the policy of this state to discourage unnecessary interference with the freedom and rights of the mentally ill. (See Bragg v. Valdez (2003) 111 Cal.App.4th 421, 429-430.)” (Hernandez, at p. 181.)
As the parties concede, there is no actual dispute between the parties because Desert Ambulance does not and has not performed nonmedical section 5150 transports since 2001 and the Barstow police have not and are not refusing to perform section 5150 transports. No section 5150 detainee has sued or threatened to sue Desert Ambulance. Therefore, it is not threatened with tort liability. The only actual difficulty presented in the record was an incident in September 2009 when Desert Ambulance transported a juvenile section 5150 detainee to a Pasadena facility and did not have possession of the correct paperwork, the original section 5150 application for admission. Instead, the parties are asking that we resolve a hypothetical conflict that has not occurred.
If the trial court had been presented with an actual controversy, some of our questions may have been answered. But, when we requested supplemental briefing about justiciability and ripeness, the parties did not articulate any real disputes. Instead, the present case, as described by defendants, “centers on a variety of hypothetical, ‘what if’ situations.” For example, the record does not explain who is involved in the ambulance transport. Is Desert Ambulance conducting section 5150 transports when accompanied by a mobile crisis team member? Are the ambulance attendants or operators qualified under Health and Safety Code section 1797.160? (Canister v. Emergency Ambulance Service, Inc. (2008) 160 Cal.App.4th 388, 406: “An ambulance driver therefore must be an EMT or EMT trainee.”) Furthermore, how exactly is Desert Ambulance paid for its services? Does it receive any payments from the county or ICEMA for any of its transports? Can it be reimbursed for the transport of an indigent section 5150 detainee if that person also qualifies as a medical emergency?
The record also demonstrates that the issue of transport for section 5150 detainees is handled variously by different counties. The relief permitted in this case may contradict the contractual arrangements organized by other agencies and ambulance providers.
Based on the present record, we are not wholly convinced of the justiciability of the controversy between the parties. We acknowledge that the parties disagree about the scope of the contractual obligations owed by Desert Ambulance to defendants. But we still are not persuaded it is “a real and substantial controversy admitting of specific relief through a decree of a conclusive character, as distinguished from an opinion advising what the law would be upon a hypothetical set of facts.” (Aetna Life Ins. Co. v. Haworth, supra, 300 U.S. at p. 241.) It seems that the parties and the trial court have failed to account for too many variables in their arguments and the court’s decision. For that reason, we find the trial court abused its discretion in granting the specific injunctive relief it did to Desert Ambulance.
Although we decline to offer an advisory opinion, we note the California courts and the state Legislature have repeatedly endorsed policies that offer protective immunity to EMS providers. (Van Horn v. Watson (2008) 45 Cal.4th 322, 330; Eastburn v. Regional Fire Protection Authority (2003) 31 Cal.4th 1175, 1183-1185, and authorities cited therein; Tarasoff v. Regents of University of California (1976) 17 Cal.3d 425; Canister v. Emergency Ambulance Service, Inc., supra, 160 Cal.App.4th at p. 405; Cruze v. National Psychiatric Services, Inc. (2003) 105 Cal.App.4th 48, 56; Schaefer’s Ambulance Service v. County of San Bernardino (1998) 68 Cal.App.4th 581, 584 [Fourth Dist., Div. Two]; Health & Saf. Code, §§ 1799.104 [EMT-II or mobile intensive care paramedics], 1799.106 [EMTs], 1799.108 [prehospital emergency field care treatment], 1799.07 [public entities and emergency rescue personnel, 1799.110 [general acute care hospital and emergency care departments] and 1799.111 [general care hospitals]; Welf. & Inst. Code, § 5278.)
IV
DISPOSITION
We reverse the order and judgment of the trial court granting a permanent injunction against ICEMA ordering Desert Ambulance to transport section 5150 detainees without an individual specifically authorized by section 5150 accompanying the transport. The trial court is directed to dismiss the action. (Paul v. Milk Depots, Inc. (1964) 62 Cal.2d 129, 135.)
Defendants, as the prevailing parties, shall recover their costs on appeal.
We concur: Ramirez P.J. King J.