Kansas Attorney General Opinion 1992-095

ROBERT T. STEPHAN
ATTORNEY GENERAL July 15, 1992
ATTORNEY GENERAL OPINION NO. 92- 95
Bob McDaneld, Administrator
Board of Emergency Medical Services
109 S.W. 6th Street
Topeka, Kansas 66603-3805
Re: Public Health--Emergency Medical Services--Powers
and Duties of Emergency Medical Services Board
Synopsis: The board of emergency medical services sets
minimum standards for municipal ambulance
services. A municipality may set its own standards
which are more stringent than the board's. K.S.A.
1991 Supp 65-6117 does not require the municipality
to set standards or take any action other than that
which is necessarily incidental to applying for a
permit. Cited herein: K.S.A. 1991 Supp. 65-6110;
65-6111; 65-6117; 65-6125; 65-6127; 65-6131; 23
U.S.C. § 401, 26 U.S.C. S 3000, 23 C.F.R. § 1204.4.
Dear Mr. McDaneld:
As administrator for the board of emergency medical services
you ask our opinion concerning an apparent conflict between
K.S.A. 1991 Supp. 65-6117 and 65-6131 on one hand and K.S.A.
1991 Supp. 65-6110 and 65-6111 on the other. Specifically,
you ask (1) whether by virtue of K.S.A. 1991 Supp. 65-6117, a
municipality may establish ambulance service standards lower
than those set by the board and (2) whether K.S.A. 1991 Supp.
65-6117 mandates that a municipality establish regulations for
an ambulance service.

K.S.A. 1991 Supp. 65-6117 provides:
"If the governing body of a municipality
establishes an emergency medical service
or ambulance service as provided in this
act, it shall establish a minimum set of
standards for the operation of such
service, for its facilities and equipment,
and for the qualifications and training of
personnel."
K.S.A. 1991 Supp. 65-6131 provides:
"Nothing in this act shall be construed to
preclude any municipality from licensing
and regulating ambulance services located
within its jurisdiction, but any licensing
requirements or regulations imposed by a
municipality shall be in addition to and
not in lieu of the provisions of this act
and the rules and regulations promulgated
thereunder."
K.S.A. 1991 Supp. 65-6110 and 65-5111 describe the emergency
medical service board's powers and duties. K.S.A. 1991 Supp.
65-6110 provides, in relevant part:
"(a) The board shall adopt any rules and
regulations necessary for the regulation
of ambulance services. Such rules and
regulations shall include: (1) A
classification of the different types of
ambulance services; (2) requirements as to
equipment necessary for ambulances and
rescue vehicles; (3) qualifications and
training of attendants,
instructor-coordinators and first
responders; (4) requirements for the
licensure and renewal of licensure for
ambulances and rescue vehicles; (5)
records and equipment to be maintained by
operators and attendants and (6) such
other matters as the board deems necessary
to implement and administer the provisions
fo this act."

K.S.A. 1991 Supp. 65-6111 then goes on to describe other
powers and duties of the board, including approving training
programs for ambulance attendants.
Also relevant is K.S.A. 1991 Supp. 65-6125 and 65-6127 which
provide for ambulance permits. K.S.A. 1991 Supp. 65-6125
provides:
"It shall be unlawful for any person or
municipality to operate an ambulance
service within this state without
obtaining a permit pursuant to this act."
(Emphasis added).
K.S.A. 65-6127 then describes the procedure in obtaining a
permit. It provides, in relevant part:
"(a) Application for a permit to operate
an ambulance service shall be made to the
emergency medical services board by the
operator of the ambulance service upon
forms provided by the administrator and
shall be accompanied by a permit fee which
shall be a base amount plus an amount for
each vehicle used by such operator in such
operator's ambulance service and which
shall be fixed by rules and regulations of
the board to cover all or any part of the
cost of regulation of ambulance services.
"(b) The application shall state the name
of the operator, the names of the
attendants of such ambulance service, the
primary territory for which the permit is
sought, the type of service offered, the
location and physical description of the
facility whereby calls for service will be
received, the facility wherein vehicles
are to be garaged, a description of
vehicles and other equipment to be used by
the service and such other information as
the board may require."
The conflict, then, is apparent. On one hand, K.S.A. 1991
Supp. 65-6117 says a municipality shall establish minimum
standards. On the other, K.S.A. 1991 Supp. 65-5125 and
65-6127 unambiguously require the municipality to obtain a
permit from the board and K.S.A. 1991 Supp. 65-6110 and

65-6111 require the board to establish rules and regulations
setting forth requirements for obtaining such permits.
In order to resolve this apparent conflict, it is helpful to
review the history of regulation of ambulance services in
Kansas. Prior to 1974 regulation of ambulance services was
essentially up to municipalities. Kansas, however, was under
pressure by the federal government to establish uniform
standards for ambulance services and a state agency to
administer the standards. The pressure came in the form of
the highway safety act, 23 U.S.C. 401 et seq. which made
receipt of certain federal funds dependent on compliance with
certain highway safety program guidelines, one of which was
found at 23 C.F.R. § 1204.4, Guide 11, which provided, and
still provides:
"HIGHWAY SAFETY PROGRAM GUIDELINE
NO. 11
EMERGENCY MEDICAL SERVICES
"Each State, in cooperation with its local
political subdivisions, should have a
program to ensure that persons involved in
highway accidents receive prompt emergency
medical care under the range of emergency
conditions encountered. The program
should provide, as a minimum, that:
"I. There are training, licensing, and
related requirements (as appropriate) for
ambulance and rescue vehicle operators,
attendants, drivers, and dispatchers.
"II. There are requirements for types and
number of emergency vehicles including
supplies and equipment to be carried.
"III. There are requirements for the
operation and coordination of ambulances
and other emergency care systems.
"IV. There are first aid training
programs and refresher courses for
emergency service personnel, and the
general public is encouraged to take first
aid courses.

"V. There are criteria for the use of
two-way communications.
"VI. There are procedures for summoning
and dispatching aid.
"VII. There is an up-to-date
comprehensive plan for emergency medical
services, including:
"A. Facilities and equipment.
"B. Definition of areas of responsibility.
"C. Agreements for mutual support.
"D. Communication systems.
"VIII. This program should be
periodically evaluated by the State and
the National Highway Traffic Safety
Administration should be provided with an
evaluation summary."
Other funding was made available by the emergency medical
services systems act of 1973, now found at 26 U.S.C. § 300d
et seq.
The first statewide regulation of ambulance services arose
from the need to meet this and other federal regulation. A
special committee to the 1974 Kansas legislature in
recommending legislation stated:
"[T]he Committee came to realize the
importance of the establishment of an
emergency medical service program in the
State of Kansas. Through the program, a
more uniform system of delivery of
emergency medical services may be
developed, which can help ensure more
competent and efficient medical service."
The committee also specifically noted the necessity of
bringing emergency medical services into compliance with
federal requirements. See Report of Special Committees to
the 1974 Kansas Legislature, Proposal 103.

In 1974, the legislature passed two bills concerning ambulance
services. In L. 1974, ch. 244, the legislature expressly
granted municipalities the authority to establish ambulance
services and to levy taxes to support the services. In
section 5 of this act language now found at K.S.A. 65-6117 was
set forth, requiring the municipality to establish minimal
operational enactment services.
The legislature's other action in 1974 on ambulances was in L.
1974, ch. 366 which created in the office of the governor an
office of emergency medical services and an emergency medical
services advisory council composed of various persons
interested in the topic of emergency medical services. These
groups had no authority to regulate. Their mandated task was
to develop "a comprehensive plan for a statewide system of
emergency medical services;" including licensure standards and
procedures. The act expired after one year.
In 1975 the legislature established an office of emergency
medical services. See L. 1975, ch. 335. In this
enactment the legislature for the first time required
licensure of ambulance services. Section 4 required that by
certain dates in the future, depending on city size, it would
be unlawful to "operate an ambulance service without obtaining
a permit pursuant to his act." Section 6 required that the
office of emergency medical services not issue a permit unless
it found the ambulance service would be "staffed and equipped
in accordance with the rules and regulations promulgated by
the secretary of health and environment. . . ."
Despite the requirement to get the permit, this enactment did
not repeal K.S.A. 1974 Supp. 65-4305 at which was codified
L. 1974, ch. 244, § 5, giving municipalities the authority
to set minimum standards. What was the legislature's
intention in enacting L. 1975, ch. 335?
The minutes of the house transportation committee stated the
bill "would require operators in cities of 20,000 or more to
have a permit. Minutes, House Transportation Committee, March
24, 1975. The minutes of the senate transportation committee
make it clear that the legislature was worried about losing
federal funds if ambulance services aren't brought into
compliance. See Minutes, Senate Committee on Transportation
and Utilities, March 11, 1975.
Since 1974, the state governmental body that issues permits
and makes rules has changed several times, but the basic
requirements and issues remain the same. One thing is clear,

however; the legislature has intended since 1974 that
ambulance services obtain a permit to operate, and to obtain
this permit the service must meet the standards set forth by
whatever state governmental body is currently authorized to
perform this task -- currently the board of emergency medical
services.
This leaves the question of the purpose and effect of K.S.A.
1991 Supp. 65-6117. In a previous opinion addressing a
slightly narrower question, we said,
"In accordance with K.S.A. 1989 Supp.
65-6131, a municipality may impose
licensing requirements or regulations that
are in addition to but not in lieu of
licensing requirements or regulations
imposed by statute or regulations
promulgated by the board under the
statutes. The board's adoption of a
regulation endorsing the documents in
question as training aids in attendant
training programs establishes statewide
what will be taught. The municipality may
establish a minimum set of standards
(K.S.A. 1989 Supp. 65-6117) but these
standards must be in addition to those set
by the board."
See Kansas Attorney General Opinion No. 90-45.
In reference to your second question, whether a municipality
must establish minimum standards pursuant to K.S.A. 1991
Supp. 65-6117, when a municipality applies for a permit,
K.S.A. 1991 Supp. 65-6127(b) requires that the operator state
the type of service provided. If the municipality is the
operator, in complying with 65-6127(b) the municipality has by
necessity established minimum standards or, if the
municipality has contracted for service the contract
presumably establishes the level of service desired.
In essence, we do not view K.S.A. 1991 Supp. 65-6117 as a
mandate to take action, or pass an ordinance, but rather a
grant of authority (in connection with 65-6131) to establish
additional standards, and if additional standards are not
established, it is merely a statement of the obvious.
In conclusion, the board of emergency medical services sets
minimum standards for municipal ambulance services. A

municipality may set its own standards which are more
stringent than the board's. If the municipality chooses not
to set additional, more stringent standards, K.S.A. 1991 Supp.
65-6117 does not require the municipality to take any action
in addition to what it would normally do in obtaining a permit.
Very truly yours,
ROBERT T. STEPHAN
Attorney General of Kansas
Steve Phillips
Assistant Attorney General
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