UNITED STATES DISTRICT COURT 

EASTERN DISTRICT OF MICHIGAN 

NORTHERN DIVISION 

TRI-TOWNSHIP AMBULANCE SERVICE,

SHEILA WHITT, and AUDREY PARKER,

Plaintiffs, 

Case Number 08-14622-BC

v. Honorable Thomas L. Ludington

NORTHEAST MICHIGAN MEDICAL 

CONTROL AUTHORITY, DEBORAH

DETRO-FISHER, and KERWIN FARMER,

Defendants.

____________________________________/ 

ORDER HOLDING IN ABEYANCE PLAINTIFFS’ MOTION FOR PRELIMINARY

INJUNCTION, DIRECTING SUPPLEMENTAL BRIEFING, AND SETTING HEARING

On October 30, 2008, Plaintiffs Tri-Township Ambulance Service (“TAS”), Sheila Whitt

(“Whitt”) and Audrey Parker (“Parker,” collectively “Plaintiffs”) filed suit against Defendants

Northeast Michigan Medical Authority (“NMMCA”), NMMCA’s Director, Deborah Detro-Fisher

(the “NMMCA Director”), and NMMCA’s Medical Director, Dr. Kerwin Fisher (the “NMMCA

Medical Director”). According to the complaint, TAS had transported patients by ambulance

between medical facilities. See generally dkt. # 1. Plaintiffs allege that Defendants have improperly

enforced a state regulation by requiring ambulance service providers to obtain a geographically

specific license from Michigan’s Department of Community Health (“MDCH”) prior to permitting

inter-facility transfers within Defendants’ jurisdiction. TAS, licensed by the MDCH to operate

within the jurisdiction of the Otsego County Medical Control Authority, contends that the

misinterpreted regulation restrains it from continuing to service a facility in NMMCA’s jurisdiction.

Whitt alleges that the interpretation has consequently deprived her mother, Parker, of TAS’s medical

transport services. Finally, Plaintiffs allege that Defendants’ conduct related to the denial of a
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license has violated, inter alia, their rights under the Fifth and Fourteenth Amendments of the United

States Constitution. 

Along with the complaint, Plaintiffs filed a motion for a temporary restraining order and

preliminary injunction. Dkt. # 2. On November 3, 2008, the Court denied Plaintiffs’ request for

temporary restraining order on the basis, inter alia, that Plaintiffs had not demonstrated irreparable

harm. Dkt. # 9. On November 18, 2008, the Court held a status conference to organize the

evidentiary issues that the parties seek to present concerning the merits of a preliminary injunction.

The parties did not present any proofs or arguments. On December 8, 2008, Defendants filed a

motion to dismiss the complaint. 

A 

The MDCH oversees and orchestrates “health policy and management of the [State of

Michigan’s] publically funded health service systems.” Department of Community Health,

http://www.michigan.gov/mdch (follow “About the Michigan Department of Community Health”

hyperlink). Approximately two million Michigan residents receive services from the MDCH

annually, including Medicaid recipients and mental health services. Id. In addition, the MDCH

coordinates with county and regional agencies to promote public health and safety. Id. Under this

authority, the MDCH and regional agencies regulate emergency medical services. 

Generally, the Emergency Medical Services Act (the “Act”), Mich. Comp. Laws §

333.20901, et seq., and MDCH regulations, Mich. Admin. Code r.§§ 325.22101 to 325.22217,

provide the framework for the licensing of life support ambulance services. The Act provides that

the MDCH shall designate authority to medical control authorities for local regulation of health

services, including ambulance providers. Mich. Comp. Laws § 333.20918(1). A medical control
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authority is administered by hospitals located within its geographical territory. Id. at §

333.20918(2). The hospitals select an advisory board, which appoints a medical director that “is

responsible for the medical control for the emergency medical services system” operated in the

medical control authority’s jurisdiction. Id. at § 333.20918(4). An ambulance provider, is

accountable to the medical control authority where the agency is licensed to operate. Id. at §

333.20918(6); § 333.20921 (1)(c). 

In addition, a medical control authority “establish[es] written protocols for the practice of

life support agencies . . . .” Id. at § 333.20919(1). With respect to protocols, the Act provides that

the medical control authority shall provide any “affected participant” an opportunity to request the

medical control authority to review the decision and the affected party retains the right to appeal an

adverse decision to the emergency medical services coordination committee for the state (“Statewide

Committee”). Id. at § 333.20919(4). A similar procedure exists for protocols adopted by the

MDCH. Id. at § 333.20919(5-7). 

The Act also requires ambulance providers to be licensed by the MDCH and provides the

MDCH shall issue an ambulance operator license to any party that submits a “proper application”

that satisfies the rules promulgated by the MDCH. Id. at § 333.20920(1-5); see also id. at §

333.20975 (authorizing MDCH to promulgate rules). The MDCH must approve or reject an

application within six months of its receipt. Id. at § 333.20935(1). If the application is merely

incomplete, the MDCH must notify the applicant of the deficiency within thirty days. Id. at §

333.20935(2). The MDCH will only approve an application “signed by the medical director

responsible for the service area . . . [t]he medical director signature shall serve as confirmation that

the medical control authority intends to provide medical control to the life support agency.” Mich.
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Admin. Code r.§ 325.22111(3); see id. § 325.22205(2) (“[M]edical director’s signature on . . .

application for licensure . . . affirms that the medical control authority intends to provide medical

control to the life support agency.”). The rules require the following process when a medical

director will not certify an application:

If the medical director refuses to sign the life support agency application for

licensure or relicensure, then the medical director shall notify the [MDCH] in

writing, within 5 business days, providing justification for denial. Refusal of a

medical director to sign a life support agency application shall result in denial

justification review by the [MDCH]. 

Id. § 325.22205(2).

Likewise, in the event that a medical control authority institutes disciplinary action against

a licensed ambulance provider, notice to the MDCH is also required. Mich. Admin. Code r.§

325.22126(2). Consequently, section 325.22126(4-5) establishes an appellate procedure for the

ambulance provider to challenge the decision. The ambulance provider is entitled to a review of the

decision by the medical control authority, the Statewide Committee, and eventually the MDCH. Id.

In the event the MDCH affirms the disciplinary action, it must provide a hearing consistent with the

Administrative Procedures Act, Mich. Comp. Laws § 24.271, et seq. Id. 

Pursuant to the authority established in the Act, the MDCH currently divides the state into

approximately sixty-six geographical areas for individual medical control authorities to locally

oversee emergency services. NMMCA is the medical control authority that serves Alpena and

Alcona counties, and parts of Montmorency and Presque Isle counties. TAS is not currently

licensed to operate in NMMCA geographical area. Defendants emphasize that the MDCH issues

licenses, while medical control authorities only certify applications. Dkt. # 13 at 12. 

B
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As introduced above, the interpretation of the Act concerning licensure sparked the dispute.

While the parties pleadings have not identified a specific statutory provision that the MDCH’s

interpretation is grounded on, it appears that the MDCH interpreted the Act to require an ambulance

operator to be licensed by a medical control authority where an inter-facility transfer begins or

terminates. The parties furnished a September 17, 2007 memorandum from the MDCH to the

medical control authorities, which concludes that the MDCH can not issue a license to an ambulance

provider solely authorizing inter-facility transfers. Id. at 10. Consequently, a medical control

authority “do[es] not have the authority to limit an ambulance operations application request for

licensure for the purpose of interfacility (sic) transfers only.” Id. 

On September 7, 2008, the MDCH held a seminar to provide an “update” of the applicable

rules and regulations. See dkt. # 13-5 at 3. A slide from the presentation provides the following

interpretation:

• Cannot license an ambulance operation for the purpose of interfacility (sic)

transfer only.

• An ambulance operation that chooses to conduct interfacility (sic) transfers

can only do so if the transfer begins or ends within their approved [medical

control authority].

Id. at 6. The presentation emphasizes two requirements contained in the statutory scheme. First,

ambulance licensure is based “upon a geographic service area.” Dkt. # 17-5 at 2. Second, the Act

requires that a licensed ambulance operator have a vehicle available at all times to respond to an

emergency within that geographic area. Id.; see 20921(1)(a) Apparently, the MDCH interpreted

these two requirements of the Act to be in conflict with the practice of issuing licenses for the

limited purpose of inter-facility transfers. Consequently, the MDCH concluded that it could not

issue limited purpose licenses. Dkt. # 13-5 at 9 (“Accordingly, it is the position of the [MDCH] that
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it may only license ambulance operations in accordance with [the Act]. And, there is no provision

in [the Act] or applicable administrative rules which would authorize the department to license an

ambulance operation for interfacility (sic) transfers.). 

Thereafter, the NMMCA Director issued a memorandum addressing the interpretation as

follows:

The [MDCH] – EMS Division recently issued a clarification of the statute which

regulates the licensing of emergency medical services (EMS) for the purpose of

providing interfacility (sic) transports of patients. The [MDCH] has made it very

clear that an ambulance service cannot conduct an interfacility (sic) transport of a

patient that does not begin or end within that agency’s medical control authority. As

a result, [TAS] has been advised by [Otsego County Medical Control Authority] that

they are in violation of the Public Health Code if they accept an interfacility transport

of a patient out of Alpena Regional Medical Center. 

Dkt. # 13-7 at 2. While the exhibits nor the pleadings explain the specific statutory provisions that

the interpretation is based on, it appears that the MDCH’s interpretation relies on the absence of a

provision permitting the licensure of inter-facility transfers. See dkt. # 13-5 at 7-9 (citing numerous

provisions from the Act, but emphasizing the absence of a provision allowing licenses for a limited

purpose); see also id. at 4 (requesting legal justification for interpretation). In any event, MDCH’s

interpretation obstructed TAS’s ability to perform certain inter-facility transfers. 

C 

At the status conference, the parties represented that NMMCA agreed to certify a limited

license that would permit TAS to continue to conduct inter-facility transfers to one facility within

NMMCA’s jurisdiction that TAS had traditionally serviced. TAS prepared an application for

licensure to be submitted to MDCH. Apparently, the NMMCA Medical Director signed the

application, providing the necessary certification for TAS to submit the application to the MDCH.

The application itself provided a section that indicated the “geographical service area,” requesting
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the “county” that the license was effective. TAS indicated the county to be Montmorency. The

NMMCA Director contends that NMMCA agreed to certify the single facility and that TAS should

have completed the box with the name of the facility only. According to Plaintiffs, the NMMCA

Medical Director certified the application before TAS completed the entire form. 

On July 21, 2008, the NMMCA Director sent an e-mail to a representative at the MDCH

requesting that it not process TAS’s application. The e-mail stated as follows:

On behalf of NMMCA and at the direction of the Alpena Regional Medical Center

Chief Operating Officer, I am requesting that you place a hold on the approval of any

changes to the [TAS] Part A portions of the MCA. Our MCA executive board is

scheduled to meet tomorrow at 2pm [sic] on this issue. I will email [sic] you with

the results immediately following that meeting.

Thank you in advance for your patience in this matter and the assistance you have

provided thus far. We have serious concerns about both the quality of care being

provided and whether or not there is a violation of statute and rules.

On July 22, 2008, the NMMCA Director sent a second e-mail to the same MDCH representative,

providing in part as follows:

I have returned from a meeting with our medical director, Dr. Tad Farmer, and the

Alpena Regional Medical Center Chief Operations Officer, Al Moe, where we

discussed the issue of licensing [TAS] to operate within out MCA. It was decided

that we do NOT wish to permit [TAS] to operate within our MCA at this time. A

letter to [TAS] detailing our rationale is being drafted and a copy of said letter will

be forwarded to your office . . . 

On July 24, 2008, a representative of the MDCH sent a facsimile copy of the application to

NMMCA Medical Director with the following note, “Per your request. Here is part 1 [of the

application] for Montmorency [County]. I won’t process their [application] until this is straightened

out.” Plaintiffs allege that the licensure application remains unresolved and that Defendants have

not provided any official notice concerning the application.

D
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In any event, two outstanding motions remain before the Court. First, Plaintiffs still seek a

temporary injunction. The motion for a preliminary injunction shall be set for hearing to permit

Plaintiffs an opportunity to advance proofs justifying the issuance of a preliminary injunction

pursuant to Federal Rule of Civil Procedure 65(a). Prior to the hearing, however, the parties shall

file supplemental briefing indicating any witnesses they intend to call, the anticipated subject of each

witness’s testimony, and the amount of time each witness shall testify. Second, Defendants filed

a motion to dismiss, and in the alternative, for summary judgment, which will be set for hearing 

Accordingly, it is ORDERED that Plaintiffs’ motion for a preliminary injunction [Dkt. # 2]

is HELD IN ABEYANCE. The parties shall appear for an evidentiary hearing on Plaintiffs’ motion

for a preliminary injunction [Dkt. # 2] and Defendants’ motion to dismiss [Dkt. # 17] on February

23, 2009 at 9:30 a.m.

It is further ORDERED that Plaintiffs shall submit a supplemental brief on or before

January 6, 2009. Defendants shall file a supplemental brief indicating any witnesses they intend

to call for rebuttal purposes on or before January 20, 2009. The briefs shall identify witnesses to

be called, the anticipated substance of testimony, and the estimated time necessary to examine each

witness. 

s/Thomas L. Ludington 

THOMAS L. LUDINGTON

United States District Judge

Dated: December 23, 2008
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PROOF OF SERVICE

The undersigned certifies that a copy of the foregoing order was served

upon each attorney or party of record herein by electronic means or first

class U.S. mail on December 23, 2008.

s/Tracy A. Jacobs 

TRACY A. JACOBS