In a stark reversal of a ruling he made two years ago, San Bernardino County Superior Court Judge Jay H. Robinson on Wednesday gave clearance for a consortium of local fire departments working in coordination with an Arizona-based ambulance company to assume the franchise for emergency medical treatment and transportation over a vast swath of 21,105-square mile San Bernardino County.
Judge Robinson’s decision confirms county leadership’s curious departure from a longstanding pay-to-play tradition in which business interest have gotten ahead by a show of generosity toward the board of supervisors and other high-ranking elected officials throughout the county.
The company that lost out in the competition for the ambulance service contract,
Greenwood Village, Colorado-based American Medical Response, had been the beneficiary of the county’s granting of exclusive operating zones reserved for companies with owners who have succeeded in insinuating themselves into the good graces of the region’s shot-callers. Over the last three years-and-a-half years, the company and its officials, once consummate insiders, have had to adjust to the reality of being outsiders on the verge of permanently looking in. Whereas previously that company had been a primary beneficiary of the pay-to-play ethos that pervades San Bernardino County, it now finds itself among the legion of companies that are shut out of holding a position of commercial advantage because the county’s governmental decision-makers have been influenced by the generosity a competing interest has exhibited toward the region’s politicians.
American Medical Response, known by the acronym AMR, maintained in a legal challenge lodged more that three years ago that San Bernardino County and its board of supervisors improperly conferred a comprehensive franchise for the provision of ambulance service on the San Bernardino County Consolidated Fire Agencies, known by its acronym CONFIRE, a joint powers authority consisting of an operation combining the assets and manpower of the Apple Valley Fire Protection District, Chino Valley Independent Fire District, the Colton Fire Department, the Loma Linda Fire Department, the Rancho Cucamonga Fire Department, the Redlands Fire Department, the Rialto Fire Department, the San Bernardino County Fire District, the Victorville Fire Department, the Big Bear Fire Department, the Montclair Fire Department, the Running Springs Fire District and the San Manuel Fire Department. That decision by the board of supervisors, made on December 5, 2023, aced out AMR.
In that call, the board of supervisors sided with a coalition of local fire departments over AMR.
In making his decision this, San Bernardino County Superior Court Judge Jay H. Robinson reversed himself, undoing a court order that had extended AMR as the ambulance service franchise provider throughout much of the county for two years beyond what the board of supervisors had originally intended.
“This court must defer to county defendant’s selection of, and award to, CONFIRE as a lawful exercise of its discretion,” Judge Robinson wrote in a ruling that was released on Wednesday, September 30, when the decision was officially recorded as a part of the judicial proceedings in the matter.
For well over three decades, American Medical Response enjoyed a near monopoly on the provision of emergency medical transport service over a wide swath of San Bernardino County. AMR inherited that preeminence upon its buyout of Mercy Ambulance, which had effectuated its own monopoly on the county ambulance franchise. Mercy’s four owners – Homer Aerts, Don Reed, Steve Dickmeyer and Terry Russ – after engaging in the late 1960s and early 1970s in cutthroat competition against one another in the operation of their four independent ambulance companies, united under the Mercy logo. Employing Dennis Hansberger, who was then serving as a lobbyist between his first set of two and his final set of three terms on the board of supervisors, as their representative, Aerts, Reed, Dickmeyer and Russ used generous political donations to the sheriff, district attorney, members of the board of supervisors and mayors and council members of the county’s cities to obtain for Mercy Ambulance what were with only a few slight exceptions exclusive operating contracts throughout most of the county, a hold they solidified when in the 1980s they created an air ambulance wing that offered rapid service to the county’s remote desert areas.
Mercy had eliminated most or all of its competition throughout the county, particularly in the Inland and Central valleys and its incorporated cities and unincorporated area, from Chino to Montclair to Ontario to Upland to Rancho Cucamonga to Fontana to Rialto to Colton to San Bernardino to Grand Terrace to Loma Linda to Redlands. American Medical Response turned up in San Bernardino County in the very late 1970s, seeking to establish for itself a niche in the largest geographical county in the lower 48 states. At first AMR confined itself to servicing the wide-open expanse of the Mojave Desert, a place Mercy was willing to let the company operate, given that the calls were sporadic, drives were long and the profits marginal. At a certain point, American Medical Response was given the county franchise pertaining to unincorporated areas of the county, that is, those places other than where there were established cities.
Having expended their youth in the fight against one another and their early- and mid- middle age in perfecting their monopoly, by late middle age, Aerts, Reed, Dickmeyer and Russ were at last ready to enjoy the fruits of their constant efforts, at which point they were persuaded to sell out to AMR.
Through close observation of how Mercy had operated or corporate takeover osmosis or both, AMR’s executives, as soon as the company had established itself as San Bernardino County’s largest ambulance service provider, began to emulate Mercy’s formula of making hefty and consistent political donations to the county’s incumbent politicians, recognizing the ease with which San Bernardino County officials can be influenced in their decision-making process through contributions to their election campaigns.
For more than three decades, AMR enjoyed primacy as San Bernardino County’s main ambulance service provider, as the sheer volume of money it made through those operations advantaged it beyond all of its possible competitors so that it could make donations typically in the range of $5,000 to the members of the county board of supervisors and $1,000 donations to mayors and city council members per election cycle.
Coexistent with AMR holding the upper hand among ambulance service providers was the concept of exclusive operating zones, which had come into vogue prior to American Medical Response’s arrival in San Bernardino County.
Decades ago, San Bernardino County, 3,132-square mile Mono County and 10,227-square mile Inyo County, which together form a huge portion of California’s massive desert outback, had banded together to create the joint powers authority ICEMA – the Inland Counties Emergency Medical Agency – which oversees emergency service provision issues in San Bernardino, Mono and Inyo counties. In a show of uncommon trust, both Mono County and Inyo County agreed to allow the San Bernardino County Board of Supervisors serve as the governing board of ICEMA. ICEMA conferred upon American Medical Response favored status in San Bernardino County that would rival that of Mercy Ambulance a generation before.
In its wisdom, the ICEMA board came to the conclusion that there should be extensive areas in San Bernardino County, Inyo County and Mono County where one ambulance company has not only primacy but a virtual monopoly in that it, and only it, is authorized and licensed to function there under normal circumstances. In San Bernardino County, Mercy and then AMR filled that role.
The ostensible rationale for granting these monopolies is that operating ambulances is an expensive proposition, not to mention one that is crucial to public health and safety. Competition between ambulance companies has the potential, or so the reasoning goes, of driving down the prices those companies charge to the point that their operations will not be profitable enough for them to remain in business. Upon these ambulance companies going out of business, the public would be put into a position where there would be insufficient emergency medical transportation service available to ensure public safety. Thus, those arrangements – the exclusive operating zones – have been established.
In this way, San Bernardino County was divided – for purposes of ambulance service – into 26 exclusive operating zones.
Certain entities disputed that the exclusive operating zones are necessary, asserting the county’s politicians were using them as a ploy by which they filled their campaign coffers through inculcating a pay-to-play ethos into the county’s governmental function in which the company or companies favored with the exclusive operating zones made heavy contributions to their political benefactors in exchange for being granted that exclusive operational status. Some who criticized the existence of exclusive operating zones maintained the monopolistic system has long endangered public safety. One of those was the county’s firefighters’ union, known as Local 935, which as early as 2012 suggested the exclusive operating approach on occasion created shortages in the High Desert’s ambulance transport system.
For years, the county’s decision-makers ignored those warnings, responding that those shortages had never proven critical.
The overall situation with regard to emergency medical care in the field and emergency medical transport, however, has been gradually evolving for decades, with some of the more financially enabled jurisdictions in San Bernardino County having striven toward training their existing firefighting personnel with regard to lifesaving skills and rudimentary medical care, such that over the years fire departments, one by one, have made a practice of hiring firefighters who have taken fire science and paramedic courses at local community colleges.

The City of Ontario in the very late 1970s and early 1980s leapt ahead of virtually all of the governmental agencies in the region, with what was then its state-of-the-art emergency dispatch system. Multiple agencies on the west side of San Bernardino County contracted with Ontario to provide dispatch service, which was computer-assisted and run out of the basement of that city’s fire department headquarters.
Between 2014 and 2019, the San Bernardino County Consolidated Fire Agencies – i.e., CONFIRE – put into place an even more refined and advanced dispatch system, one that had features the Ontario Fire Department dispatch system lacked. Consequently, many of the fire departments that had previously contracted with the Ontario Fire Department to handle their dispatch function allowed those contracts to elapse in favor of having CONFIRE take on that function.
In 2022, with the near monopoly that the private sector/for-profit ambulance companies had on certified/licensed paramedics in San Bernardino County in the 1970s, 1980s and 1990s having come to an end, the county entertained the concept of making two radical departures from its past practices with regard to ambulance service provision: 1) dispensing with merely “rolling over” what the county referred to as “a grandfathered process” that conferred most of the ambulance franchises on AMR by doing away with the exclusive operating zone concept entirely through opening up the bidding process and 2) considering public agencies as potential providers of ambulance service.
After seriously considering that option, the county on December 20, 2022 released a request for proposals – a solicitation of bids – inviting prospective providers to offer ground ambulance service in 11 of the county’s 26 exclusive operating areas.
In what was a disappointment to many, no other private ambulance company than AMR responded to the request. Of note, however, San Bernardino County’s Consolidated Fire Agencies – CONFIRE – also responded.
In its response to the solicitation for bids, AMR stated it could commit 12,889 weekly unit hours to respond to calls, had 111 ambulances available during peak system demand and stationed throughout the service area backed with 39 additional available ambulances available to meet surges. It emphasized that it was the current provider of the services with vehicle infrastructure in place and 10 managers and 18 field supervisors and a medical director familiar with the comprehensive needs of the service area. The company offered rates of $3,958 for both basic life support and advanced life support, $2,834 to carry out an interfacility transport, and $4,392 for critical care transport.
In its response to the solicitation, CONFIRE said it would subcontract with Priority Ambulance, which also serves Maricopa County in Arizona and therefore could devote 10,371 weekly unit hours to respond to calls, had 93 ambulances available at peak demand, with 45 additional ambulances available to meet surges throughout the service area and that it will establish ambulance staging locations, put on-board personnel in place and acquire vehicles upon receiving the contract. It offered an assurance that it has leadership and management to meet the demands of providing the service, including nine managers and 18 operations supervisors as well as a medical director and that it controls the regional emergency services communication system. Its proposed rates for its advance life support service were $3,547 for non-emergency and interfacility transfer, $4,053 for emergency transport, $2,533 for non-emergency basic life transport and $3,167 for emergency basic life transport and CCT $5,067 for critical care transport.
What the county referred to as an “independent review panel” made up of four evaluators individually scored each proposal on 14 key areas – system requirements, response time standards, clinical performance, deployment plans, vehicles, medical supplies and equipment, personnel, hospital and community requirements, disaster preparedness/response, quality management, electronic patient care reports, centralized emergency medical dispatch capability, financial and administrative requirements qualifications and future system enhancements – for the purpose of making a recommendation to the county for the final negotiation of contract terms. The total cumulative scores, against a standard with 1,720 points maximum, favored AMR, which registered 1,519 total points against 1,515 points for CONFIRE.
There was some nuance to the scoring, in that one of the evaluators favored AMR by 35 points, 419 to 384, while the other three evaluators found in favor of CONFIRE by scores of 383 to 373, 363 to 346 and 385 to 381.
With the competition having ended in a dead heat, the institutional bias within a governmental entity – the county – in favor of a consortium of governmental entities – CONFIRE – which was competing with a private sector entity was soon evident. Of no little import was that one of CONFIRE’s constituent agencies was the county fire division. Nor did it hurt CONFIRE’s case that when it came to handing out political donations, the union representing the firefighters with the Apple Valley Fire Protection District, the Chino Valley Independent Fire District, the Colton Fire Department, the Loma Linda Fire Department, the Rancho Cucamonga Fire Department, the Redlands Fire Department, the Rialto Fire Department, the San Bernardino County Fire District, the Victorville Fire Department, the Big Bear Fire Department, the Montclair Fire Department, the Running Springs Fire District and the San Manuel Fire Department and the firefighters themselves had proven every bit as and even more generous than AMR.
There was also, county officials said, a financial incentive in choosing CONFIRE that did not exist in allowing AMR to keep the ambulance franchise.
Assembly Bill 1705, passed in 2019, allows an ambulance service provider operated by a governmental entity such as the state, a county, a city or fire protection district to receive a supplemental Medi-Cal reimbursement when the patient being transported is a Medi-Cal recipient, this in addition to the payment the provider would otherwise receive for that service. So, by contracting with a government-operated provider like CONFIRE, the county would be able to capture those supplemental Medi-Cal payments, whereas if the county contracted with a private sector provider such as AMR, it would not be eligible for such reimbursements. Thus, the added “value” of the arrangement involving CONFIRE dictated that the county contract with it rather than AMR, according to county officials
On October 27, 2023, the county emailed AMR a notice of intent to recommend that it be awarded a contract extension from the time its current contract expired on March 31, 2024 from April 1, 2024 through September 30, 2024 to allow CONFIRE to get prepared to take on the contract for an initial term from October 1, 2024 through September 30, 2029.
AMR lodged a protest, alleging the county had failed to follow the selection procedures, did not adhere to requirements specified in the request for proposal, had awarded the contract to the entity which had lost in the competition and that it had otherwise violated state and/or federal law.
At the December 5 board of supervisors meeting, Supervisor Jesse Armendarez seconded by Supervisor Curt Hagman, based on County Purchasing Agent Ariel Gill’s review of AMR’s protest and recommendation that it should be denied, made a motion to deny the protest from American Medical Response and award the contract to Consolidated Fire Agencies and its private subcontractor Priority Ambulance. That vote passed unanimously.
AMR sued, which suspended CONFIRE’s takeover of the ambulance franchise and perpetuated American Medical Response’s continuing delivery of the service while the matter was being litigated
On October 2024, Judge Robinson ruled in favor of AMR, stating that the county “By inventing a new procurement process… willingly broke free from the constraints of a state-approved process.” He questioned the county’s rationale for overriding the evaluation panel’s 1,519 to 1,515 ranking in favor of AMR call of the evaluation panel in favor of AMR. ‘“This decision amounted to an evidence-free policy change of ambiguous motivation,” Robinson state in granting AMR a preliminary injunction blocking the takeover.
In December 2025, the Fourth Appellate District Court of Appeals made a published finding reversing Judge Robinson, reversed his restraining order. In May 2026, an injunction preventing the county from having CONFIRE take over ambulance services was lifted by the court.
On Tuesday September 29, Judge Robinson noted that the county was jumping the gun in stating that as of midnight, October 1, CONFiIRE, in conjunction with Priority would become the county’s ambulance service provider. That decision, the judge noted was set to be made on September 30. Nevertheless, he said, the public interest was served by there being no interruption in emergency services, and he refused to grant a temporary restraining order AMR had requested on September 25 that would have suspended the CONFIRE takeover beyond Thursday.
On Wednesday, September 30, Judge Robinson issued the decision that had been anticipated by the county, when he stated on the record that “The court finds it erred in its principal holding that the EMS Act and the RFP [request for proposals] imposed ministerial duties on [the] county defendants. The court further finds it erred in its secondary holding that county defendants abused their discretion in awarding CONFIRE the contract. Consequently, the court reconsiders its final order and hereby denies AMR’s petition for writ of mandate.”