Trinidad Area Health Association v. Trinidad Ambulance District.
2024 COA 113. No. 23CA0658. Special Districts—Service Plan Compliance—Declaratory Relief—Injunctive Relief.
October 17, 2024
Trinidad Area Health Association (the hospital) is a medical facility that serves residents of Trinidad and the surrounding areas. Trinidad Ambulance District (the ambulance district) is a special district under Colorado’s Special District Act (the Act) that provides ambulance services in the hospital’s region and is the only authorized ambulance service in Las Animas County. The ambulance district and the hospital have never operated under a formal contract. As a special district, the ambulance district must follow its approved service plan, which requires that it provide 24-hour coverage for the treatment and transportation of the sick or injured. In practice, the ambulance district has to respond to approximately 2,000 911 calls in the region and perform hundreds of interfacility transfers (IFTs) for the hospital each year. Due to an increase in long-distance IFTs and the resulting effect on crew availability, safety concerns caused by crew fatigue, and financial considerations, the ambulance district informed the hospital that it would no longer perform IFTs to Denver. It subsequently revised its policies to further restrict IFTs. To help alleviate crew availability concerns, the hospital entered into a 60-day agreement with the ambulance district to pay $50 per hour to any paramedic willing to perform IFTs while off duty. The ambulance district’s counsel subsequently sent a letter to the hospital to develop a contract that would make the hospital the payer of last resort for certain IFTs and restrict long-distance IFTs to specified hours. The hospital didn’t respond to counsel’s letter, but it filed a complaint against the ambulance district seeking declaratory and injunctive relief. It alleged that the ambulance district materially modified its service plan without proper approval by imposing restrictions on IFTs in violation of CRS § 32-1-207(2)(a). The hospital also moved for a preliminary injunction to enjoin the ambulance district from making unauthorized material modifications to its service plan without the requisite approval. The trial court ruled in the hospital’s favor on its claim for declaratory relief, concluding that the service plan requires the ambulance district to perform unrestricted IFTs with 24-hour coverage and that its attempt to restrict IFTs amounted to a reduction in services that constituted a material modification to its service plan. However, the court denied the hospital’s request for an injunction, determining that the ambulance district was continuing to perform IFTs for the hospital and that it had conformed to its service plan so far as practicable, given the increased number of long-distance IFTs and the resulting safety concerns.
The ambulance district initially appealed the trial court’s declaratory judgment, and the hospital cross-appealed the declaratory judgment and injunction denial. But the ambulance district voluntarily dismissed its appeal, so the only remaining claim was the hospital’s cross-appeal, in which it first argued that the trial court erred by concluding that it wasn’t practicable for the ambulance district to perform unrestricted IFTs as required by its service plan. Under § 32-1-207(1), after a special district is organized, the district must conform to its approved service plan “so far as practicable.” And under § 32-1-207(2)(a), a special district must obtain approval from the county or municipality that approved its original service plan for any “material modification” to that plan. As a matter of first impression, the court of appeals interpreted “practicable” to mean “reasonably capable of being accomplished” and “feasible in a particular situation.” The court thus concluded that under the Act, a special district must conform to its service plan unless under the totality of the circumstances the district’s compliance isn’t reasonably capable of being accomplished or isn’t feasible in the particular situation. Here, the trial court determined with record support that the ambulance district’s compliance with its service plan’s requirement to provide around-the-clock IFTs wasn’t practicable given bona fide safety concerns.
The hospital also contended that the trial court abused its discretion by denying its injunction request and leaving it no enforcement mechanism on the declaratory relief. Because this case was decided after a consolidated hearing on the hospital’s preliminary injunction motion and a trial on the merits under CRCP 65(a)(2), the court focused on the trial court’s decision denying the hospital a permanent injunction. First, the fact that the trial court granted the hospital only a declaratory judgment does not leave the hospital with no enforcement mechanism, because the hospital may yet seek further relief under § 13-51-112 and CRCP 57(h). And even if further relief weren’t available, the trial court did not abuse its discretion in denying a permanent injunction because the hospital failed to prove that irreparable harm would occur without an injunction.
The judgment was affirmed.