Today’s post revisits the issue of paying for ambulance services and in fact first appeared as a comment on the posts Paying for ambulance services (October 4, 2014) and Ombudsman investigates Ambulance Victoria’s practice of charging for non-transport services (June 13, 2019). The comment was:

I called 000 in suburban Vic[toria] as I was home alone, it was 4am and I needed medical advice about scary nausea and vomiting, I repeatedly said do not call an ambulance and asked if there was any other way of seeking medical advice regarding if I should go to a hospital. Call taker signed me up and put me on a waitlist to speak with a GP via teleconference (they must refer to this 24hour GP service) but it would be a 60 min wait time. I fell asleep before the teleconference with this 24 hour GP and awoke to 2 paramedics knocking on my door at 8am saying it was unresolved on their system so they were sent to check on me. They took my vitals and details and now I have been invoiced despite not authorizing any ambulance service? Can I make a VCAT claim?

Important Disclaimer

This is of course not the place for legal advice. My correspondent should seek advice from a lawyer practising in Victoria – eg a community legal service – to get specific advice on their particular circumstances as well as advice on how to respond to any claims from AV and local advice about the jurisdiction and practices of VCAT and the Victorian Magistrates Court. They should not rely on what follows to make any decision on how to resond to any claim for payment from Ambulance Victoria (AV).

Ambulance fees

The right of Ambulance Victoria to charge, and the obligation to pay, for ambulance services is set out in the Ambulance Services Act 1986 (Vic). Section 16(a) says ‘An ambulance service may— (a) charge reasonable fees for services rendered…’ The Secretary of the Department of Health and Human Services may ‘give directions to an ambulance service relating to— (a) the fees that the service may charge…’ (s 10(5)). The fee schedule is available at https://www.health.vic.gov.au/patient-care/ambulance-fees and see also https://www.ambulance.vic.gov.au/transport/transport-faqs/.

Section 10(8) says:

If a person has been transported by an emergency ambulance service, the fee charged under a direction given by the Secretary under subsection (5)(a) for that service, is payable by that person whether or not the person consented to the provision of the service.

Although there is a fee for ‘Treatment Without Transport’ (currently $586) there is no clear statement – no equivalent of s 10(8) – to say who, if anyone, has to pay that fee.

The Ombudsman’s report (2019)

The Ombudsman’s report into the practice of charging patients for treatment without transport (Victorian Ombudsman, Investigation of a complaint about Ambulance Victoria (28 May 2019) noted that in a letter to that complainant, Ambulance Victoria relied on s 10(8) as authority to charge the fee for treatment without transport. The Ombudsman quoted s 10(8) and continued (at [67]-[68]):

When asked to explain why the section was misquoted, AV wrote:

“I have also reviewed Sect 10(8) of the Ambulance Services Act. You are correct in that it refers to “transport” rather than attendance. As it’s currently written, the Act does not provide legislative standing to charge ‘non-consenting’ patients for ambulance attendance only.

“I acknowledge the reference to S.10(8) should not have been included in the letter to [Simon], given he was not transported. This was an oversight of the author and will be raised with him.”

In response to the draft report, AV acknowledged the practice of relying on section 10(8) of the Ambulance Services Act to bill for Treatment without Transport was incorrect and gave an undertaking to counsel staff on this issue.

The Ombudsman recommended that:

Further to section 10(c) of the Charter of Human Rights and Responsibilities Act 2006 (Vic) note that full, free and informed consent for Treatment without Transport may include conveying relevant information about potential costs, and consider ways to adequately inform patients accordingly.

VCAT and the Magistrates court

VCAT only has jurisdiction where legislation gives it jurisdiction. There are no provisions in the Ambulance Services Act giving VCAT jurisdiction to review decisions made under that Act.  VCAT has a ‘small claims’ jurisdiction under the Australian Consumer Law and Fair Trading Act 2012 (Vic) however the issue of ambulance fees would probably not fall within the relevant definition, not least because it is a dispute ‘not arising under a contract’ (see Arts Law Centre of Australia, Debt Recovery – Small Claims Procedure (Victoria) 2010; see also Australian Consumer Law and Fair Trading Act 2012 (Vic) s 183 definition of ‘small claim’).  If VCAT does not have jurisdiction, then the Magistrates Court does.

Where someone believes that they are owed money, it is up to them to prove their case. They can write invoices, send letters of demand etc but they cannot compel the other person to pay unless they get a judgment from a court or tribunal.  Some jurisdictions (eg the ACT) allow an applicant to seek an order that they do not owe the money claimed (see ‘debt declaration’ at https://www.acat.act.gov.au/case-types/civil-disputes). In the absence of that jurisdiction the alleged debtor would have to deny liability and wait for the alleged creditor to sue, and then seek an order from the court that no debt is due. That is of course slow and expensive. What’s worse is that the creditor may put the debt in the hands of debt collectors who can make the alleged debtor’s life a misery without ever going to the effort of going to court.

Discussion

Today’s correspondent did ring triple zero and one can understand why an ambulance was dispatched. The patient was diverted to a GP line. When the GP answered they presumably could not communicate with the person. That may have meant they had got up to go to the toilet, had fallen asleep or had collapsed and were critically ill.  If it was the last scenario and no action was taken that would, I think, be seen as a failing of the health system. (I pause to note that my correspondent rang at 4am, allowing for a 60-minute wait he was expected to speak to a doctor by 5am.  Presumably the call was not connected but even then, it took three hours – until 8am – for an ambulance to arrive. If they were ‘collapsed and critically ill’ they would have been in a very bad way with a three-hour delay).

Although we may think it misguided to ring triple-zero people may not know there are other options (such as the Health Direct Hotline). This person rang triple zero asking for information, not an ambulance. Presumably when the ambulance crew arrived, and notwithstanding the Ombudsman’s recommendation, they did not advise the patient that allowing them to conduct an examination would cost in excess of $500.

Regardless of whether it was ‘right’ to call 000 or not, s 10(8) imposes an obligation to pay only a person who has been ‘transported by an emergency ambulance service’. There is no provision that says a person who has been treated, or examined, but not transported is liable to pay a fee. I cannot see any obligation to pay ambulance fees in Victoria where there is no transport and where the person has not consented to the service or to pay a fee.  Section 16(a) may give the ambulance service the power to charge the fee but there is no equivalent to s 10(8) to impose an obligation on anyone to pay it.

The counter to that argument would be an ‘implied consent’. If I ring a plumber and say there is an urgent issue with the stormwater drain, the plumber would come around and probably fix the problem without a long discussion about fees and would be entitled to sue for his or her reasonable fees. it would be expected that everyone understood this was a fee for service agreement. If I asked about fees before the work began he or she would have to give disclosure on their fees. That fee is due and payable as part of contract law or the equitable right to sue on the quantum meruit (‘a reasonable sum of money to be paid for services rendered or work done when the amount due is not stipulated in a legally enforceable contract’.). Where the person has themselves rung 000 and asked for an ambulance, AV would be able to make a similar argument. What is different in this case is that the person specifically said they did not want an ambulance. And AV, presumably, did not explain when the paramedics arrived that if they came in, it would cost.

My correspondent says they did not authorize ‘any ambulance service’ but they did when they allowed the paramedics to come in and and cooperated with their treatment. Despite advertising however many people would still not know that ambulance services, unlike public hospitals, are not free. This was why the Ombudsman thought it imperative that this is communicated to people.

In summary, my correspondent could argue that they specifically said they did not want an ambulance sent and they were not informed that there would be a cost if they allowed the paramedics to check them over; the Act anticipates AV charging for transport, not treatment without transport; and in the absence of an equivalent to s 10(8) there is no legal obligation to pay where there is examination but no transport.

AV, on the other hand, could argue that the Act that gives the secretary the power to set, and AV the power to charge a fee in turn implies an obligation to pay the fee. Further it is known, and the fact that the caller didn’t want an ambulance implies that they knew, ambulance services are not free. The caller did consent to ambulance services when they allowed paramedics to enter their home and cooperated with them in their examination. AV is therefore entitled to its fees on the basis of either the statute, an implied contract or the quantum meruit.

Remedies

The simple remedy is to pay the bill.

Failing that, given the Ombudsman report of 2019, the fact that s 10(8) has not been amended and, it would appear, AV are not, or did not, give ‘relevant information about potential costs, and … adequately inform’ this patient a further complaint to the ombudsman may be helpful.

An alleged debtor may want to refuse to pay and leave it to AV to sue them and then defend the claim though that is both expensive and time consuming and if the matter is referred to debt collector or credit reporting agencies can have serious implications. There is no jurisdiction in VCAT to seek a declaration that the debt is not owed unless and until the creditor seeks to recover the debt.

Important Disclaimer

I repeat the important warning from the start of this post. This is not the place for legal advice. My correspondent should seek advice from a lawyer practising in Victoria – eg a community legal service – to get specific advice on their particular circumstances as well as advice on how to respond to any claims from AV and local advice about the jurisdiction and practices of VCAT and the Victorian Magistrates Court. They should not rely on what has been written here to make any decision on how to respond to any claim for payment from Ambulance Victoria (AV).

This blog is made possible with generous financial support from the Australasian College of Paramedicine, the Australian Paramedics Association (NSW), Natural Hazards Research Australia, NSW Rural Fire Service Association and the NSW SES Volunteers Association. I am responsible for the content in this post including any errors or omissions. Any opinions expressed are mine, and do not necessarily reflect the opinion or understanding of the donors.