Ever since St. Charles Health System opened an immediate care clinic in La Pine in 2018, the La Pine fire district’s ambulances have been called to deliver patients from the clinic to Bend several times each week.

Fire district officials say many of these calls are far from emergencies: conditions like chest pains or sprained ankles. The cost of an ambulance ride is traditionally borne by the patient or the patient’s insurer, but under a fire district ordinance now in effect, the district is sending the bills to St. Charles.

The hospital has so far refused to pay and is now suing to stop the practice.

“The ordinance is arbitrary and unreasonable under the United States Constitution and the Oregon Constitution,” reads the lawsuit, filed Monday in Deschutes County Circuit Court. “The Ordinance is harmful for patients and the community of La Pine.”

The La Pine Rural Fire Protection District is St. Charles’ ambulance provider for the La Pine area, one of eight ambulance service areas in the St. Charles system.

St. Charles opened an immediate care clinic in La Pine in response to data showing many patients at its Bend facilities were from La Pine. And there was indeed a need for medical services: St. Charles’ two clinics in La Pine now see around 10,000 patients per year.

While the clinic was expected to reduce the fire district’s ambulance workload, in reality, it increased. The fire district is now called around two times per week when a clinic doctor recommends transferring a patient to St. Charles Bend. Fire district officials have called these calls overkill, akin to trained paramedics acting as taxi drivers.

In August 2019, the district’s board passed an ordinance giving Fire Chief Mike Supkis the authority to impose fees for responding to calls he deems nonemergencies.

Since Jan. 1, when the ordinance went into effect, the La Pine fire district has sent invoices to St. Charles for 50 patient trips to the Bend hospital, billed for at least $2,000 each. The fire district next sent the invoices to a collection agency, which sent St. Charles a draft lawsuit demanding $300,000 plus a 35% collection fee.

On Monday, St. Charles asked a judge to strike down the fire district’s ordinance and award the health system attorney fees.

Among other arguments, St. Charles claims the ordinance interferes with the doctor-patient relationship. When a doctor calls for an ambulance transport it is because they have determined it is necessary, regardless of what the fire chief says.

“The (fees) vest ‘sole discretion’ in the Fire Chief to determine the medical question of what constitutes a medical emergency,” the lawsuit states. “The Fire Chief is not a medical doctor.”

The fire district has yet to respond to the suit. Messages left with the district office were not returned Monday.