When an elderly couple called an ambulance during a medical emergency, they asked the driver to take them to a hospital where their physicians have privileges. The driver refused because the county they live in requires that they be taken to the nearest hospital. They sued the county and lost in the trial court, and a California Court of Appeal has now ruled in favor of the county’s nearest-hospital policy.

Acting Presiding Justice Coleman Blease of California’s Third District Court of Appeal, writing for a unanimous three-judge panel, affirmed the judgment of Sacramento Superior Court Judge Gerri Wood. The case, decided on November 1, is unpublished.

Plaintiff-appellants David and Katherine Warren based their appeal on two arguments—their standing to sue and their right to privacy. Blease agreed that the couple did have standing to sue the County of Sacramento, whose policies were at issue, but found their claims of a right to privacy unpersuasive.

The Sacramento County Emergency Medical Services Agency (SCEMSA) was approved by Sacramento County to “administer and control the provision of emergency ambulance services.” One of the County’s policies “governs where ambulances take people,” and to this end, lists criteria the ambulance driver must take into consideration when deciding where to take patients. One of these criteria fit the medical condition of the Warrens.

SCEMSA’s policies set out rules for transporting patients who are both stable and unstable. While stable patients have some latitude to select destination hospitals, one policy states that trauma patients with unstable or obstructed airways or other unstable conditions “shall be taken to the most accessible receiving hospital.”

The Warrens, both of whom are over 70, have heart problems and are at risk of stroke. They want to go to a hospital where they can be treated by their preferred physicians. They went to court for the right to choose their hospital and based their case on their right to privacy and a section of the Probate Code. They claimed these laws provide them a right to make “medical decisions about ambulance destinations.”

Both of the Warrens are over 70, have experienced “several cardiac incidents, and are at risk of strokes.” On previous occasions, when the Warrens experienced heart problems, they were taken to the nearest hospital, Mercy San Juan Medical Center, which had not extended privileges to the doctors who normally treat them. The Warrens had requested an “informed consent exception” to Sacramento County’s policies, but it was denied because the SCEMSA review committee found that Mercy San Juan had a “higher certification for stroke care” than UC Davis, where plaintiffs’ doctors did have privileges.

In August 2017, after SCEMSA denied their exemption, the Warrens took their request to the Sacramento County Board of Supervisors. The Board declined to hear their proposal saying it was not in their jurisdiction. Next, in April 2018, they amended their complaint and added three new causes of action: SCEMSA was not the proper reviewing authority; the unconstitutionality of the criteria for taking trauma patients to the most accessible receiving hospital; and a request that that pertinent section of the County’s rules be amended to permit patients, not County policies, to select destination hospitals.

The trial court found the Warrens had no “actionable right to privacy” and dismissed their action with prejudice, which means that plaintiffs may not refile the same claim in the same court.

Justice Blease began his discussion of the case by detailing the statutory authority of SCEMSA. He made it clear that state law authorizes that agency to direct and manage California’s emergency medical services. He then discussed appellants’ reliance on the State’s constitutional guarantee of a right to privacy to support their right to choose the destination of ambulance services. He explained that although the constitution does give people the right to retain “personal control over the integrity of one’s body,” this right is not absolute and must be balanced against other important interests.”

He reviewed both state and federal precedents that hold that while the right to privacy allows a person to refuse medical treatment, neither gives people the right to ask for any particular treatment. No jurisdiction provides a fundamental right to privacy when health and safety are at stake, especially when time is of the essence, as it is with emergency medical transportation. Applying the “rational basis” test to the Warren’s case he concluded they lacked a “constitutionally protected privacy interest” and ruled that SCEMSA’s hospital-choice policy survived constitutional scrutiny.

Blease then reviewed the appellant’s Probate Code argument. Once again, after citing relevant sections, he came to a similar conclusion. He explained that the Probate Code “codifies the right to refuse treatment,” but does not give anyone the right to receive “any particular form of treatment.” Affirming the lower court’s judgment, he concluded that since appellants failed to find a right of privacy in any of their supporting materials, “they cannot attack it in the courts.”