Does Maryland's emergency medical services agency regulate 'litter van' stretcher transport, or does the Washington-area transit commission?

Plain-English summary

The head of the Maryland Institute for Emergency Medical Services Systems (MIEMSS) asked the Attorney General whether MIEMSS had jurisdiction over "litter van" services, which transport people on stretchers, operating within the territory covered by the Washington Metropolitan Area Transit Commission (WMATC), an interstate body that regulates for-hire transportation in Montgomery and Prince George's Counties and the District of Columbia.

The opinion concluded that litter vans met Maryland's statutory definition of "ambulance," since they are vehicles designed and equipped to transport people who are sick, injured, or otherwise incapacitated, so MIEMSS generally had jurisdiction to license them statewide. But within the WMATC's territory, the opinion found that the interstate transit compact's broad preemption clause suspended conflicting state transportation laws, and that WMATC had already treated similar wheelchair and litter van transport as "transportation for hire" within its own jurisdiction in prior WMATC orders. Because MIEMSS's ambulance regulations went well beyond a narrow "inspection of equipment and facilities" exception to that preemption clause, the opinion concluded that MIEMSS could not regulate litter van service within Montgomery and Prince George's Counties to the extent WMATC had already asserted authority over it there.

Currency note

This opinion was issued in 1995. Subsequent statutory amendments, court decisions, or later AG opinions may have changed the analysis. Treat this page as historical context, not current legal advice. Verify current law before relying on any specific rule or jurisdictional boundary mentioned here.

Common questions

Did a 1995 Maryland opinion say litter van stretcher services counted as ambulances?
Yes. The opinion concluded that litter vans met the statutory definition of "ambulance" under ED § 13-1D-15, because they are vehicles designed and equipped to transport sick, injured, or otherwise incapacitated people, so MIEMSS generally had authority to license them.

Did the opinion say MIEMSS could regulate litter van services everywhere in Maryland?
No. The opinion concluded that within Montgomery and Prince George's Counties, part of the Washington Metropolitan Area Transit Commission's territory, MIEMSS's regulation was preempted to the extent the WMATC had already asserted jurisdiction over that same litter van service under the interstate transit compact.

Did the opinion say Maryland's vehicle inspection laws still applied to litter vans in the WMATC's territory?
The opinion suggested a narrow "inspection of equipment and facilities" exception to preemption applied primarily to general vehicle laws like titling and mechanical inspection requirements, not to MIEMSS's specific ambulance licensing regulations, which went well beyond that narrow exception.

Background and statutory framework

At the time of this opinion, ED § 13-1D-15 charged MIEMSS with licensing and regulating commercial ambulance companies statewide, defining "ambulance" broadly to include any vehicle designed, constructed, or equipped for transporting people who are sick, injured, wounded, or otherwise incapacitated. Separately, the Washington Metropolitan Area Transit Regulation Compact, adopted by Maryland, Virginia, and the District of Columbia and codified at Transportation Article § 10-203, created the WMATC to regulate for-hire transportation within a defined Metropolitan District covering Montgomery and Prince George's Counties, and included an express clause suspending conflicting state transportation laws.

The opinion reviewed a series of WMATC orders, dating back to 1976, in which the Commission had already found that wheelchair and litter van transport for disabled or non-ambulatory passengers qualified as "transportation for hire" within its own jurisdiction, distinguishing that service from true emergency ambulance transport. Applying federal preemption principles from Supreme Court and D.C. Circuit case law interpreting the compact, the opinion concluded that MIEMSS's detailed ambulance licensing scheme could not be layered on top of WMATC-approved litter van service within the Metropolitan District without creating the kind of dual, conflicting regulation the compact was designed to avoid, and that the compact's narrow exception for laws about equipment and facility inspection was not broad enough to save MIEMSS's full regulatory scheme there.

Citations and references

Statutes:

• ED § 13-1D-15, charging MIEMSS with licensing and regulating commercial ambulance companies and defining "ambulance"
• ED § 13-1D-15(a)(2), the statutory definition of "ambulance" as a vehicle designed or equipped to transport sick, injured, or otherwise incapacitated people
• Transportation Article § 10-203, codifying the Washington Metropolitan Area Transit Regulation Compact

Cases:

• Universal Interpretive Shuttle Corp. v. Washington Metropolitan Area Transit Commission, 393 U.S. 186, 189 (1968), on Congress's intent to avoid subjecting WMATC-regulated transportation to two separate regulatory masters
• Democratic Central Committee v. D.C. Transit System, 459 F.2d 1178, 1181 (D.C. Cir. 1972), on construing a designated regulatory agency's jurisdiction as exclusive of parallel jurisdiction where possible
• C.T. Hellmuth & Assoc. v. Washington Metropolitan Area Transit Authority, 414 F. Supp. 408, 409 (D. Md. 1976), on an interstate compact's status as superior to conflicting state law
• Baltimore & Annapolis Railroad Co. v. Washington Metropolitan Area Transit Commission, 642 F.2d 1365, 1370-73 (D.C. Cir. 1980), on deference to WMATC's own long-standing jurisdictional determinations

Source

• Landing page: https://oag.maryland.gov/resources-info/Pages/attorney-general%E2%80%99s-opinions.aspx
• Original PDF: https://oag.maryland.gov/resources-info/Documents/pdfs/Opinions/1995/80oag118.pdf

Original opinion text

118 [80 Op. Att'y

        EMERGENCY MEDICAL SERVICES

TRANSPORTATION ) JURISDICTION OVER "LITTER VAN"
SERVICES

                      August 2, 1995

Robert R. Bass, M.D., FACEP
Executive Director
Maryland Institute for Emergency
Medical Services Systems

  You have requested our opinion whether the Maryland Institute

for Emergency Medical Services Systems ("MIEMSS") has
jurisdiction over "litter van" services in the territory of the
Washington Metropolitan Area Transit Commission ("WMATC" or
"Commission").

  Several companies are, or have considered, operating "litter

van" services in Maryland within the area governed by the
WMATC. These services offer transportation of individuals on
stretchers. Under one view of the applicable law, litter van services
do not fall within the jurisdiction of MIEMSS, but rather are a non-
medical service to be regulated solely by the WMATC as
transportation for hire. Under another view of the law, litter vans
fall within the statutory definition of "ambulance," involve genuine
medical considerations, and therefore are within MIEMSS'
jurisdiction.

  Our opinion is as follows: Litter van service is generally

within MIEMSS' jurisdiction, because it is an "ambulance" service
as defined by law. However, litter van service within Prince
George's and Montgomery Counties is outside MIEMSS'
jurisdiction, to the extent that the WMATC exercises jurisdiction
over such service within its territory.

Gen. 118] 119

                                  I

              Meaning of "Ambulance" Service

 MIEMSS is charged with licensing and regulating all

commercial ambulance companies operating in Maryland. §13-1D-
15 of the Education ("ED") Article, Maryland Code. Within
MIEMSS, the State Office of Commercial Ambulance Licensing and
Regulation oversees the licensing and regulation of the commercial
ambulance industry. The commercial ambulance regulations are
found in Title 14, Subtitle 22 of the Code of Maryland Regulations.

  An "ambulance" is defined in ED §13-1D-15(a)(2) as "any

vehicle designed and constructed or modified and equipped to be
used, maintained, or operated for the transportation of individuals
who are sick, injured, wounded or otherwise incapacitated." The
definition of ambulance is the same in the regulation, COMAR
14.22.01.01B(7)(a), with an exclusion: Subsection (b) specifically
excludes from the definition of ambulance any "vehicle designed
and constructed or modified and equipped with a hydraulic lift
which is used, maintained or operated, exclusively for transporting,
in wheelchairs, nonambulatory patients who do not require the use
of equipment and trained personnel found in an ambulance."
(Emphasis added.)

  This definition of "ambulance" surely includes litter vans. To

the best of our knowledge, most persons in stretchers are generally
"sick, injured, [or] wounded," and they would be uniformly
considered "otherwise incapacitated" by virtue of being confined to
a stretcher and requiring assistance for mobility.1 Further, as we
understand it, litter vans are outfitted with special restraints, and
usually lifts as well; litter vans therefore would fall within the first
part of the definition of an ambulance, because they are "designed
and constructed or modified and equipped to be used, maintained or
operated for the transportation of [patients]." 2

 1
     We will refer to such persons in this opinion as "patients."
 2
     For the same reasons as set forth in the text, the statutory

definition of "ambulance" might well also include "wheelchair vans."
However, we need not address that point, because wheelchair vans are
currently excluded by regulation from the operative definition. See
(continued...)

120 [80 Op. Att'y

  Even if litter vans fall within the apparent definition of

"ambulance," it has been suggested, the non-emergency nature of
most of the transports by litter van would provide grounds for
limiting the scope of the statute to exclude this service. However,
the statute itself contains neither an express limitation of this kind
nor any implication that it is limited to emergency purposes only.3

  In addition, nearly all commercial ambulance transports are

considered non-emergency. This was the case in 1989 as well, when
the General Assembly first assigned the regulation of commercial
ambulances to MIEMSS. Thus, if the suggested limitation were to
be engrafted onto the statutory definition of "ambulance," the
limitation would in practical terms repeal the entire regulatory
scheme, a result that we are sure the General Assembly did not
intend.

  In short, we have no difficulty concluding that "litter vans" or

"stretcher vans" are within the definition of "ambulance" in ED §13-
1D-15 and therefore generally within MIEMSS' jurisdiction.

                                II

        Possible Conflict With WMATC Authority

A. Introduction

   The WMATC was established in 1960 by the Washington

Metropolitan Area Transit Regulation Compact, adopted by
Maryland, Virginia and the District of Columbia, and approved by
Congress. See generally Alexandria, Bancroft & Washington
Transit Co. v. Washington Metropolitan Area Transit Commission,
323 F.2d 777, 779-80 (4th Cir. 1963). The WMATC is charged
with regulating the transportation for hire by any carrier of persons
in a specific geographic area, called the Metropolitan District, which

  2
(...continued)

COMAR 14.22.01.01B(7)(b).
3
Words of a statute are to be given their ordinary and plain meaning,
absent a manifest contrary intent on the part of the Legislature. Tatum v.
Gigliotti, 321 Md. 623, 628, 583 A.2d 1062, 1064 (1991).

Gen. 118] 121

includes Montgomery and Prince George's Counties. Except for
some airport services, WMATC does not regulate transportation that
extends outside of the Metropolitan District.

  The Compact, which is codified in §10-203 of the

Transportation Article, contains an express preemption clause.
Under Article XIV of the Compact, all Maryland laws, rules,
regulations and orders relating to transportation subject to the Act,
other than those related to the inspection of equipment and facilities,
are suspended.

B. Nature of Services Approved

  In its role as regulator of transportation of passengers for hire

in the Metropolitan District, the WMATC has construed its own
authority to cover the nonemergency movement of passengers in
wheelchair and litter vans.

   Apparently the first case before the WMATC in this area was

In re Ironsides Medical Transportation Corp., Order No. 1527 (Mar.
30, 1976). The applicant in that case sought a certificate of public
convenience and necessity to transport "disabled, infirm,
handicapped, or wheelchair patients and their baggage and
attendants" primarily "to and from hospitals, clinics, medical offices,
and nursing homes." Order at 1, 2. The Commission noted that the
transportation would be rendered "in specially modified van-type
equipment," that "the vehicle operators are specially trained
emergency medical technicians," and that there was "a need for
specialized medical transportation services ... to transport persons
between residences and clinics, medical offices, or hospitals for the
purpose of receiving medical treatments." Order at 2. Based on
these and other factors, the Commission granted the application, but
restricted it to transportation of handicapped or disabled passengers.

  In the case of In re Rodwell Buckley, t/a Elrod Transportation

Service, Order No. 1749 (Sept. 16, 1977), the WMATC considered
the applications of seventeen entities for approval to operate
wheelchair van services in the Metropolitan District. The
Commission found that the proposed operations were subject to the
jurisdiction conferred by the Compact:

        [T]he prime business purpose of each
        applicant is the derivation of revenue from

122 [80 Op. Att'y

       transportation. Unlike ambulance service
       where the movement of passengers is a mere
       adjunct to the emergency medical diagnosis
       and/or treatment administered, here the pure
       purpose of the service proposed is the
       movement of passengers between points in the
       Metropolitan District.      Accordingly, the
       Commission finds that the proposed
       transportation of non-ambulatory passengers
       is transportation for hire within the meaning
       of the above sections of the Compact.

Order at 25.4 With respect to the vehicles themselves, the
Commission found: "Each [wheelchair van] is specially equipped for
the proposed transportation services with a ramp, wheelchairs,
stabilizing equipment, seat belts, flares, fire extinguishers and first-
aid kits." Order at 4. The other sixteen applications considered at
that time had similar special equipment, and some of them included
plastic "sick bags." See, e.g., Order at 9. In granting some of the
applications, the Commission found that the vehicles were "safe and
well-equipped for the proposed transportation." Order at 27.

  In a later opinion, the Commission apparently expanded the

nature of service that it would license, without discussion of the
jurisdictional question, although that order was still limited to
wheelchair van service. In Perkins Ambulance and Wheelchair
Service, Inc., Order No. 2898 (Aug. 21, 1986), the applicant
specifically distinguished itself from previously-approved services
by stating that its vehicles would be specially equipped to handle
emergencies and other extraordinary situations and would be driven
by registered emergency medical technicians ("EMT's") Order at 1.
This increased level of medical service was described as
"particularly useful for kidney patients" ..., "many of whom are non-
compliant with fluid restrictions, which can result in shortness of
breath thereby necessitating oxygen en route to dialysis." Order at

  4
     The Commission also found that the proposed wheelchair van

operations did not fall within the "taxicab exception" to the WMATC's
jurisdiction, for two reasons: because the vehicles would not "accept or
solicit" passengers along the public streets and highways; and because the
service was not available to the general public, but only to persons who
were disabled, handicapped, or otherwise confined to wheelchairs. Order
at 26.

Gen. 118] 123

2. 5 The Commission noted that the portable oxygen, trauma kit and
   cellular telephone on the vehicles were "all for use in emergencies,"
   and that the drivers, "by virtue of their training as EMT's, [are]
   capable of using the emergency equipment and dealing with non-
   ambulatory persons in general." Order at 7.

   Since 1991, the Commission's regulatory structure has changed
   from a "certificate of public convenience and necessity" approach,
   which required a showing of need for or uniqueness of the proposed
   service, to a "certificate of authority" model, which focuses on
   fitness and compliance with regulations and the public interest.
   Under this new, more competitive approach, many carriers have
   received approval for wheelchair van service, primarily in the
   District of Columbia under its Medicaid program.

   In Safai Management Company, Inc., t/a Para-Med
   Wheelchair Transportation, the approval notes that the
   transportation will be for "senior citizens and Medicaid passengers
   to and from medical facilities." Order No. 3930 (Apr. 30, 1992).
   Many other carriers have been granted similar approval with very
   little description of the service, primarily on the basis of the D.C.
   Medicaid reimbursement rates as a tariff. E.g., RDM Enterprises,
   Inc., Order No. 3801 (Aug. 6, 1991); Abdlhemeed Sidig, t/a TriCare
   Transportation, Order No. 4398 (Sept. 29, 1994). Only one or two
   carriers currently have separate tariffs for litter or stretcher van
   service, but others could add this service simply by amending their
   tariffs.

C. Preemption Analysis

  1.    Preemption principles.

  Since the WMATC Compact has the status of a federal as well

as a State statute, we must examine whether it conflicts with and
takes precedence over the Maryland statute concerning licensure of
commercial ambulance services. We begin that analysis with the

  5
     In addition, the order notes that "treatment hypotension may occur

20 to 30 minutes after dialysis. When this occurs patients need oxygen and
blood pressure monitoring and, on occasion, must be returned to the
facility to be stabilized." Order at 4. The order did not explain how a
single EMT driver would provide this oxygen and blood pressure
monitoring during the return trip from the facility.

124 [80 Op. Att'y

general law of preemption, which has been summarized recently by
the Supreme Court as follows:

      Article VI of the Constitution provides that the
      laws of the United States "shall be the
      supreme Law of the Land; ... any Thing in the
      Constitution or Laws of any state to the
      Contrary notwithstanding." Art. VI, cl. 2. ...
      Consideration of issues arising under the
      Supremacy Clause starts with the assumption
      that the historic police powers of the States
      are not to be superseded by ... Federal Act
      unless that is the clear and manifest purpose
      of Congress.

          Congress' intent may be explicitly stated
      in the statute's language or implicitly
      contained in its structure and purpose. In the
      absence of an express congressional
      command, state law is pre-empted if that law
      actually conflicts with federal law or if federal
      law so thoroughly occupies a legislative field
      as to make reasonable the inference that
      Congress left no room for the States to
      supplement it.

           When Congress has considered the issue
      of pre-emption and has included in the
      enacted legislation a provision explicitly
      addressing that issue, and when that provision
      provides a reliable indicium of congressional
      intent with respect to state authority, there is
      no need to infer congressional intent to pre-
      empt state laws from the substantive
      provisions of the legislation. Such reasoning
      is a variant of the familiar principle of
      expression unius est exclusio alterius:
      Congress' enactment of a provision defining
      the pre-emptive reach of a statute implies that
      matters beyond that reach are not pre-empted.

Gen. 118] 125

Cippolone v. Liggett Group, Inc., 505 U.S. 516, 112 S.Ct. 2608,
2617-18 (1992) (internal quotation marks, brackets, and citations
omitted).

  For purposes of preemption analysis, a compact is the same as

a federal statute, because "by entering into an interstate compact, a
state effectively surrenders a portion of its sovereignty; the compact
governs the relations of the parties with respect to the subject matter
of the agreement and is superior to both prior and subsequent law"
of the signatory states in conflict with the compact. C.T. Hellmuth
& Assoc. v. Washington Metropolitan Area Transit Authority, 414
F. Supp. 408, 409 (D. Md. 1976); 1978-79 Op. Atty. Gen. 165 (Va.
Oct. 24, 1978). Moreover, "one party [to an interstate compact] may
not enact legislation which would impose burdens upon the compact
absent concurrence of the other signatories." C.T. Hellmuth, 414
F.Supp. at 409 (citing cases).

 2.     Express preemption under the Compact.

 As was true in the Cippolone case, the statute we are

examining (the WMATC Compact) contains an express preemption
provision, so we must look to the intent of Congress and the
contracting parties as set forth in that provision. In Article XIV, §2,
the Compact provides as follows:

             (a) The applicability of each law, rule,
        regulation, or order of a signatory relating to
        transportation subject to this [Compact] shall
        be suspended on the effective date of this
        [Compact, which was July 1, 1988].

             (b) The provisions of subsection (a) of
        this section do not apply to a law of a
        signatory relating to inspection of equipment
        and facilities.

The general preemption clause in subsection (a) is very broadly
worded. Its term "relating to transportation" surely extends to the
separate licensure of ambulances and litter vans by MIEMSS.
Hence, MIEMSS' licensure is within the scope of this clause if the
licensed transportation is "subject to this [Compact]."

126 [80 Op. Att'y

  The Compact applies generally to "transportation for hire by

any carrier of persons between any points in the Metropolitan
District." Article XI, §1. As noted above, the WMATC has
expressly interpreted nonemergency wheelchair van service to be
"transportation for hire" within the meaning of the Compact and
presumably has made the same implicit finding for litter van service.
Although one could debate that conclusion on factual or policy
grounds, the WMATC is certainly within its legal authority to reach
that conclusion. See Hazen v. Chambers, 108 F.2d 741 (D.C. Cir.
1939) (ambulances are "passenger vehicles for hire" within meaning
of license tax statute; "Sick or well, one who is carried, for hire,
through the streets in a vehicle kept and driven by another for such
purposes seems to us to be a passenger in the ordinary sense of the
word."); Banner Sightseeing Co. v. WMATC, 731 F.2d 993, 994
(D.C. Cir. 1984) ("Nothing in the law strips the WMATC of its
jurisdiction simply because those providing transportation for hire
are also in another business; the law looks only to whether
transportation for hire is involved.").

   Moreover, since the WMATC is an instrumentality of two

states and the District of Columbia and was created with the
approval of Congress, and since WMATC has addressed the issue
of its own jurisdiction for the closely related service of wheelchair
van transports, any arguments that MIEMSS or others may have
about the WMATC's jurisdiction should be addressed to the
WMATC itself for reasoned reconsideration, rather than declared by
one of the signatory states. See Baltimore & Annapolis Railroad
Co. v. Washington Metropolitan Area Transit Commission, 642 F.2d
1365, 1370-73 (D.C. Cir. 1980) (WMATC may not overrule
jurisdictional decision in effect for 12 years without reasoned
analysis). Cf. D.C. Transit System v. Washington Metropolitan Area
Transit Commission, 366 F.2d 542, 544 (4th Cir. 1966) ("that the
Commission is the final interpreter of its own orders is no longer
debatable.").6 Thus, to the extent that a litter van service is deemed

  6
     See also 366 F.2d at 543 (order of the WMATC affirmed because

its ultimate finding upon stipulated facts was "not without support" and
"not contrary to law"); Executive Limousine Service, Inc. v. Goldschmidt,
628 F.2d 115, 121 (D.C. Cir. 1980) (decisions about the public
convenience and necessity in providing transportation service at Dulles
Airport must be made by the WMATC, not by the FAA); Alexandria,
Bancroft & Washington Transit Co. v. Washington Metropolitan Area
(continued...)

Gen. 118] 127

by the WMATC to be within its jurisdiction and granted a certificate
of authority by the WMATC, its service within points of the
Metropolitan District is exempt from regulation by MIEMSS under
Article XIV, §2(a) of the Compact.

  3.    The "inspection" exception.

        It remains to be considered whether certain Maryland

statutes and regulations might be within the exception to preemption,
set out in Article XIV, in §2(b) for laws "relating to inspection of
equipment and facilities." At a minimum, this exception permits
enforcement of Maryland statutes, such as Titles 22 and 23 of the
Maryland Vehicle Law, relating to inspection of equipment and
facilities for vehicles in general.

  With respect to ambulances, the enabling statute states that

MIEMSS's regulations must require that "each ambulance operated
by the ambulance service be equipped with adequate equipment and
supplies" for certain purposes and that "each ambulance operated by
the ambulance service be inspected" in accordance with the
Maryland Vehicle Law or certain government or volunteer
standards. ED §13-1D-15(c)(2)(i), (iii). The regulations implement
these provisions, in much greater detail.7

   MIEMSS' regulations do relate to inspection of equipment and

facilities, but they go much beyond the requirements of the
WMATC, which merely determines on a general level whether the
applicant is fit, willing, and able to perform the transportation
properly. If these regulations were applicable, a carrier would
certainly have to satisfy different and apparently more stringent
requirements than those of the WMATC, and in some aspects such
dual compliance might be impossible.

 6
   (...continued)

Transit Commission, 323 F.2d 777, 780-81 (4th Cir. 1963) (court must
uphold WMATC findings of fact if supported by substantial evidence and
may reverse determination of public convenience and necessity only if
agency abused its discretion).
7
For example, a whole chapter of the regulations describes minimum
required equipment. COMAR 14.22.07.

128 [80 Op. Att'y

  Thus, a broad interpretation of the exception to preemption for

"inspection of equipment and facilities" would result in "dual
regulatory jurisdiction on the most fundamental matters." Universal
Interpretive Shuttle Corp. v. Washington Metropolitan Area Transit
Commission, 393 U.S. 186, 189 (1968). As the Supreme Court said
in that case, because "Congress was endeavoring to simplify the
regulation of transportation by creating WMATC," we "cannot
ascribe to Congress a purpose of subjecting [a transportation service]
to these two separate masters." 393 U.S. at 193 and 191. Similarly,
in addressing the jurisdiction of the WMATC, the D.C. Circuit
observed:

       [T]he overall scheme tends to suggest that the
       exercise of a jurisdiction which might conflict
       with the jurisdiction of the Commission is to
       be sharply circumscribed.... [W]hen Congress
       has provided for a coherent scheme of
       statutory regulation, the jurisdiction of the
       designated regulatory agency is to be
       construed, wherever possible, as exclusive of
       any arguably parallel jurisdiction.

Democratic Central Committee v. D.C. Transit System, 459 F.2d
1178, 1181 (D.C. Cir. 1972).

   An interpretation allowing partial application of MIEMSS'

regulations to WMACT-approved litter van services poses another
difficulty: MIEMSS would have no enforcement mechanism for its
regulations. Unlike the registration, titling, and mechanical and
emission inspections in the Vehicle Law, each of which can be
applied to prevent the doing of some particular act relating to a
motor vehicle, MIEMSS' authority is an overall administrative
licensing scheme for an ambulance service; this licensing scheme
does not have separate enforcement mechanisms for each of its
parts. If MIEMSS cannot license a litter van service because the
service is approved by WMATC, then MIEMSS would have no
effective authority over that service, even for equipment and
facilities inspection requirements.

  In light of the legal and practical difficulties that could be

created by partially overlapping regulation, we conclude that the
exception to preemption for laws "relating to inspection of
equipment and facilities" was meant to extend primarily to the

Gen. 130] 129

Vehicle Law and not to the specific provisions of the MIEMSS
statute and regulations for commercial ambulances, which were not
in effect in 1960 when the WMATC was formed or in 1988 when
the Compact was substantially revised.

                           III

                      Conclusion

  In summary, it is our opinion that MIEMSS may generally

regulate litter van service within Maryland, but its authority to
regulate such service is preempted to the extent that the WMATC
asserts jurisdiction over such service within the Washington
Metropolitan District.

                                 J. Joseph Curran, Jr.
                                 Attorney General

                                 William F. Howard
                                 Assistant Attorney General

Jack Schwartz
Chief Counsel
Opinions and Advice