The AMR San Bernardino County lawsuit is still active. American Medical Response sued the county in 2024 after the Board of Supervisors awarded a five-year ambulance contract to a consortium of local fire agencies called Consolidated Fire Agencies (ConFire), and AMR has since lost in both federal court and the California Court of Appeal. The underlying state writ-of-mandate case continues in San Bernardino County Superior Court, and AMR remains the county’s active ambulance provider as of mid-2026.1Trellis Law. American Medical Response of Inland Empire v. County of San Bernardino et al.
What AMR Is Challenging
On December 5, 2023, the Board of Supervisors voted 5-0 to award the ambulance contract for October 2024 through September 2029 to ConFire, ending AMR’s roughly four-decade run as the county’s exclusive provider.2San Bernardino Sun. American Medical Response Out as San Bernardino County Ambulance Provider AMR had received a marginally higher score in the county’s competitive bidding process: 1,519 points to ConFire’s 1,515, a gap of less than a quarter of one percent. Three of the four individual evaluators, however, ranked ConFire higher, and the County Administrative Office deemed the scores “substantially equivalent” and negotiated with both bidders.3Justia. American Medical Response of Inland Empire v. County of San Bernardino, D085716
A central reason the board chose ConFire was financial. As a public entity, ConFire qualifies for supplemental Medi-Cal reimbursements under California’s Assembly Bill 1705, an add-on payment of roughly $1,050 per eligible emergency transport that private providers like AMR cannot access.4California Department of Health Care Services. Public Provider Ground Emergency Medical Transportation Intergovernmental Transfer Program The board also cited faster promised response times and closer integration with local fire departments.5Victor Valley Daily Press. San Bernardino County Cuts Ties With American Medical Response AMR formally protested the selection in November 2023, arguing the county was required to negotiate only with the highest-scoring bidder. The board denied the protest.3Justia. American Medical Response of Inland Empire v. County of San Bernardino, D085716
The Federal Antitrust Case
AMR filed first in federal court. On February 2, 2024, it sued the county, the Inland Counties Emergency Medical Agency (ICEMA), the Board of Supervisors, and ConFire in the U.S. District Court for the Central District of California, alleging a violation of Section 1 of the Sherman Antitrust Act. AMR’s theory was that the county had handed an exclusive ambulance monopoly to a “politically preferred provider” in disregard of the competitive process.6Ninth Circuit Court of Appeals. American Medical Response of Inland Empire v. County of San Bernardino, No. 24-3195
District Judge Kenly Kato dismissed the antitrust claim without leave to amend on April 19, 2024. The county, she ruled, was shielded by Parker immunity, the doctrine that protects local governments from federal antitrust liability when they implement clearly authorized state policy. The court declined to hear AMR’s remaining state-law claims.3Justia. American Medical Response of Inland Empire v. County of San Bernardino, D085716
A three-judge Ninth Circuit panel (Judges Callahan, Desai, and De Alba) affirmed on April 30, 2025. The panel found that California’s Emergency Medical Services Act clearly articulates a policy of displacing competition in emergency ambulance services and that the ConFire award was a “foreseeable result” of that policy. Even procedural errors in the RFP, the court held, would not strip the county of Parker immunity; challenges to how the bidding process was administered belonged in state court.6Ninth Circuit Court of Appeals. American Medical Response of Inland Empire v. County of San Bernardino, No. 24-3195
The State Court Case and Reversed Injunction
AMR filed in San Bernardino County Superior Court on April 30, 2024 (Case No. CIVSB2416492), seeking a writ of mandate to force the county to follow what AMR called mandatory procurement rules. The company argued the county had a “ministerial duty” to negotiate exclusively with the highest-scoring proposer.3Justia. American Medical Response of Inland Empire v. County of San Bernardino, D085716
That argument initially worked at the trial level. On September 12, 2024, Superior Court Judge Jay H. Robinson granted AMR a preliminary injunction, halting the county’s planned October 2024 transition to ConFire and keeping AMR in place.7EMS1. Judge Places Calif. County’s Plan to Replace AMR on Hold Judge Robinson later suggested the board appeared to have ignored the public bidding process in favor of a preferred vendor.8San Bernardino Sun. Court Rules in Favor of San Bernardino County in Ambulance Provider Dispute
The county and ConFire appealed. On December 18, 2025, with the opinion certified for publication on January 5, 2026, California’s Fourth District Court of Appeal reversed the injunction in a 31-page opinion by Presiding Justice Judith McConnell, joined by Justices Joan K. Irion and David M. Rubin. The panel rejected AMR’s core theory that the county had a ministerial duty to award the contract to the top scorer. The RFP’s own language, the court said, gave the board discretion to weigh factors beyond raw scores, including each proposer’s ability to meet county needs and deliver the “best value.” The board acted “well within its legal discretion” in choosing ConFire, and AMR failed to show a likelihood of prevailing on the merits.3Justia. American Medical Response of Inland Empire v. County of San Bernardino, D085716 The case was remanded with instructions to deny the injunction and reconsider the bond amount.8San Bernardino Sun. Court Rules in Favor of San Bernardino County in Ambulance Provider Dispute
Where Things Stand in Mid-2026
AMR is still on the road. The appellate court’s remittitur returned jurisdiction to the trial court on April 28, 2026, and the writ-of-mandate case has continued to move forward, with trial briefs filed in June 2026.1Trellis Law. American Medical Response of Inland Empire v. County of San Bernardino et al. County spokesperson David Wert confirmed in early 2026 that “the case is still ongoing and additional proceedings are pending.”8San Bernardino Sun. Court Rules in Favor of San Bernardino County in Ambulance Provider Dispute
ConFire has not started providing ambulance service. Its website still lists the service as “Coming Soon.”9ConFire. EMS Service AMR’s vice president of operations, Mike Rice, said the company “will continue to serve the community with professionalism and reliability while the legal process continues.”8San Bernardino Sun. Court Rules in Favor of San Bernardino County in Ambulance Provider Dispute AMR also retains the option of asking the California Supreme Court to review the appellate decision, though the high court would decide at its discretion whether to hear it.10SBC Sentinel. State Appeals Court Lets ConFire Take Ambulance Franchise