******************************************************** NOTICE ******************************************************** This document was converted from WordPerfect to ASCII Text format. Content from the original version of the document such as headers, footers, footnotes, endnotes, graphics, and page numbers will not show up in this text version. All text attributes such as bold, italic, underlining, etc. from the original document will not show up in this text version. Features of the original document layout such as columns, tables, line and letter spacing, pagination, and margins will not be preserved in the text version. If you need the complete document, download the WordPerfect version or Adobe Acrobat version, if available. ***************************************************************** Before the Federal Communications Commission Washington, D.C. 20554 In the Matter of ) ) MIAMI VALLEY HOSPITAL, ) HELENE FULD MEDICAL CENTER, ) MERCER MEDICAL CENTER, ) ST. JOSEPH'S REGIONAL HEALTH CENTER,) UNIVERSITY OF IOWA HOSPITALS ) AND CLINICS, ) WINCHESTER MEDICAL CENTER, INC., AND) DEACONESS HOSPITAL ) ) Requests for Permanent Waiver For Special) Emergency Radio Service Paging Facilities on) 453.025, 453.075, 453.125 and 453.175 MHZ in ) Dayton, Ohio; Trenton, New Jersey; Hot Springs, ) Arkansas; Iowa City, Iowa; Winchester, ) Virginia; and Cincinnati, Ohio ) ORDER Adopted: April 30, 1999 Released: May 3, 1999 By the Chief, Public Safety and Private Wireless Division, Wireless Telecommunications Bureau: I. INTRODUCTION 1. We have before us Requests for Waiver filed by Miami Valley Hospital, Helene Fuld Medical Center, Mercer Medical Center, St. Joseph's Regional Health Center, University of Iowa Hospitals and Clinics, Winchester Medical Center, Inc., and Deaconess Hospital, asking that the Commission grandfather their existing Special Emergency Radio Service (SERS) paging systems operating on certain 453 MHz frequencies. Each of these seven hospitals contends that it meets at least one criterion for a grant of a permanent waiver permitting the continued operation of its existing SERS paging system. Specifically, the hospitals contend that relocation of their respective paging systems would disrupt public safety communications. Based on the record established in each case, we conclude that these Requests for Waiver should be granted. II. BACKGROUND 2. Emergency Medical Radio Service Report and Order. On January 14, 1993, the Commission established the Emergency Medical Radio Service (EMRS) as a new Public Safety Radio Service (PSRS). The EMRS was created as a discrete radio service to enhance the reliability of emergency medical radio communications by dedicating specific frequencies solely to life support related transmissions. The Commission reallocated thirty-nine VHF frequencies for EMRS use, and limited eligibility to persons or entities who provide basic or advanced life support services on an ongoing basis. Four of these frequencies, 453.025/.075/.125/.175 MHz, were previously assigned for one-way paging operations under SERS. The International Municipal Signal Association and the International Association of Fire Chiefs, Inc. (IMSA/IAFC) were designated as the joint certified frequency coordinators for the EMRS because of their previous experience coordinating emergency medical communications. 3. In reassigning the four 453 MHz frequencies for EMRS use, the Commission recognized the concerns of existing SERS licensees on these channels and acknowledged that in certain situations an accommodation may be warranted to allow licensees to continue operating. It, therefore, provided a process by which one-way medical paging systems operating on the subject frequencies may permanently remain on their existing frequencies through waiver of the Commission's Rules. Under this process, a paging system may be grandfathered if a licensee currently operating on a one-way paging channel demonstrates that either: (1) adequate spectrum exists for emergency medical transmissions in its area of operation; (2) relocation of its medical paging system would not serve the public interest; or (3) relocation would significantly disrupt public safety communications. Licensees were provided a five-year period -- from January 14, 1993, through January 14, 1998, -- within which to request that their systems be grandfathered. Otherwise, licensees operating on these 453 MHz frequencies were requested to cease one-way medical paging operations after January 14, 1998. 4. Waiver Grants. On February 8, 1996, the Commission released a Memorandum Opinion and Order reaffirming its decision to establish the EMRS and reallocate thirty-nine SERS frequencies for emergency medical communications. The Commission stated that the record supported the need for additional spectrum for emergency medical use because the substantial increase in the demand for emergency medical service frequencies nationwide significantly overburdened existing frequencies. Further, the Commission granted a request by ProNet, Inc., to waive permanently mandatory reassignment of 453.125 MHz in the greater Chicago metropolitan area to EMRS. The Commission concluded that although ProNet was only required to meet one criterion, it met all the established criteria. ProNet demonstrated, with findings from a study of spectrum usage (Trott Study I), that existing emergency medical service channels in the Chicago area displayed virtually no congestion, and that ProNet's SERS system was intensely utilized. The Commission noted that ProNet's migration to another channel other than ProNet's would involve significant cost, and, because of ProNet's intense use of 453.125 MHz, such migration would likely cause disruption to public safety communications. 5. On March 19, 1998, the Wireless Telecommunications Bureau (Bureau) granted Petitions for Permanent Waiver filed by Kaiser Foundation Hospitals/Kaiser Foundation Health Plan, Inc. (Kaiser), and New York Hospital-Cornell Medical Center (NYH). In the Kaiser case, the Bureau concluded that permanently grandfathering Kaiser's paging system on 453.025 MHz would avoid not only a considerable expenditure of resources, but would prevent interruption of these important communications. Further, a study by Trott Communications Groups, Inc. (Trott Study II), submitted by Kaiser, demonstrated that without the availability of 453.025 MHz there was sufficient EMRS spectrum in the Southern California metropolitan area to meet existing needs. The Bureau also concluded that considering the significant conversion costs, relocation of Kaiser's system would not serve the public interest. 6. In NYH, the Bureau concluded that granting the waiver request would prevent interruption of important communications because it would avoid the need to obtain new equipment and implement a process for switching to a new frequency. Also, a study of frequency utilization (Trott Study III) indicated that adequate spectrum remained to meet the needs of EMRS entities in New York City even with NYH's continued use of 453.025 MHz. The study also indicated that usage levels on other SERS and Business Radio Service frequencies considered as potential "replacement" channels were so high that such spectrum was insufficient to support the added volume of NYH's pagers. The Bureau held that both Kaiser and NYH met the requisite showing for grant of their waiver requests. 7. Miami Valley Hospital, Helene Fuld Medical Center, Mercer Medical Center, St. Joseph's Regional Health Center, University of Iowa Hospitals and Clinics, Winchester Medical Center, Inc., and Deaconess Hospital have all filed requests for waiver seeking to continue their medical paging operations on the subject 453 MHz frequencies. They all assert that relocation of their paging operations to frequencies other than those on which they are currently operating would significantly disrupt public safety communications. As a result, they contend that permanent grandfathering of their paging systems is warranted. III. DISCUSSION 8. To obtain a waiver of the frequency reassignment implemented by the EMRS Report and Order, a petitioner is required to meet any one of three established criteria. As discussed below, we find that all seven hospitals have made the requisite showing and have met at least one criterion making them eligible for a grant of their request for a permanent waiver. 9. Miami Valley Hospital (MVH). On October 21, 1997, MVH filed a Request for Waiver (MVH Waiver Request) to continue to operate its medical paging operations on 453.175 MHz. MVH indicated that 453.175 MHz is required for vital communications between the doctors, nurses, and technicians who staff its hospital and are responsible for the care of patients with critical illnesses. MVH monitored the various frequencies available to it under the Rules and found that those frequencies are so heavily loaded that transferring its communications to those frequencies would most likely result in calls to its ambulances and support staff having intolerable waits to get through. In addition, MVH states that conversion to a different medical emergency frequency would cost a minimum of $25,000 in fixed equipment as well as the replacement cost of 2,000 pagers. Further, MVH notes that there is no other user of 453.175 MHz in the Dayton, Ohio, area and that requiring it to move to another frequency is a useless exercise in light of the fact that 453.175 MHz is presently lying fallow. We believe that MVH has shown that granting its request for a permanent waiver to allow it to continue its paging operations on 453.175 MHz would prevent interruption of vital life- saving communications. Therefore, we conclude that MVH has demonstrated that relocation of its paging system to a new frequency would significantly disrupt public safety communications. Accordingly, we find that grant of MVH Waiver Request is warranted based on the circumstances described herein. 10. Helene Fuld Medical Center (Helene Fuld) and Mercer Medical Center (Mercer). On January 10, 1998, these two hospitals each submitted a Request for Waiver (Helene Fuld Waiver Request and Mercer Waiver Request) so that they could continue to operate their medical paging operations on 453.125 MHz and 453.025 MHz, respectively. By letter of February 20, 1998, Helene Fuld and Mercer advised that they were merging to become Capital Health System (Capital). The ultimate plan for Capital is to have one communications system covering both hospital locations, which are three miles apart. The hospitals conducted research to determine if there were a significant number of emergency squads or other users on 453.125 MHZ or 453.025 MHz in the Trenton, New Jersey area. Their research showed that those frequencies were not heavily loaded in that area. Relocation to other frequencies would require the recystallization of approximately 550 pagers that are used to summon doctors, nurses and other hospital personnel, especially in emergency situations. According to the hospitals, switching to new frequencies would cost approximately $37,000. Based on the data submitted by Helene Fuld and Mercer, we conclude that they have demonstrated that relocation of their medical paging operations would significantly disrupt public safety communications. As a result, we find that the Helene Fuld Waiver Request and the Mercer Waiver Request should be granted. 11. St. Joseph's Regional Health Center (St. Joseph's). On January 14, 1998, St. Joseph's requested a permanent waiver (St. Joseph's Waiver Request) permitting it to continue its medical paging operations in the Hot Springs, Arkansas, area on the frequency 453.175 MHz. St. Joseph's hired Trott Communications Group (Trott) to conduct a study regarding spectrum availability in the area of its operations. According to St. Joseph's, the study showed that there is more than adequate spectrum available for EMRS tranmissions in the Hot Springs, Arkansas area. The channel activity recorded by Trott showed that the MED channels in St. Joseph's area of operations experienced a peak hour usage of between 0 percent and 1.5 percent and an average usage percentage of between 0% and 0.1%. Thus, existing EMRS channels are on the average unused over 99.9 percent of the time in the Hot Springs, Arkansas area. As a result, Trott concluded that a surplus of EMRS channel capacity exists in that location. 10. St. Joseph's argues that the relocation of its medical paging system from frequency 453.175 MHz would be contrary to the public interest because of the high costs such a relocation would impose on the hospital. According to C & W Communications, consultants engaged by St. Joseph's, the replacement of existing transmitting facilities and pagers capable of operating on another frequency would cost approximately $300,000.00. St. Joseph's asserts that it would be unreasonable to require it to relocate it paging system at such a signficant cost, with no apparent gain to public safety or quality of the hospital's communications. St. Joseph's also argues that relocation to a different paging frequency would significantly disrupt the hospital's public safety communication because relocating the approximately 2,640 pages each day to its physicians, nurses and other personnel would require the purchase, installation and configuration of an essentially new paging system. St. Joseph's contends that such disruption would prevent doctors from responding to a "Code Blue" call to revive a patient in cardiac arrest and preclude technicians from quickly responding to outages of the hospital's computers which monitor patients' vital signs. According to St. Joseph's, immediate termination of its medical paging operations on the frequency 453.175 would be catastrophic -- for example, dispatch of ambulances would be delayed and Code Blue teams would not be notified immediately of cardiovascular emergencies. Based on the data submitted by St. Joseph's, we conclude that it has demonstrated that relocation of its medical paging operations to another frequency would significantly disrupt public safety communications. Thus, we find that grant of the St. Joseph's Waiver Request is warranted. 12. University of Iowa Hospitals and Clinics (UIHC). By letter, filed January 5, 1998, UIHC has requested a permanent waiver (UIHC Waiver Request) permitting it to continue its medical paging operations in Iowa City, Iowa, area on the frequency 453.025 MHz. UIHC uses 3,000 pagers in conjunction with its medical paging system. UIHC states that the EMRS frequencies that are available can adequately support all current and future radiocommunications in its area. UIHC further states that its continued use of the frequency 453.025 MHz would not compromise the level of EMRS service in eastern Iowa. According to UIHC, a frequency search on the frequency 453.025 MHz within a 75 miles radius of the hospital revealed that no interference was caused and that no other entity was using the frequency. With respect to potential relocation, UIHC contends that each pager would have to be re-crystallized or replaced at a minimum cost of $215,000. In addition, the radio transmitters supporting the paging system would also need to be replaced and upgraded at a cost of approximately $30,000. UIHC notes that its current medical paging system processes over 10,000 pages each day and is used by doctors, nurses, surgeons, specialists, critical care and other support staff. UIHC argues that if this communication capability were not available, it would detrimentally impact the services and level of patient care. For example, UIHC contends that many of the pages transmitted are critical because they are intended for Code Blue Teams, Code Green Teams (patient violence management) and Disaster Activation Teams. UIHC also uses its medical paging system to provide basic and advanced life support services. The paging system of UIHC is in use 24 hours a day, 7 days a week, 365 days a year. Based on the data submitted by UIHC, we conclude that it has demonstrated that relocation of its medical paging operations to another frequency would significantly disrupt public safety communications. Therefore, we find that grant of the UIHC Waiver Request is warranted. 13. Winchester Medical Center, Inc. (Winchester). By letter of January 10, 1998, Winchester has requested a permanent waiver (Winchester Waiver Request) permitting it to continue to operate its medical paging system in Winchester, Virginia, on the frequency 453.025 MHz. Winchester indicated that the hospital is dependent upon its existing paging system operating on the frequency 453.025 MHz to communicate medical emergency codes and other life threatening situations to the appropriate medical teams, such as the Neonatal Transport Team, the Cardiac Response Team, and the Fire Response Team. A frequency usage study conducted by Communications Engineering Technology, Inc. revealed that there were only seven other users of the frequency 453.025 MHz within a 100 miles radius of Winchester. In addition, replacement of the two base transmitters and the five hundred pagers in the system would cost $176,000.00. Further, Winchester states that the hospital's transmitters and pagers provide the only paging functions for all critical notifications for the hospital's emergency code teams, neonatal transport teams, physician paging, fire response, cardiac teams, and bedside patient call functions. Winchester also submits that the ability of the hospital to contact the appropriate medical teams necessary to react to emergency medical code or fire conditions within the hospital, to summon neonatal transport personnel, to contact physicians and to enable patients to summon nurses and physicians is critical to patient care. According to Winchester, all of these types of paging communications involve life and death situations, and the quality and consistency of these communications cannot be compromised. Based on the data submitted by Winchester, we conclude that it has demonstrated that relocation of its medical paging operations to another frequency would significantly disrupt public safety communications. Thus, we find that grant of the Winchester Waiver Request is warranted. 14. Deaconess Hospital (Deaconess). On April 17, 1998, Deaconess requested a permanent waiver (Deaconess Waiver Request) permitting it to continue to operate its medical paging system in Cincinnati, Ohio, on the frequency 453.075 MHz. Deaconess states that it has monitored other frequencies now available to it under the Rules and has concluded that the shared frequencies are heavily loaded and that calls to ambulances and medical staff would have delays of several minutes. It further states that such delays would be intolerable given the emergency nature of the communications. According to Deaconess, such delays would endanger the health and welfare of the public, especially acutely ill patients. It further argues that disruption of its medical paging system would cause extreme problems in that it currently operates 720 paging units on its system, and it is has made no provision for an alternative paging system. Further, Deaconess states that its current system is heavily used, providing vital emergency communications to the doctors, nurses and technicians who staff its hospital. Based on the data submitted by Deaconess, we conclude that it has demonstrated that relocation of its medical paging operations to another frequency would significantly disrupt public safety communications. Therefore, we find that grant of the Deaconess Waiver Request is warranted. IV. CONCLUSION 15. In sum, we conclude that each of the seven subject hospitals has met at least one criterion established in the EMRS Report and Order for the permanent grandfathering of its medical paging system. Therefore, we grant their requests for permanent waiver to permit them to continue their one-way medical paging systems on the subject frequencies in the 453 MHz band. This action services the public interest because the hospitals' migration to other paging frequencies would pose unnecessary risks to essential medical paging communications without significant concomitant public interest benefits. V. ORDERING CLAUSES 16. Accordingly, IT IS ORDERED, pursuant to Section 4(i) of the Communications Act of 1934, as amended, 47 U.S.C.  154(i), and Sections 90.20(d)(60), 90.22 and 90.125 of the Commission's Rules, 47 C.F.R.  90.20(d)(60), 90.22 and 90.125, that the Requests for Waiver filed by Miami Valley Hospital, Helene Fuld Medical Center, Mercer Medical Center, St. Joseph's Regional Health Center, University of Iowa Hospitals and Clinics, Winchester Medical Center, Inc. and Deaconess Hospital to continue operating their medical paging systems on 453 MHz frequencies ARE GRANTED. 17. This action is taken under delegated authority pursuant to Section 0.131 and 0.331 of the Commission's Rules, 47 C.F.R.  0.131 and 0.331. FEDERAL COMMUNICATIONS COMMISSION D'wana R. Terry Chief, Public Safety and Private Wireless Division Wireless Telecommunications Bureau j:\prd\depont\miami.mjd