5.20.010 Title.

A. This chapter shall be known as the Marion County ambulance service ordinance, and may be so cited and pleaded.

B. First Amendment to Ambulance Service Ordinance. Ordinance No. 1172 shall be known as the first amendment to the Marion County ambulance service area (ASA) ordinance and ASA plan, and may be so cited and pleaded.

C. Second Amendment to Ambulance Service Ordinance. Ordinance No. 1249 shall be known as the second amendment to the Marion County ambulance service ordinance and may be so cited and pleaded. [Ord. 1249 § 1, 2007; Ord. 1172 § 1, 2002; Ord. 1067 § 1, 1997.]

5.20.020 Authority.

This chapter is enacted pursuant to ORS 203.035, 682.031 and 682.062 and OAR 333-260-0000 to 333-260-0070. [Ord. 1264 § 2(9), 2008; Ord. 1249 § 2, 2007; Ord. 1172 § 2, 2002; Ord. 1067 § 2, 1997.]

5.20.030 Policy and purpose.

A. Findings. The board of commissioners finds:

1. That ORS 682.062 requires Marion County to develop and adopt a plan for the county relating to the need for a coordination of emergency ambulance services and to establish ambulance service areas (ASAs) consistent with the plan to provide efficient and effective emergency ambulance services.

2. That this chapter, which establishes ASAs consistent for selecting emergency ambulance providers to the ASAs, and the ambulance service advisory committee, together with the document known as the Marion County ambulance service area plan (ASA plan), attached to the ordinance codified in this chapter as Exhibit A, and incorporated herein by this reference, make up the complete plan for emergency ambulance services for Marion County.

3. That the provisions of ORS 221.485, 221.495, 478.260(3), and 682.025 through 682.089 require Marion County to develop and adopt a plan for emergency ambulance services that recognizes the authority of cities and rural fire districts to operate and regulate emergency ambulance services within their own territories, subject to the ASA plan. That the provision of effective and efficient emergency ambulance services pursuant to the Marion County ambulance service area plan within cities and rural fire protection districts must be accomplished primarily on a cooperative basis. Marion County will employ the provisions of the Marion County ambulance service area plan when voluntary compliance cannot be obtained.

B. First Amendment to Ambulance Service Ordinance.

1. Purpose. Ordinance No. 1172 shall amend this chapter and the Marion County ASA plan by revising the number of ASAs, amending the ASA boundaries, revising the ASA advisory committee composition, and making other revisions to the ASA plan.

2. Findings. The board of commissioners finds that:

a. ORS 682.062 requires Marion County to provide notice and consult with each person, city or rural fire protection district within the county that desires to provide ambulance services prior to amending a plan for the county relating to emergency ambulance services, which it did through public hearings on October 30th and November 27, 2002; and

b. The provisions of ORS 682.025 through 682.071 require Marion County to consider all proposals for providing ambulance services and the existing boundaries of cities and rural fire protection districts upon any subsequent review of the ASA plan for the provision of effective and efficient emergency ambulance services, and that competing proposals for the boundary between ASA No. 1 and ASA No. 4 were received from the city of Salem and Marion County Fire District No. 1; and

c. Ordinance No. 1172, which amends the ASAs for the provision of effective and efficient emergency ambulance services, and changes the composition of the ambulance service advisory committee, together with the document known as the Marion County ambulance service area plan (ASA plan), attached to Ordinance No. 1172 as Exhibit A, and the ambulance service areas shown on the map attached to Ordinance No. 1172 as Exhibit B, incorporated herein by this reference, make up the complete plan for emergency ambulance services for Marion County.

C. Second Amendment to Ambulance Service Ordinance.

1. Purpose. Ordinance No. 1249 shall amend this chapter and the Marion County ASA plan by adding prearranged and nonemergency ambulance service to the ASA franchise areas with exceptions for certain nonemergency ambulance services and interfacility ambulance transfers, and for certain types of transports that do not provide medical services.

2. Findings. The board of commissioners finds that the ability to provide nonemergency and interfacility ambulance services by providers within the exclusive ASA areas helps offset the costs associated with providing emergency ambulance service and is an important component to their financial stability, clinical and operational performance, and the prevention of system degradation. [Ord. 1264 § 2(9, 14), 2008; Ord. 1249 § 3, 2007; Ord. 1172 § 3, 2002; Ord. 1067 § 3, 1997.]

5.20.040 Definitions.

The words and phrases in this chapter shall have the meaning provided in ORS Chapter 682 and OAR Chapter 333, Division 28, unless specifically defined herein to have a different meaning.

Other specific definitions include:

“Administrator” means the person designated by order of the board to administer this chapter and the duly authorized deputy or assistant of such person.

“Ambulance service area,” “service area” or “ASA” means the geographical area which is assigned to one ambulance provider and may include a county, two or more contiguous counties or a portion of such county(ies).

“Board” means the board of commissioners for Marion County, Oregon.

“Committee” means the ambulance service area advisory committee created pursuant to this chapter.

“Franchise” means a franchise to provide emergency and nonemergency ambulance service issued by the board pursuant to this chapter.

“Person” means and includes individuals, corporations, associations, firms, partnerships, joint stock companies, cities, rural fire protection districts, and combinations thereof formed and existing pursuant to Oregon Revised Statutes. [Ord. 1249 § 4(1), 2007; Ord. 1067 § 4, 1997.]

5.20.050 Exemptions.

This chapter shall not apply to:

A. Ambulances owned or operated under the control of the United States Government.

B. Vehicles and aircraft being used to render temporary assistance in the case of a major catastrophe or emergency with which the ambulance services of the surrounding locality are unable to cope, or when directed to be used to render temporary assistance by an official at the scene of an accident.

C. Vehicles operated solely on private property or within the confines of institutional grounds, whether or not the incidental crossing of any public street, road or highway through the property or grounds is involved.

D. Ambulances or vehicles transporting patients from outside the county to a health care facility within the county, or which are passing through without destination in the county. [Ord. 1067 § 5, 1997.]

5.20.060 Administration.

The administrator, under the supervision of the board and with assistance of the committee, shall be responsible for the administration of this chapter. In order to carry out the duties imposed by this chapter, the administrator, or persons authorized by the administrator, are hereby authorized to enter on the premises of any person regulated by this chapter at reasonable times and in a reasonable manner to determine compliance with this chapter and regulations promulgated pursuant thereto. The administrator shall also have access to records pertaining to ambulance service operations of any person regulated by this chapter. These records shall be made available within five working days to the administrator at the person’s place of business, or copies made and provided as requested by the administrator. [Ord. 1067 § 6, 1997.]

5.20.070 Ambulance service areas.

A. For the efficient and effective provision of emergency ambulance services in accordance with the ASA plan, the ambulance service areas shown on the map attached as Exhibit B* to the ordinance codified in this chapter, and incorporated herein by this reference, are hereby adopted as the ambulance services areas for Marion County. The board, after notice to affected ASA providers and by the adoption of an order, may adjust the boundaries of the ASA from time to time as necessary to provide efficient and effective emergency ambulance services. [Ord. 1067 § 7, 1997.]

*    Code reviser’s note: Exhibit B was amended by Ordinance No. 1172.

5.20.080 Ambulance service providers regulated.

No person shall provide emergency ambulance services or nonemergency ambulance services in Marion County, Oregon, unless such person is franchised in accordance with the applicable provisions of this chapter. [Ord. 1249 § 4(2), 2007; Ord. 1067 § 8, 1997.]

5.20.090 Application for ambulance service franchise.

A. Applications for franchises shall be on forms provided by the administrator. In addition to information required on the forms, the administrator may require any additional information he or she deems necessary to ensure compliance with this chapter.

B. The applicant shall provide the following information:

1. The name and address of the person or agency applying.

2. The ambulance service area the person desires to serve, the location(s) from which ambulance services will be provided, and the level of service to be provided.

3. A statement as to whether or not the person will subcontract for any service to be provided. If some service will be provided by subcontract, a copy of that subcontract shall be provided.

4. A list of vehicles to be used in providing emergency ambulance services including year, make and model, and verification that each vehicle is certified as a basic life support and/or advance life support vehicle by the state of Oregon.

5. A statement that all equipment and supplies in each ambulance conform to state standards.

6. A list of personnel to be used in providing emergency ambulance service and their current emergency medical technician level and certificate number, or other appropriate certification.

7. Proof of financial ability to operate, including an operating budget for public bodies or financial statement for private entities, references and/or statement of past ambulance service. Private companies must provide a profit and loss statement in addition to the above materials. Other appropriate financial information, such as income, tax returns, or reports by governmental authorities shall also be submitted upon request. Public bodies must provide information regarding the sources and amounts of funding for emergency ambulance services.

8. Proof of public liability insurance in the amount of not less than $100,000 per person and $500,000 per accident for bodily injury, and not less than $100,000 for property damage, in the form of a certificate of insurance or letter from the carrier. Applicants may be self-insured.

9. A statement of experience in providing emergency ambulance service of a comparable quality and quantity to ensure compliance with this chapter, regulations promulgated thereunder, any franchise issued, and the ambulance service area plan.

10. Proof of ability to comply with the terms and conditions of the ASA plan and applicable county ordinances, in the form of a narrative summary.

11. A description of any prepaid ambulance service plan, including number of members, number of years of operation, funding, and term.

12. Information, in the form of run logs, medical records, physician advisory correspondence, audit reports, training records, policy and procedure manuals and equipment records and inventories, and any other records or materials requested.

13. In the case of an application to transfer or take over an already assigned franchise:

a. A detailed summary of how the proposed change will improve emergency ambulance response time, and the quality and level of services to the ASA. It shall include an assessment of how the proposed change will impact the existing first response system.

b. Evidence that the call volume in the ASA is sufficient to financially or otherwise justify the change in service.

C. The board may from time to time, by order, adopt fees to defray the actual reasonable costs incurred by Marion County in processing applications, and adopt annual franchise fees to defray the reasonable costs of Marion County in administering this chapter. [Ord. 1067 § 9, 1997.]

5.20.100 Existing ambulance service providers.

Persons who meet the application requirements of MCC 5.20.090 and who were providing service on the effective date of the ordinance codified in this chapter shall be franchised to provide emergency ambulance service for the ASA they were serving on the effective date of the ordinance codified in this chapter. [Ord. 1067 § 10, 1997.]

5.20.110 Review of application for franchise.

A. Applications shall be reviewed by the administrator, who shall make such investigation as he or she deems appropriate, and who may request assistance of other persons as necessary.

B. The administrator shall notify the holder of a franchise for providing emergency ambulance service to an ASA of any applications by another person to take over that franchise.

C. Unless the time is extended by the board for good cause, the administrator shall make his or her recommendation to the board to grant, deny, modify or attach appropriate conditions to the application. The administrator shall transmit his or her recommendation within 60 days after the application and any required supplemental information has been received. [Ord. 1067 § 11, 1997.]

5.20.120 Board action on application for franchise.

Upon receipt of the administrator’s recommendation, the board:

A. Shall publish notice of its intent to hold a public hearing on the application and administrator’s recommendations at least 10 days, but not later than 30 days, following publication of notice.

B. May require additional investigation by the administrator if it finds that there is insufficient information on which to base its action.

C. Shall, upon the basis of the application, the administrator’s recommendation, such other information as is permitted by this chapter, and such information as is presented to the board at the public hearing, make an order granting, denying or modifying the application or attaching conditions thereto.

D. Shall not make an order adverse to the applicant or to the holder of, or applicant for, another franchise effective less than 30 days after the date of such order and shall notify such persons in writing of the order. The board may suspend operation of this subsection and enter an emergency order if it finds that there is an immediate and serious danger to the public or that a health hazard or public nuisance would be created by a delay.

E. After the board makes an order granting an emergency ambulance service franchise, with or without conditions, and the franchisee finds he/she is unable to provide a particular service, the administrator may permit the franchisee to subcontract such service to another person if the administrator finds that the quality and extent of the service would not be jeopardized. The administrator may require the filing of such information as he or she deems necessary. [Ord. 1067 § 12, 1997.]

5.20.130 Franchise terms and renewals.

A. Thereafter, unless the board finds that a longer or shorter term is required in the public interest, the term of an emergency ambulance service franchise shall be five years, beginning on January 1st of a year and ending December 31st five years later.

B. Unless grounds exist for refusal to renew a franchise under provisions for suspension or revocation as set forth in MCC 5.20.160, or unless the franchise is to be given to a new person, franchises shall be renewable. Application for renewal shall be made on forms provided by the administrator.

C. Not more than 180 days and not less than 120 days prior to the expiration of the franchise, or such other times as may be allowed by board order, a franchisee wanting to renew the franchise and any person desiring to take over the franchise shall submit an application to the administrator.

D. Review of all applications for renewal or take over of a franchise shall be conducted in the same manner as for an application pursuant to MCC 5.20.090, 5.20.110 and 5.20.120. [Ord. 1067 § 13, 1997.]

5.20.140 Early discontinuance of service by franchisee.

A. If a franchisee discontinues service before the expiration of his/her franchise, the board shall set a time by which applications must be submitted for a new franchise in the ASA.

B. The administrator shall develop an interim plan for coverage of the ASA, using existing franchisees and/or other available resources until the ASA can be reassigned.

C. The administrator shall issue a temporary certificate(s) valid for a stated period not to exceed six months, entitling a person(s) to provide emergency ambulance service in all or part of the ASA. The administrator may renew a temporary certificate for one additional six-month period. [Ord. 1067 § 14, 1997.]

5.20.150 Transfer of franchises.

A franchisee may transfer his/her franchise to another person only upon written notice to and approval by the board. Review of an application for transfer of a franchise shall be conducted in the same manner as for an application pursuant to MCC 5.20.090, 5.20.110 and 5.20.120. [Ord. 1067 § 15, 1997.]

5.20.160 Enforcement of franchise provisions.

A. Subject to the policies stated in MCC 5.20.030, and in addition to the remedy provided in MCC 5.20.170, and penalties provided elsewhere in this chapter, the administrator shall, upon reasonable cause, make an investigation to determine if there is sufficient reason and cause to suspend, modify, revoke or refuse to renew a franchise as provided in this section.

If, in the judgment of the administrator, there is sufficient evidence to constitute a violation of applicable local, state or federal law, this chapter, ORS Chapter 682 or the rules promulgated thereunder, the ASA plan, or if the franchisee has materially misrepresented facts or information given in the application for the franchise, the administrator shall notify the franchisee in writing, by certified mail, return receipt requested, or by personal service, as is provided by law for the service of a summons, of the violation and what steps he or she must take to cure the violation. The administrator shall send a copy of the notice to the committee and to the board.

Ten days following the receipt of notice of violation, the board may enter its order of revocation, modification, suspension or nonrenewal, and may thereby revoke, modify, suspend, or not renew the franchise, unless prior thereto the franchisee shall file with the board a request for a hearing on the administrator’s notice of violation. If said request is timely filed, or if the board so moves on its own, revocation, modification, suspension, or non-renewal will be stayed until the board can, at its earliest convenience, hold a public hearing thereon. Notice of said hearing shall be given to the franchisee by mail and to all others by publication in a newspaper of general circulation in the county or the ASA at least 10 days prior to such hearing. The burden of proof at the hearing held hereunder shall be upon the franchisee.

B. In lieu of the suspension or revocation of the franchise, the board may order that the violation be corrected and make the suspension or revocation contingent upon compliance with the order within the period of time stated therein. Notice of the board action shall be provided by mail to the franchisee. The notice shall specify the violation, the action necessary to correct the violation, and the date by which the action must be taken. The franchisee shall notify the board of the corrective action taken. If the franchisee fails to take corrective action within the time required, the board shall notify the franchisee by certified mail, return receipt requested, or by personal service that the franchise is suspended or revoked upon service of the notice.

C. Should the franchisee fail to comply with the board’s order, then the board may take any steps authorized by law to enforce its order. [Ord. 1067 § 16, 1997.]

5.20.170 Preventing interruption of service.

Whenever the board finds that the failure of service or threatened failure of service would adversely impact the health, safety or welfare of the residents of this county, the board shall, after reasonable notice, but not less than 24 hours’ notice to the franchisee, hold a public hearing. Upon appropriate findings after the hearing, the board shall have the right to authorize a franchisee or other person to provide services. [Ord. 1067 § 17, 1997.]

5.20.180 Appeals, abatement and penalties.

A. All decisions of the board under this chapter shall be reviewable by the circuit court of the state of Oregon for Marion County, only by way of writ of review.

B. The provision of emergency ambulance service by any person in violation of this chapter, or regulations promulgated thereunder, is a nuisance and the board may, in addition to other remedies provided by law or by this chapter, institute injunctive abatement or other appropriate legal proceedings to temporarily or permanently enjoin or abate such emergency ambulance service.

C. Any person who violates any of the provisions of this chapter is guilty of a violation. Failure from day to day to comply with the terms of these provisions shall be a separate offense for each day. Failure to comply with any provision shall be a separate offense for each such provision.

D. Violations of these provisions are punishable, upon conviction, by a fine of not more than $500.00 for a noncontinuing offense, i.e., an offense not spanning two or more consecutive calendar days. In the case of a continuing offense, i.e., an offense which spans two or more consecutive calendar days, violation of the provisions is punishable by a fine of not more than $500.00 per day up to the maximum of $1,000 as provided by law. [Ord. 1067 § 18, 1997.]

5.20.190 Duties of ambulance service franchisee.

The franchisee:

A. Shall conduct its operation in compliance with all applicable state and federal laws, rules and regulations, the terms of this chapter and the Marion County ambulance service area plan.

B. Shall not fail or refuse to respond to an emergency call for service if an ambulance is available for service.

C. Shall not respond to a medical emergency or a request for a prearranged, nonemergency medical transport originating outside its assigned ambulance service area except:

1. When the franchisee assigned to the ASA is unavailable to respond and the franchisee is requested by another franchisee or 911 dispatch to respond; or

2. When the response is for supplemental assistance or mutual aid.

D. Shall not voluntarily discontinue service to his/her assigned ASA until he/she has:

1. Given 90 days’ written notice to the administrator; or

2. Obtained written approval of the board.

E. Subsection (D) of this section shall not apply to:

1. Change, restriction or termination of service when required by any public agency, public body or court having jurisdiction;

2. Transfer of franchises pursuant to MCC 5.20.150. [Ord. 1249 § 4(3), 2007; Ord. 1067 § 19, 1997.]

5.20.200 Ambulance service area (ASA) advisory committee.

A. There is hereby created an ambulance service area (ASA) advisory committee.

1. The committee shall consist of 11 members:

a. One emergency physician/medical director.

b. One public advanced life support agency representative.

c. One private advanced life support agency representative.

d. One public agency first response provider (nontransporting).

e. Four public members.

f. One EMT or paramedic representing a public agency.

g. One EMT or paramedic representing a private agency.

h. One health care facility administrator, emergency room nurse or nurse manager.

2. The administrator and other Marion County staff as the board deems appropriate shall be ex officio members of the committee.

B. Members shall be appointed by and serve at the pleasure of the board. The board may appoint additional persons to the committee to serve as ex officio members or advisors. The board may appoint or approve designation of alternates to serve in the absence of persons appointed to the committee.

C. Except for the ASA administrator and other Marion County staff, appointments shall be for staggered terms on the initial committee for a term not to exceed three years. Subsequent appointments shall be for three-year terms. Members shall serve until their successors are appointed and qualified. Vacancies shall be filled by the board for the balance of the unexpired term. Persons may be appointed to successive terms.

D. The committee shall elect a chairperson. The committee shall meet at such times as it deems necessary or as called by the administrator or the board. The chairperson or any two members of the committee may call a special meeting with five days’ notice to other members of the committee; provided, however, that members may waive such notice.

E. The majority of the appointed membership of the ambulance service area advisory committee will constitute a quorum for the transaction of all committee business.

F. In addition to other duties prescribed by this chapter the committee shall:

1. Review and make recommendations to the administrator regarding the selection criteria for determining a franchise to provide emergency ambulance service.

2. Regularly provide information to the board from pre-hospital care consumers, providers and the medical community.

3. Periodically review the ASA plan and make recommendations to the board including, but not limited to:

a. Review the standards established in the plan and make recommendations regarding improvement of or new standards as required by OAR 333-28-120(1-3).

b. Monitor the coordination between emergency medical service resources.

c. Review dispatch procedures and compliance.

d. Review the effectiveness and efficiency of the ASA boundaries.

4. Implement the quality assurance program outlined in the ASA plan to ensure compliance with the ASA plan.

5. Perform such other duties as directed by the board. [Ord. 1269 § 3, 2008; Ord. 1172 § 4, 2002; Ord. 1067 § 20, 1997.]

5.20.210 Regulations of ambulance service.

Upon its own motion or upon a recommendation of the committee, the board may adopt ordinances, resolutions or orders regulating emergency ambulance service and implementing this chapter. Such regulations shall not conflict with ORS Chapter 682 and rules promulgated pursuant thereto. [Ord. 1067 § 21, 1997.]

5.20.220 Initial responder.

Nothing in these provisions prohibits a 911 agency, responsible for the dispatching of emergency services, from dispatching an initial responder to the scene of a medical emergency in addition to dispatching an emergency ambulance service provider. [Ord. 1067 § 22, 1997.]

5.20.230 Nonemergency ambulance services.

The ambulance service area plan (ASA plan) is amended to include nonemergency ambulance services as shown in Exhibit A, attached to the ordinance codified in this section and by this reference incorporated herein. [Ord. 1249 § 5, 2007.]

5.20.240 Amendments, construction, effective date and emergency clause.

A. Any judgment or declaration by any court of competent jurisdiction that any portion of this chapter is unconstitutional or invalid shall not invalidate any other portion of this chapter.

B. Upon recommendation of the committee or upon its own motion, the board may from time to time amend the provisions of this chapter. Amendments shall be made only after a public meeting before the board with such advance notice of the meeting as deemed appropriate by the board or as generally provided by ordinance, regulation or order of the board.

C. In order to provide efficient and effective emergency ambulance service in Marion County and thereby preserve the health, safety and welfare of the residents and inhabitants of the county, an emergency is declared to exist and the terms and provisions of this chapter shall become effective upon enactment of the ordinance codified in this chapter. [Ord. 1067 § 23, 1997.]