Chapter 7.82
AMBULANCES
Sections:
7.82.030 Exclusive operating area(s).
7.82.040 Ambulance provider agreement (formal written agreement).
7.82.050 Emergency ambulance services.
7.82.060 Ambulance provider agreement suspension, revocation, nonrenewal and levying of fines.
7.82.010 General provisions.
A. Title. This chapter shall be known as the "Ambulance Ordinance of Amador County."
B. Authority.
1. California Code of Regulations, Title 22, Division 9, Section 100168(b): An approved EMT-P service provider shall have a written agreement with the local EMS agency in order to participate in the advanced life support program and comply with all applicable state regulations and local policies and procedures, including a mechanism to assure compliance.
2. California Health and Safety Code (The EMS Act) Sections 1797, et seq., particularly 1797.85 and 1797.224, allow local EMS agencies to create exclusive operating areas for emergency ambulance services, as defined herein.
3. California Health and Safety Code Section 1797.85 defines an "exclusive operating area" as an area in which the local EMS agency, upon the recommendation of a county, restricts operations to one or more emergency ambulance services or providers of limited advanced life support.
C. Purpose and Intent.
1. To enact formal policies and regulations to assist the local EMS agency in creating a comprehensive system governing virtually every aspect of emergency ambulance services in Amador County. The policies and regulations are required for operation of emergency ambulance services within Amador County in order to provide for the public health, safety and welfare.
2. To recommend to the local EMS agency that it amend the transportation plan to provide for an exclusive operating area encompassing the geographic boundaries of the county of Amador for provision of all emergency ambulance services for the purpose of safeguarding the financial viability of Amador County’s ambulance service provider, American Legion Ambulance, in order to promote the health and welfare of the public by ensuring the continued provision of emergency ambulance services for both rural and urban areas of Amador County.
D. Exemptions.
1. This chapter shall not apply to vehicles operated as ambulances and to persons engaged in the provision of ambulance service where ambulance services are rendered at the request of any county communications center or at the request of any law enforcement or fire protection agency during any "state of war emergency," "state of emergency," or "local emergency" as defined in Government Code Section 8558 or during any period (not over thirty days, but renewable every thirty days) when the county health officer determines that adequate emergency ambulance services will not be available from existing county providers.
2. The county health officer may grant a variance from terms of this chapter if such action is necessary to protect the public health, safety, or welfare. Such action may include the issuance of temporary ambulance provider agreements to provide for a transition period created by unanticipated service deficiencies.
3. This chapter shall not prevent any peace officer, fire fighter, or physician licensed to practice medicine in this state, from arranging for the transportation of an individual, in need of emergency medical care, when no emergency ambulance with an appropriate ambulance provider agreement is available, and such transportation is required immediately for the preservation of life or to avoid substantial impairment of the person to be transported.
4. This chapter does not apply to aircraft providing air ambulance services. (Ord. 1490(part), 1999).
7.82.020 Definitions.
"Acute care facility" means a facility licensed by the State Department of Health Services as a general acute care hospital.
"Advanced life support (ALS)" means special services (EMT-P level skills) designed to provide definitive prehospital emergency medical care, including, but not limited to, cardiopulmonary resuscitation, cardiac monitoring, cardiac defibrillation, advanced airway management, intravenous therapy, administration of specified drugs and other medicinal preparations, and other specified techniques and procedures administered by authorized personnel under the direct supervision of a base hospital as part of a local EMS system at the scene of an emergency, during transport to an acute care hospital, during interfacility transfer, and while in the emergency department of an acute care hospital until responsibility is assumed by the emergency or other medical staff of that hospital. (H&S Code 1797.52)
"Air ambulance" means an aircraft specially constructed, modified or equipped and used for the purpose of responding to emergency calls and transporting critically ill or injured patients, with a medical flight crew that has at a minimum two attendants certified or licensed in advanced life support, as defined in Title 22 of the California Code of Regulations, Chapter 8, Article I, Section 100280.
"Allied pre-hospital care provider" means physician’s assistants and registered nurses, authorized per protocols approved by the local EMS agency medical director to function within the EMS system.
"Ambulance" means a vehicle specially constructed, modified or equipped and used for the purpose of transporting sick, injured, convalescent, infirm, or otherwise incapacitated persons that require transportation while on a gurney. At a minimum, any ambulance operating in Amador County must be staffed and equipped at the BLS level.
"Ambulance provider agreement" means a formal written agreement between the local EMS agency and an ambulance service provider which stipulates conditions under which the provider operates in the provision of emergency ambulance services within Amador County.
"Ambulance service provider" means a person, firm, partnership, corporation, or other organization which has an agreement with the local EMS agency to furnish emergency ambulance services within Amador County.
"Ambulance station" means the premises (including living quarters) located within Amador County from which the ambulance service provider renders service to a particular region within the county, as determined by the Local EMS agency.
"Authorized EMS dispatch center" means a dispatch center authorized by the local EMS agency for dispatch of emergency medical services within Amador County.
"Basic life support (BLS)" means emergency first aid and cardiopulmonary resuscitation procedures which, as a minimum, include recognizing respiratory and cardiac arrest and starting the proper application of cardiopulmonary resuscitation to maintain life without invasive techniques until the victim may be transported or until advanced life support is available (H&S Code 1797.60)
"Code of response" means codes that denote the level of ambulance response. Criteria for these response codes shall be defined in the dispatch protocols of the authorized dispatch center(s) by the medical director of the local EMS agency:
1. Code I. Scheduled ambulance response without red lights and siren.
2. Code II. Immediate ambulance response or transport without red lights and siren.
3. Code III. Immediate ambulance response or transport using red lights and siren, as permitted in Section 21055 of the California Vehicle Code.
"Critical care transport (CCT)" means the transport of a patient by ambulance between medical facilities where it has been determined by the patient’s physician that such transport requires medical supervision beyond the scope of the practice of EMT-Ps.
"Emergency ambulance services" means all services originating in Amador County that require the use of an ambulance, including but not limited to advanced life sup port, basic life support, interfacility patient transfer, and critical care transport.
"Emergency medical dispatcher" means any person employed by an agency, public or private, providing emergency medical dispatch service who has successfully completed a local EMS agency approved EMD training program that is consistent with the training guidelines established by the state EMS authority.
"Emergency medical services" means the services needed to provide urgent medical care in a condition or situation in which an individual has a need for immediate medical attention or where the potential for such need is perceived by emergency medical personnel, a public safety agency, or, with respect to interfacility transfers, qualified medical personnel of the transferring facility. Emergency medical services shall include, but not be limited to, all emergency ambulance services provided in Amador County.
"Emergency medical technician-I" or "EMT-I" means an individual who has been certified by the EMT-I certifying authority and trained in all facets of basic life support to perform the scope of practice described in Title 22 of the California Code of Regulations, Chapter 2, Article 2, Section 100063.
"Emergency medical technician--paramedic" or "EMT-P" means an individual currently licensed as an EMT-P in the state of California and currently locally authorized, whose scope of practice to provide advanced life support is according to standards prescribed in Title 22 of the California Code of Regulations, Division 9, Chapter 4.
"Exclusive operating area" means a geographical area in which the local EMS agency, upon the recommendation of a county, restricts operations to one or more providers of emergency ambulance services in accordance with Health and Safety Code, Sections 1797.224 and 1797.85.
"Interfacility transfers" is the transportation by ambulance of a person from one medical facility to another. Local EMS Agency. The local EMS agency for Amador County is the Mountain-Valley Emergency Medical Services Agency; however, the Amador County board of supervisors has the power and may in the future designate another agency to serve as the local EMS agency for Amador County.
"Medical facility" means a hospital, medical clinic, doctor’s office, nursing home, long-term care facility, hospice, rehabilitation facility, or any other facility at which patients are treated or cared for by licensed medical staff. A patient’s home does not constitute a medical facility.
"Transportation plan" means the plan developed by the local EMS agency of Amador County as referenced in Division 2.5 of the Health and Safety Code, Sections 1797.224 and 1797.85. The transportation plan is the "local plan" that defines the optimal type of exclusive operating area for the county of Amador. (Ord. 1490(part), 1999).
7.82.030 Exclusive operating area(s).
A. Noncompetitive Process. Amador County recommends that the local EMS agency amend its transportation plan, as necessary, to restrict provision of all emergency ambulance services within the geographical boundaries of Amador County to American Legion Ambulance of Amador County. Since American Legion Ambulance of Amador County has been providing emergency ambulance services in Amador County without interruption and without a change in the "manner and scope" of said services since prior to January 1, 1981, Amador County recommends that the local EMS agency restrict provision of emergency ambulance services in Amador County to American Legion Ambulance of Amador County without engaging in a competitive process. (See Health and Safety Code Section 11797.224)
B. Competitive Bid Process. Upon determination by the county board of supervisors, the Amador County may recommend to the local EMS agency that the exclusive operating area, or a portion thereof, be subject to a competitive bid process with the following stipulations:
1. The transportation plan of the EMS plan of the local EMS agency shall be modified as necessary to be consistent with any changes in, or division of, the exclusive operating area.
2. The application process for prospective ambulance service providers shall follow the policy of the local EMS agency.
3. The competitive bid process shall be developed and administered by the local EMS agency and shall include a process of appeal, which requires the following: (1) that any appeal shall be in writing and shall be filed with the local EMS agency within thirty days of a determination by the local EMS agency to award a contract for emergency ambulance services following a competitive bid process; (2) that a hearing on an appeal shall be held within ninety days from the receipt of the appeal shall; and (3) that the decision rendered following hearing on the appeal shall be final. (Ord. 1490(part), 1999).
7.82.040 Ambulance provider agreement (formal written agreement).
A. Ambulance Provider Agreement Requirement. No person (either as owner, agent or otherwise) or entity shall furnish, operate, conduct, maintain or otherwise engage in or advertise, offer or profess to engage in the provision of emergency ambulance services originating in Amador County, unless the person or entity is qualified for, and is currently a party to, a formal written ambulance provider agreement with the local EMS agency for Amador County. No ambulance provider agreement is required for persons or entities who (1) pick up patients at sites outside of Amador County and deliver them by ambulance (or otherwise) to sites within Amador County, and/or (2) pick up patients at sites outside of Amador County, transport them through Amador County, and deliver them to sites outside of Amador County.
B. Term of Ambulance Provider Agreement. Amador County recommends to the local EMS agency that ambulance provider agreements have a duration of five (5) years, renewable upon recommendation by the Amador County board of supervisors to the local EMS agency.
C. Transfer of Ambulance Provider Agreements. No agreement shall be transferred to another person, partnership, corporation, agency or other organization except upon prior written approval of the local EMS agency with formal written concurrence of the Amador County board of supervisors. Application for transfer of any ambulance provider agreement shall be subject to the same terms, conditions, and requirements as if the application were for an original agreement.
D. Renewal of Ambulance Provider Agreements. The ambulance service provider shall seek renewal of their ambulance provider agreement by filing with the local EMS agency an application for renewal, in writing, on a form furnished by the local EMS agency. The application for renewal shall be accompanied by a renewal fee of one hundred dollars.
1. An ambulance provider agreement for provision of emergency ambulance services in an exclusive operating area which is granted in accordance with this chapter may be renewed more than once.
2. Renewal Determination. An application for renewal shall be granted within ninety days of receipt of the renewal application, unless one of the following occurs:
a. The local EMS agency, in concurrence with the county health officer, determines that the applicant has failed to comply with the terms and obligations of the ambulance provider agreement.
b. The local EMS agency, in concurrence with the county health officer, determines that the applicant fails to meet the requirements for provision of emergency ambulance services in the particular operating area.
c. The local EMS agency, in concurrence with the county health officer, determines that the public health, safety and welfare no longer supports or justifies the making of an ambulance provider agreement with the applicant.
d. The local EMS agency has determined that the exclusive operating area in Amador County should be divided or otherwise modified.
e. The local EMS agency has determined that a competitive process should be utilized to select the provider(s) of emergency ambulance services with Amador County.
f. The Amador County board of supervisors has recommended to the local EMS agency that the exclusive operating area be divided or otherwise modified, and the local EMS agency has not yet considered the recommendation.
g. The Amador County board of supervisors has recommended to the local EMS agency that a competitive process be utilized to determine who will provide emergency ambulance services within Amador County, and the local EMS agency has not yet considered the recommendation.
E. Appeal from Denial of Issuance of Ambulance Provider Agreement. If an agreement cannot be reached between the applicant for renewal and the local EMS agency, the applicant may file an appeal within thirty days with the local EMS agency. A hearing on the request shall be scheduled within ninety days from the receipt of a written request for an appeal hearing.
1. The hearing may be held before a hearing officer designated by the local EMS agency’s board of directors.
2. Decision Finality. The decision of the board of directors or its designated hearing officer rendered following the hearing shall be final.
F. Variances and Temporary Agreements.
1. The county health officer may grant a variance from the terms of this chapter if such action is necessary to protect the public health, safety, or welfare. Such action may include, but is not limited to, the issuance of temporary ambulance provider agreements. Such variance or temporary agreements shall remain in effect for the period indicated by the county health officer but not to exceed one hundred eighty days.
2. The local EMS agency, may authorize a temporary ambulance provider agreement to an ambulance service provider based outside the county and properly licensed by the California Highway Patrol for an initial period not to exceed three days (may be renewed) for special activities. Such agreement shall adhere to local EMS agency policies and procedures for special events and shall contain such additional conditions and restrictions that the local EMS agency, deems appropriate for the operation.
G. Allied Prehospital Care Provider Response to EMS Requests. The local EMS agency may authorize and develop policies and procedures for the use of allied prehospital care providers to provide emergency medical services within the EMS system in Amador County.
H. Critical Care Transport Requirements. Ambulances engaged in the transport of critical care patients are required to have an ambulance provider agreement that meets the requirements specified herein and any additional requirements properly promulgated in accordance with local EMS agency policy. (Ord. 1490(part), 1999).
7.82.050 Emergency ambulance services.
A. Level of Service. Unless directed by a treating physician for an interfacility transfer or authorized by an EMS dispatch center to respond an ambulance staffed and equipped at the BLS or CCT level, the level of response to ambulance requests shall be by ALS ambulance.
B. Nondispatch Ambulance Requests. If requests for emergency ambulance services are received by an ambulance service provider, other than through an authorized EMS dispatch center, the provider must respond to these requests by following protocols approved by the local EMS agency medical director. (Ord. 1490(part), 1999).
7.82.060 Ambulance provider agreement suspension, revocation, nonrenewal and levying of fines.
Amador County recommends that the local EMS agency adopt the following regulations regarding suspension, revocation and nonrenewal of ambulance provider agreements and the levying of fines:
A. Cause. The local EMS agency with concurrence of the county health officer may suspend, revoke, or decline to renew an ambulance provider agreement for cause, including but not limited to the following: (1) the provider fails to comply and maintain compliance with, or violates, any applicable provisions, standards, or requirements of the ambulance provider agreement, any state law or regulation, this chapter, or any regulations promulgated hereunder; (2) the provider fails to make and retain adequate records showing its dispatch operations, or fails to make such records available for inspection by the local EMS agency; (3) the provider accepts a request to provide emergency medical services when it is either unable or unwilling to provide the requested service; (4) the provider accepts a request to provide emergency medical services and fails to inform the person or dispatching agent requesting such service of any anticipated delay in response; and/or (5) the provider accepts a request to provide emergency medical services and causes an ambulance to respond from a location more distant than the one to which the request was directed without first obtaining the consent of the person or dispatching agent requesting the emergency medical services. Suspension is not a condition precedent to revocation or nonrenewal.
B. Notice Issuance Prior to Suspension, Revocation, Nonrenewal. Before suspension, revocation, or nonrenewal for cause, the local EMS agency shall give written notice to the provider, specifying why such action is contemplated and giving the provider a reasonable period of time, not less than seven nor more than fifteen days, to correct noncompliance or to request a hearing to challenge the proposed action. The hearing shall be held not later than thirty days after receipt of a request for such hearing. The notice and hearing provisions shall not apply to a nonrenewal which occurs due to a decision by the local EMS agency or the Amador County board of supervisors to divide or otherwise modify the exclusive operating area(s) or to utilize a competitive process to determine who will provide emergency ambulance services within Amador County, as set forth in Section 7.82.040(D)(2)(d) through (g) of this chapter.
C. Hearing. At the hearing the local EMS agency has the burden of proof and shall present evidence as to why such action should be taken and answer the evidence presented by the provider.
D. Hearing Officer. Hearings conducted pursuant to this chapter shall be conducted before a hearing officer designated by the board of directors of the local EMS agency. The hearing officer may issue subpoenas for the production of documents or the attendance of witnesses. The hearing officer shall determine whether oral evidence at the hearing shall be recorded by a court reporter. At the conclusion of said hearings the hearing officer shall prepare a written statement setting forth in summary fashion his findings and conclusions with regard to the matters submitted for his decision. The parties shall equally bear the expense of the hearing officer and the cost of the hearing. Each party shall bear its own expenses.
E. Emergency Action. The local EMS agency may reduce the period of time for compliance under a suspension or revocation notice to no less than twenty-four hours and set the matter for hearing immediately upon expiration of said period, if the local EMS agency makes written preliminary findings that such action is necessary to protect the public health, safety and welfare. When, as a result of such an emergency proceeding, an agreement is suspended or revoked, the provider may request an additional hearing at which the provider will have the burden of establishing renewed compliance justifying reinstatement of the agreement. Such additional hearing will be commenced within fifteen calendar days of the provider’s request. The request for, or the scheduling of, an additional hearing shall not stay operation of the suspension or revocation order.
F. Evidence. In hearings conducted pursuant to this chapter, evidence must be relevant, noncumulative, and of such nature as responsible persons are accustomed to relying on in the conduct of serious affairs. So far as practicable, the hearing shall be conducted under Section 11513 of the Government Code and witnesses may be examined under Section 776 of the Evidence Code.
G. Decision of Hearing Officer. The written decision of the hearing officer, consisting of a summary of the evidence, his findings and conclusions shall be issued within thirty days after the conclusion of the hearing. Judicial renew of the decision of the hearing officer shall be held pursuant to the Code of Civil Procedure Section 1094.5 and 1094.6. Such review must be initiated by filing a petition for writ of mandate pursuant to Code of Civil Procedure Section 1094.5 not later than ninety days following the date on which the decision of the hearing officer became final. The decision of the hearing officer shall be final upon the date it is mailed to the parties by certified mail. (Ord. 1490(part), 1999).
7.82.070 User complaints.
Any user or subscriber to an ambulance service provider contending that he/she has been required to pay an excessive charge beyond published rates for services, or that he/she has received inadequate services, may file a written complaint with the local EMS agency setting forth such allegations. The local EMS agency shall notify the ambulance service provider of such complaint and shall investigate the matter to determine the validity of the complaint. If the complaint is determined to be valid, the local EMS agency shall take reasonable and proper actions to secure compliance with the conditions of this chapter and may convene a hearing before the board of directors of the local EMS agency to determine whether a fine should be levied against the ambulance service provider. The ambulance service provider shall have the right to attend with representation and introduce evidence at any such hearing. (Ord. 1490(part), 1999).