It is the purpose of this article to:
(1)
Establish
a regulated ambulance service system which can provide clinical quality
of care, with reasonable, reliable response time standards, and with
the goal of furnishing the best possible chance of survival, without
disability or preventable complication, to each ambulance patient.
(2)
Establish
a sole-provider ambulance system, because it is unreasonable to have
unnecessarily high rates to make needed improvements to ambulance
service in the service area, when a more efficiently designed system
can achieve the same results at lower cost. The most efficient design
to achieve the goals of high-quality service, at the lowest cost,
consistent with the quality of care required, is the implementation
of the system described herein.
(3)
Provide
a method to develop specific performance standards, adequate review,
and either continuation of service or an appropriate procedure to
obtain alternate proposals from other providers.
(4)
To
provide more effective medical oversight by recognizing a multi-jurisdictional
medical control board of licensed physicians expert in emergency medicine
and related specialties as the entity empowered hereunder to oversee
and regulate all clinical aspects of the emergency medical system
which affect patient care within this jurisdiction.
(Ordinance 2001-06-01, art. 1, adopted 6/21/01)
The following words and phrases, as used in this article, shall
have the following meanings:
That unit of local government designated in the interlocal
agreement which has accepted responsibility for providing administrative
and clerical services necessary to the orderly issuance, renewal,
suspension, revocation, or restriction of licenses, certifications
and permits pursuant to authorization by the medical control board,
which licenses, certifications, and permits shall be accepted as valid
throughout the regulated service area, including this jurisdiction.
Any vehicle which is equipped to provide treatment of life-threatening
emergencies through the use of advanced airway management, intravenous
therapy, and other advanced pre-hospital care procedures, and which
is equipped to transport sick or injured persons to or from health
care facilities.
Any privately or publicly owned motor vehicle or helicopter
that is specially designed or constructed and equipped and is intended
to be used for and is maintained or operated for the transportation
of patients.
Any person being transported in a reclining position within
the regulated service area to or from a health care facility except
when the transportation originates outside the regulated service area.
That entity which is then currently under contract to provide all ambulance and ambulance patient services within this jurisdiction and throughout the regulated service area, except those services specifically exempted by section 7.02.003 of this article.
A health care facility which possesses a Level 4 or higher
trauma categorization as defined by the department of state health
services.
Those membership fees, mileage charges, subsidy payments,
if any, and total average bill (exclusive of mileage charges) approved
for this jurisdiction by the city council from the uniform schedule
of price/subsidy options.
A physician licensed to practice medicine in the state and
certified by the medical control board as knowledgeable of the pre-hospital
emergency medical protocols, EMS radio procedures and the general
operating policies of the ambulance service contractor, and from whom
ambulance personnel may take medical direction by radio or other remote
communications device.
That group of officials elected to govern the affairs of
this city.
The geographic area encompassing the regulated service area
plus unincorporated areas of Collin County and such counties as may
choose to contract with the ambulance service contractor pursuant
to a contract incorporating clinical standards required hereunder,
and incorporating financial provisions with those contained in the
contract with the ambulance service contractor.
An individual who is a “specially skilled emergency
medical technician” under chapter 773, Texas Health and Safety
Code, or its successor.
That network of individuals, organizations, facilities and
equipment including, but not limited to, East Texas Medical Center
Emergency Medical Service, whose participation is required to generate
a clinically appropriate, pre-planned system-wide response to each
request for pre-hospital care and/or interfacility transport, so as
to provide each patient the best possible chance of survival without
disability, given available financial resources.
That adjustment justified on the basis of either an increase
in the system standard of care whose cost of implementation and ongoing
compliance exceeds the then-remaining balance of the “upgrade
reserve,” or on the basis of an unusual increase in the cost
of a factor of production when such increase in cost is industry-wide
and the result of causes beyond the ambulance service contractor’s
reasonable control.
That service and those units (e.g., fire department, first
responders) which provide initial stabilization and trained assistance
on-scene and, when required, en route to medical facilities, as well
as certain extrication and rescue services. In accordance with priority
dispatch protocols, a response unit is routinely sent to all presumptively
classified life-threatening calls within the ETMC-EMS service area.
Any rotary wing aircraft providing basic or advanced life
support services and patient transportation originating from the scene
of emergency incidents which occur within the contract service area.
That certain agreement between the cities of Lavon, Lucas,
Murphy, Parker, Sachse, St, Paul, Wylie and such other cities which
shall participate in the Southeast Collin County EMS Coalition for
EMS services, adopted effective __________, 2001, pursuant to section
791.001 et seq. of the Texas Government Code annotated and known as
the Interlocal Cooperation Act, and called herein interlocal agreement.
That ambulance service contract between the Southeast Collin
County EMS Coalition and the ambulance service contractor.
An official inquiry into the circumstances involving an ambulance
run or request for ambulance service, conducted by the medical director
or a licensed physician designated by the medical director, or by
the medical control board.
That direction given ambulance personnel by a base station
physician through direct voice contact, with or without vital sign
telemetry, as required by applicable medical protocols promulgated
by the medical control board, and by chapter 773, Texas Health and
Safety Code, or its successors.
That board of physicians established and empowered by this
article to update from time to time the system standard of care and
to monitor compliance with that system standard of care.
An emergency physician, expert in the pre-hospital practice
of emergency medicine, appointed by the ambulance service contractor.
Any diagnosis-specific or problem-oriented written statement
of standard procedures, or algorithm, promulgated by the medical control
board as the proper standard of pre-hospital care for a given clinical
condition.
The individual corporate limits of the individual cities
which are members of the Southeast Collin County EMS Coalition.
A written agreement between one or more providers of ambulance
service whereby the signing parties agree to provide backup ambulance
service to one another under conditions and pursuant to terms specified
in the agreement.
A person qualified as a certified “paramedic emergency
medical technician” as defined by chapter 773, Texas Health
and Safety Code, or its successor.
Any individual, firm, partnership, association, corporation,
governmental entity, or other group or combination acting as a unit.
The combined corporate limits or legal boundaries of all
jurisdictions which adopt this Uniform EMS Ordinance.
That person among the certified personnel assigned to an
ambulance, not the driver, who is a certified paramedic designated
by the ambulance service contractor as the individual in command of
the ambulance.
Any public event located within the regulated service area,
for which standby ambulance service is arranged in advance, and for
which an ambulance (or ambulances) are hired by the sponsor of the
event or other interested party.
A vehicle which is specially constructed, equipped, staffed,
and employed in the interfacility transport of patients whose requirements
for en-route medical support are likely to exceed the clinical capabilities
of a paramedic level ambulance.
The combined compilation of all priority dispatching protocols,
pre-arrival instruction protocols (i.e., ambulances), protocols for
selecting destination hospital, and standards for certification of
pre-hospital care personnel (i.e., telephone call takers, ambulance
personnel, and on-line medical control physicians), as well as standards
governing requirements for on-board medical equipment and supplies,
and licensure of ambulance services and first responder agencies.
The system standard of care shall simultaneously serve as both a regulatory
and contractual standard.
(Ordinance 2001-06-01, art. 2, adopted 6/21/01)
(a)
No
person shall operate or cause to be operated an ambulance nor furnish,
conduct, maintain, advertise or otherwise be engaged in the business
or service of the transportation of ambulance patients within the
regulated service area, or provide special events standby coverage,
unless such person is the ambulance service contractor. No person
shall knowingly solicit ambulance services as regulated herein except
the ambulance service contractor.
(b)
However, the prohibitions set forth in subsection (a) of this section shall not be applicable to an ambulance or ambulance service provider which is:
(1)
Rendering assistance to patients in the case of a major catastrophe
or emergency with which the ambulance service contractor’s ambulances
are insufficient or unable to cope;
(2)
Transporting a patient who is picked up from a location beyond the
regulated service area and transported to a location within the regulated
service area; or
(3)
Transporting a patient who is picked up from a location beyond the
regulated service area and transported to a location beyond the limits
of the regulated service area and only incidentally passing through
the regulated service area.
(c)
The ambulance service contractor may use another ambulance service provider for non-emergency transfers to and from the member jurisdictions, if the ambulance service contractor is unable to perform the service due to unavailability or due to exceeding the number of transports as set forth in subsection (d) of this section.
(d)
The
ambulance service contractor shall have the option to transport non-emergency
transports to and from the member jurisdictions but will limit the
number of such transports that [by] the ambulance service contractor’s
generally dedicated unit for the contract service area to no more
than five (5) per month.
(e)
All
emergency and non-emergency calls and requests for ambulance services
originating within the member jurisdictions will be dispatched through
or to the ambulance service contractor’s dispatch center.
(f)
Violations
of this article are hereby declared to be public nuisances and shall
be prohibited and abated in actions at law or in equity.
(Ordinance 2001-06-01, art. 3, adopted 6/21/01)
(a)
System standard of care adopted.
The system standard
of care as defined herein is hereby adopted as the minimum requirement
for compliance with this article, and the medical control board is
hereby recognized as the clinical standards-setting body for this
jurisdiction.
(b)
Physician participation.
Any hospital within this jurisdiction
which operates an emergency room or emergency department meeting the
requirements of an approved emergency room/department shall be eligible
to appoint its physician director of said emergency room or department
(or his/her physician designee) to membership on the medical control
board, and such representative shall have full voting rights when
the MCB has been notified in writing by an officer of the hospital.
(c)
Coordination of activities.
The medical director appointed
by the ambulance service contractor shall serve as ex officio, nonvoting
chair of the medical control board, and shall be responsible for arranging
meetings, creating the agenda, keeping minutes, ensuring compliance
with this article, and developing a process for monitoring compliance
with the system standard of care, subject to approval by the medical
control board.
(d)
Duties and responsibilities.
Responsibilities of the
medical control board shall be as follows:
(1)
To set the system standard of care and provide periodic revisions.
The system standard of care shall address minimum requirements and
recommended higher standards governing the licensure of organizations,
the certification of individuals, and the permitting of vehicles employed
within the EMS system, and shall be developed in accordance with the
following table of contents:
(2)
Authorize the issuance, denial, revocation, suspension, or restriction
of licenses, permits and certifications issued pursuant to this article.
(3)
Licenses, certifications, and permits in good standing issued by
any jurisdiction within the regulated service area pursuant to written
authorization by the medical control board shall be recognized and
accepted as valid by this jurisdiction.
(e)
Selection of patient destination.
Medical protocols
approved by the medical control board shall establish protocols for
selection of the destination hospital, which protocols shall be strictly
followed by paramedic personnel and on-line medical control physicians,
except when a departure from protocol is justified on the basis of
special considerations of patient care or practical barriers to implementation
(e.g., blocked roads, hospital divert status, etc.). In developing
such “transport protocols,” the medical control board
shall strictly adhere to the following priorities of consideration,
and shall recognize these priorities in the sequence presented:
(1)
First consideration:
Patient care and safety;
(2)
Second consideration:
Patient/family choice;
(3)
Third consideration:
Fairness in distribution of patients
among hospitals. In this regard, the following rules shall apply:
(A)
Non-emergencies.
All “non-emergency patients”
(as defined by patient-assessment protocols approved by the medical
control board) shall be transported to the destination selected by
the patient, the patient’s family, or the patient’s personal
physician, without exception.
(B)
Non-life-threatening emergencies.
Patients experiencing
a “non-life-threatening emergency” (as defined by patient-assessment
protocols approved by the medical control board) shall be transported
to the facility of choice designated by the patient, the patient’s
family, or the patient’s personal physician, or, if no such
preference is stated, to the nearest hospital approved by the medical
control board for receipt of patients experiencing non-life-threatening
emergencies.
(C)
Life-threatening emergencies.
Patients experiencing
life-threatening emergencies (as defined by patient-assessment protocols
approved by the medical control board) shall, in accordance with transport
protocols approved by the medical control board, be delivered to the
“nearest appropriate facility,” taking into consideration
the patient’s condition and location, the patient’s medical
requirements, and the respective capabilities of hospitals within
(and, for some types of patients, outside) the “contract service
area.” Such transport protocols shall not be inconsistent with
then currently approved trauma system protocols (when available).
(D)
Enforcement.
Inappropriate and unjustified deviations
from these patient-destination protocols by a paramedic without direct
authorization by a base station physician or inappropriate and unjustified
instructions regarding such deviation by a base station physician
shall be subject to sanction by the medical control board provided
such sanctions are applied in accordance with due process procedures
approved by the city attorney. Such sanctions may include reprimand,
suspension of certification, or revocation of certification, depending
upon frequency and severity of error.
(f)
Binding arbitration available.
In the event any hospital
desires to dispute a policy of the medical control board affecting
patient distribution, that hospital may at its option institute procedures
for binding arbitration as follows:
(1)
The hospital wishing to contest the specified policy shall present
its position in writing to the medical control board, including one
or more proposed remedies acceptable to the hospital.
(2)
If the medical control board rejects all remedies proposed by the
hospital, the hospital may appoint a physician expert in the medical
specialty to which the contested policy is related to serve as a member
of an arbitration team, provided that such physician shall have no
affiliation, direct or indirect, with any hospital or physician group
practicing within the contract service area.
(3)
The medical control board shall then appoint a physician expert in
the medical specialty to which the contested policy is related to
serve as a member of the arbitration team, provided that such physician
shall have no affiliation, direct or indirect, with any hospital or
physician group practicing within the contract service area.
(4)
The two appointed members of the arbitration team shall then jointly
appoint a third physician expert in the medical specialty to which
the contested policy is related to serve as the third member of the
arbitration team, provided that such physician shall have no affiliation,
direct or indirect, with any hospital or physician group practicing
within the contract service area.
(5)
The arbitration team shall then review such written documentation
related to the dispute as may be available, and shall conduct such
site visit inspections and on-site interviews as the team deems appropriate,
and shall render a decision on the disputed matter either in favor
of the medical control board or in favor of the hospital initiating
the arbitration process, and such decision shall be final. The arbitration
team shall not have authority to impose any resolution which was not
proposed by either the medical control board or the hospital initiating
the proceedings.
(6)
The actual and reasonable cost of the arbitration process, including
consulting fees and travel reimbursement, shall be paid by the hospital
initiating the arbitration process.
(Ordinance 2001-06-01, art. 4, adopted 6/21/01)
All persons and entities regulated under this article shall
comply with the laws of the state and [with] reference to permits,
licenses, minimum equipment and minimum qualifications of operators
and attendants and all state and federal laws and regulations applicable
to its ambulance operation.
(Ordinance 2001-06-01, art. 5, adopted 6/21/01)
(a)
It
shall be unlawful for any person, with intent to defraud, to request
or accept the service of any ambulance within the city, having no
intention of paying for such service.
(b)
Failure,
by the person requesting or accepting the services of an ambulance,
to pay to the person furnishing such service the customary charge
therefor within ninety (90) days after demand for payment is made,
shall be prima facie evidence of intent to defraud and prima facie
evidence that such person had no intention of paying for such services
when the same were requested or accepted.
(c)
Demand
for payment, as used in this article, shall be written demand, sent
by registered or certified mail addressed to the person requesting
or accepting such services and to the address given by or on behalf
of such person at the time the services were requested or accepted.
Intent to defraud or intention not to pay for such services may be
shown by direct evidence.
(Ordinance 2001-06-01, art. 6, adopted 6/21/01)
Any person who shall violate any provision of this article shall be deemed guilty of a misdemeanor and upon conviction thereof shall be fined as provided in section 1.01.009 of the municipal code. Each day such violation shall continue, or be permitted to continue, shall be deemed a separate offense. It shall not be necessary for the complaint to negative any exception contained in this article concerning any prohibited act, but any such exception made in this article may be urged as a defense by any person charged by such complaint.
(Ordinance 2001-06-01, art. 7, adopted 6/21/01)
