The purpose of this chapter is to provide for the public health,
safety, and welfare in the operation of prehospital emergency care
resources through the establishment of effective standards for the
operation, equipment, and personnel of ambulance service. It is intended
that this chapter be consistent with and supplement the provisions
of the emergency medical services systems and the Pre-hospital Emergency
Medical Care Personnel Act (Division 2.5 of the Health and Safety
Code).
(Ord. 564 § 3, 2005)
For the purposes of this chapter, the following definitions
shall apply. These definitions are meant only to supplement and not
to supplant the definitions set forth in Division 2.5 of the Health
and Safety Code.
means a vehicle certified by the California Highway Patrol
that is specifically constructed, modified, equipped, designed, used
and operated for transporting sick, injured, convalescent, or otherwise
incapacitated persons. "Medi-vans" and/or "gurney-vans" are not included
in this definition, nor are they meant to be used interchangeably
with "ambulance."
means a person, organization, company, corporation, or other
entity, whether public or private, which provides ambulance services.
means a written agreement between the local EMS agency and an ambulance provider entered into pursuant to Section 11.15.040 of this chapter.
means area(s) designated by the board of supervisors for
the provision of emergency medical services. The map depicting and
defining the geographic service areas shall be available from the
permit officer.
means the transportation (including, but not limited to,
interfacility transfers) by an ambulance provider of sick, injured,
convalescent, or otherwise incapacitated persons and the furnishing
of authorized pre-hospital medical care in conjunction therewith.
means the Lassen County board of supervisors.
means Chapter 11.15 of the Lassen County Code.
means Lassen County.
means the Emergency Medical Service Systems and the Prehospital
Emergency Medical Care Personnel Act as set forth in Division 2.5
of the Health and Safety Code. Any reference thereto shall be deemed
to refer to the Act as it may be amended subsequent to the enactment
of the ordinance codified in this chapter.
means an ambulance service area for which the local EMS agency,
upon the recommendation of Lassen County, restricts operations to
one or more emergency ambulance services.
means the California Health and Safety Code. Any reference
thereto shall be deemed to refer to the Code as it may be amended
subsequent to the enactment of the ordinance codified in this chapter.
means the entity which the Lassen County board of supervisors
has designated or contracted with pursuant to the Emergency Medical
Service Act to fulfill the duties and responsibilities prescribed
in the act to be undertaken by a "local EMS agency" as that term is
defined in the Act.
means the County administrative officer or his or her designee.
means an individual, firm, partnership, association, corporation,
company, group of individuals acting together for a common purpose,
or any organization of any kind.
means an ambulance provider agreements, which is limited
in duration (not to exceed ninety days), executed between the LEMSA
and an ambulance provider.
means the state of California.
(Ord. 564 § 3, 2005; Ord. 564-A § 2, 2007)
(a)
The permit officer shall make necessary and reasonable rules and
regulations covering ambulance service operation, ambulance transport
equipment, ambulance personnel, and standards of dispatch for the
effective and reasonable administration of this chapter.
(b)
These regulations shall include, but not be limited to:
(1)
Response time standards for emergency responses in each area of the
county;
(2)
Identification of required operational reports and dispatch records;
(3)
Personnel requirements;
(4)
Equipment requirements;
(5)
Vehicle requirements;
(6)
Dispatch center requirements and dispatching procedures;
(7)
Countywide system status management plan; and
(8)
Other operational and dispatch standards.
(c)
The minimal level of care that is to be provided for all primary
response units is advanced life support.
(Ord. 564 § 3, 2005)
(a)
No person (either as owner, agent or otherwise) shall furnish, operate,
conduct, maintain or otherwise engage in or advertise, offer or profess
to engage in ambulance service unless the person holds (and is entitled
to hold) a currently valid ambulance operator's permit or a contract
with Lassen County to provide ambulance service within an exclusive
operative area.
(b)
No person (either as owner, agent or otherwise) shall furnish, operate,
conduct, maintain or otherwise engage in or advertise, offer or profess
to engage in air ambulance service unless the person holds (and is
entitled to hold) a currently valid ambulance operator's permit. This
includes air ambulance services that are based outside of Lassen County
that provide emergency response within Lassen County.
(c)
No permit is required for the delivery into Lassen County of persons
picked up outside the county boundaries.
(Ord. 564 § 3, 2005)
(a)
The local EMS agency, upon recommendation of the board of supervisors,
may, designate an ambulance service area within Lassen County as an
exclusive operating area, as defined by Section 1797.85 of the California
Health and Safety Code.
(b)
Except as described in subsection c of this section, a competitive process meeting the requirements of Section 1797.224 of the California Health and Safety Code shall be used to grant an exclusive operating permit to a single provider within any competitive exclusive operating area. The county shall use a written request for proposals that shall identify the minimum and desired criteria that will be used to select the ambulance service. It shall include, but not be limited to, all applicable requirements established by this chapter.
(c)
Any ambulance service operating in Lassen County and meeting the
requirements of Section 1797.224, California Health and Safety Code
may apply for a non-competitively granted exclusive operating permit.
Only one exclusive operating permit may be granted within any zone.
(d)
A contract shall be negotiated with the ambulance provider selected
within each exclusive operating area. It shall bind the ambulance
provider to the requirements established by this chapter and any greater
requirements established through the competitive process.
(Ord. 564 § 3, 2005; Ord. 564-A § 3, 2007)
(a)
In addition to the county's permitting process and in conformity
with the Emergency Medical Services System Act and the regulations
adopted pursuant thereto, any ambulance service operating in Lassen
County shall meet all requirements of the local EMS agency, including
maintaining a current provider agreement.
(b)
The policies and procedures governing the terms and conditions of
ambulance provider agreements shall include, but not be limited to,
staffing and certification requirements for ambulance personnel, deployment
and usage requirements, performance standards, reporting requirements,
insurance and workers' compensation requirements, training requirements,
mutual aid requirements, and vehicle maintenance standards.
(Ord. 564 § 3, 2005)
(a)
Liability Insurance.
(1)
Each ambulance permittee, at its sole cost and expense, shall obtain
and maintain at minimum compliance with all of the following insurance
coverage(s) and requirements. Such insurance coverage shall be primary
coverage as respects the county and any insurance or self-insurance
maintained by the county shall be in excess of contractor's insurance
coverage and shall not contribute to it:
(A)
Workers' compensation in the minimum statutorily required coverage
amounts;
(B)
Automobile liability insurance for each of the permittee's vehicles
used in the performance of its permit, including owned, nonowned (e.g.,
owned by the permittee's employees), leased or hired vehicles;
(C)
Comprehensive or commercial general liability insurance coverage,
including coverage for: (i) bodily injury, (ii) personal injury, (iii)
broad form property damage, (iv) contractual liability, and (v) cross-liability;
(D)
Professional liability insurance.
(2)
If any of the above insurance coverage is provided on a "claims made"
rather than "occurrence" form, the permittee shall maintain the required
coverage for a period of three years after the expiration of its permit.
The permittee may maintain the required post-permit coverage by renewal
or purchase of prior acts or tail coverage. This provision is contingent
upon post agreement coverage being both available and reasonably affordable
in relation to the coverage provided during the term of this agreement.
For purposes of interpreting this requirement, a cost not exceeding
one hundred percent of the last annual policy premium during the term
of this agreement in order to purchase prior acts or tail coverage
for post agreement coverage shall be deemed to be reasonable.
The board of supervisors shall by resolution set the minimum
limits for the required insurance coverage. These shall take effect
ninety days after adoption by the board of supervisors.
(b)
Financial Responsibility. An ambulance provider shall provide the
permit officer with information in reference to any pending action
or unpaid judgments or liens against the provider, and the notice
of the transactions or acts giving rise to the judgments or liens.
The ambulance provider shall notify the permit officer in writing
of the actions within one week of the notification from the levying
agency. The reported information will be reviewed by the permit officer
who will make a determination regarding the effect this information
will have on the agency's ability to provide continuous service.
(c)
Performance Security.
(1)
The board of supervisors shall by resolution set the amount of a
performance security for ambulance permittees. The amount shall be
that required to ensure continuous availability of emergency ambulance
service in the event of a major breach by the permittee.
(2)
The permittee, prior to beginning service, shall provide a performance
bond or other security method to the permit officer in the amount
set in a form acceptable to the permit officer. Acceptable methods
may include a cash bond, insurance bond, irrevocable letter of credit,
or lien on vehicles and equipment.
(3)
The performance security shall be structured so that in the event
of a major breach by the permittee, the security is immediately transferred
to Lassen County, with any challenge or appeal to follow.
(d)
Service Level. The permittee shall be approved by the LEMSA as an
advanced life support provider prior to beginning service.
(e)
Response Standards.
(f)
Unauthorized response. No ambulance service shall cause or allow
its ambulances to respond to a location without first receiving a
specific request from a Lassen County primary or secondary public
safety answering point for such service at that location.
(g)
Advertising.
(1)
No person or organization shall announce, advertise, offer, or in
any way claim that it provides emergency ambulance service unless
it possesses a currently valid, emergency ambulance service permit.
(2)
No person or organization shall announce, advertise, offer, or in
any way claim that it provides advanced life support services unless
it has been approved as an advanced life support provider by the Lassen
County EMS Agency.
(3)
No permittee under this chapter shall announce, advertise, offer,
or in any way publicize any seven-digit phone number for use in emergencies.
Any use of a seven-digit phone number for nonemergency ambulance service
shall include the phrase "FOR EMERGENCIES, CALL 9-1-1" in capital
letters that are at least as big as the letters used for the seven-digit
telephone number.
(h)
Rates.
(1)
The allowable rates that the holder of a competitively granted exclusive permit may charge for providing emergency service shall be established as part of the competitive process and incorporated into the contract described in Section 11.15.035(d).
(2)
The board of supervisors may set by resolution the emergency rates
that all other ground ambulance permittees may charge for providing
emergency service.
(Ord. 564 § 3, 2005)
(a)
An application for an ambulance permit shall be accompanied by payment
of an application fee, which shall include the ambulance permit fee
for the first year's permit.
(b)
An application for renewal of an ambulance permit shall be accompanied
by payment of an annual permit fee.
(c)
The board of supervisors shall set the fees by resolution. The fees
shall not exceed the reasonable cost of administering and enforcing
this chapter as determined by the board of supervisors.
(Ord. 564 § 3, 2005)
The provisions of this chapter shall not apply:
(a)
To the delivery of persons from outside Lassen County who are transported
to medical facilities in Lassen County by ambulances based and properly
licensed in another jurisdiction;
(b)
To persons engaged in the provisions of ambulance services when the
services are rendered at the request of any county communications
or dispatch center, or at the request of any law enforcement or fire
protection agency during a "state of war emergency," a "state of emergency,"
or a "local emergency" as those phrases are now, and may hereafter,
be defined in Section 8558 of the California Government Code;
(c)
Whenever the county health officer determines that adequate emergency
ambulance service will not be available from existing providers. The
exemption provided in this subsection shall not exceed thirty days,
but may be renewed for additional thirty-day periods thereafter, without
limitation, at the discretion of the county health officer, should
the officer determine, at the time of each renewal, that adequate
emergency ambulance service will not be available from existing providers.
The county health officer, in approving any thirty-day exemption as
provided in this subsection, may condition such exemption on such
terms as may, in the sole discretion of the county health officer,
be appropriate and shall report, in writing, to the board of supervisors
each time an exemption period is authorized. The county health officer
may delegate his/her authority to the LEMSA for providing exemptions
to this chapter and the reporting requirements;
(d)
Whenever any peace officer, firefighter, certified emergency medical
technician I/II, licensed paramedic, registered nurse, nurse practitioner,
physician's assistant or physician arranges for the transportation
of an individual in need of emergency medical care when no ambulance
with a current ambulance provider agreement, or provisional ambulance
provider agreement, is available and such transportation is required
immediately;
(e)
To ambulances owned and operated by agencies of the federal and state
government;
(f)
To ambulances owned and operated by a governmental agency which operates
a search and rescue organization, provided the ambulance(s) are not
regularly used to transport patients, except as part of rescue operations;
(g)
To an ambulance provider that provides specialized transport services
(such as, but not limited to, neonatal transport services) that are
not available through those ambulance services with a current ambulance
provider agreement;
(h)
To air ambulance operations;
(i)
Red Rock Road to the Sierra County line.
(Ord. 564 § 3, 2005)
(a)
Investigations and Inspections.
(1)
The ambulance service permittee shall cooperate with the permit officer
or designee in any investigations of possible violations of this chapter
and shall make all dispatch logs and similar dispatch records available
for inspection and copying at reasonable times at the permittee's
regular place of business.
(2)
At the request of the permit officer or his designee the ambulance
provider shall submit self inspections of all ambulances on a form
to be provided by the permit officer. The ambulance provider shall
allow the permit officer or designee to inspect, on a preannounced
or unannounced basis, all ambulances used to provide ambulance service.
The inspections should be held, whenever possible, during normal business
hours at the ambulance operations center. The purpose of such inspections
may include, but shall not be limited to, determining if the ambulance
and its equipment and appurtenances, including radios, are in good
working order, properly maintained, and equipped for the provision
of ambulance service.
(b)
The permit officer may suspend or revoke an ambulance operator's
permit for:
(1)
Failure to comply and maintain compliance with, or for violation
of, any applicable provision, standard or requirement of state law
or regulation, of this chapter, or of any regulations promulgated
under this chapter; or
(2)
Failure to make and retain records showing its operations in any
area covered by this chapter, including, but not limited to, dispatching,
response, personnel, vehicles, medical treatment or billing, or failure
to make such records available for inspection by the permit officer
or designee; or
(3)
Accepting an emergency call when it is either unable or unwilling
to provide the requested service or fails to inform the person requesting
such service of any delay and fails to obtain consent of such person
before causing an ambulance to respond from a location more distant
than the one to which the request was directed; or
(4)
Failure to pay any fine issued pursuant to this section within ten
business days; or
(5)
Failure to maintain local EMS agency approval as an advanced life
support service.
(c)
Suspension is not a condition precedent to revocation.
(d)
The board of supervisors shall set by resolution maximum fines for
violation of this chapter.
(e)
Fines, not exceeding the amount established by the board of supervisors,
may be issued by the permit officer for:
(1)
Failure to respond to an emergency call within the required response
times; or
(2)
Failure to provide required clinical or operational reports, including
dispatch records;
(3)
Failure to respond to an emergency call with an advanced life support
unit;
(4)
Failure to comply with the countywide system status management plan;
(5)
Failure to comply with requirements for personnel, equipment, and
vehicles; or
(f)
Notice Issuance. Before any punitive action, the permit officer shall
give written notice to the permittee specifying why such action is
contemplated and giving the permittee a reasonable period of time
(not less than five nor more than fifteen business days) to comply
with the provisions in question or to show cause against suspension
or revocation and setting a date for hearing thereon.
(g)
Hearings.
(1)
Hearing Officer. Hearings conducted pursuant to this chapter shall
be conducted before a hearing officer designated by the county administrator.
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 the hearings, the hearing officer shall
promptly prepare a written summary of the evidence and proposed findings
and conclusions for consideration by the permit officer. The parties
shall equally bear the expense of the hearing officer and the cost
of the hearing. Each party shall bear its own expenses.
(2)
Hearing Procedure. At the hearing, the permit officer has the burden
of proof and may present evidence as to why such action should be
taken and to answer the evidence presented by the permittee.
(3)
Evidence. In hearings conducted pursuant to this chapter, evidence
must be relevant, noncumulative, and of such nature as responsible
persons are accustomed to rely 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.
(h)
Emergency Action. The permit officer 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 the period when the permit officer 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, a permit is suspended or revoked, the permittee may request
an additional hearing at which the permittee will have the burden
of establishing renewed compliance justifying reinstatement of the
permit. Such additional hearing will be commenced within five days
of the permittee's request. The request for, or the scheduling of,
an additional hearing shall not stay operation of the suspension or
revocation order.
(i)
Decision. The permit officer shall issue a written decision within
thirty days after conclusion of the hearing.
(j)
A fine not to exceed five hundred dollars for each additional violation
of this chapter after the second violation within one year. Notwithstanding
the above, a first offense may be charged and prosecuted as a misdemeanor.
Payment of any penalty herein shall not relieve a person from the
responsibility for correcting the violation.
(Ord. 564 § 3, 2005)
If any provision of this chapter or the application of any provision
of this chapter to any person or circumstances is held invalid by
a court of competent jurisdiction, that invalidity shall not affect
any other provision or application of this chapter which can be given
effect without the invalid provision or application, and to this end,
the provisions of this chapter are expressly made severable.
(Ord. 564 § 3, 2005)
