Adequate emergency medical services, including ambulance services, are indispensable to the health, safety and well-being of the Sacramento community.
Because of the geographic nature of the County, the proximity of hospitals and other health care centers, the inability of ambulance services to recover charges for emergency responses to low income persons and responses to false alerts and other calls which do not result in the provision of a service, and other factors, a fragmented delivery system with unlimited competition in the delivery of such services, whether by public or private entities, will not guarantee either adequate response to all areas of the County and to all income segments of the population or affordable and cost-effective services.
Pursuant to the provisions of the Emergency Medical Services Act (Health and Safety Code Section 1797, et seq.), Health and Safety Code Section 13862(e), and the County's Emergency Medical Services Plan, the purposes of this chapter are to establish a regulatory system by licensing and otherwise, to administer and control the provision of emergency ambulance services, including emergency ambulance services, and to impose affirmative service obligations to be performed by licensees, guaranteeing the adequacy and efficiency of emergency ambulance services to the County, including any incorporated portion thereof.
(SCC 578 § 8, 1983; SCC 0923 § 1, 1993; SCC 0924 § 1, 1993)
The County Director of the Department of Health Services is charged with the responsibility of administering the regulations imposed by this chapter and exercising the authority conferred thereby. Such authority shall include the power and duty delegated to the Local Emergency Medical Services Agency (LEMSA) as so defined by Health and Safety Code section 1797.200. The Director shall appoint the LEMSA Administrator. The LEMSA Administrator shall develop, implement, and administer the LEMSA in accordance with the requirements as set forth in Health and Safety Code Section 1797.200, et seq.
To these ends, the County Director of the Department of Health Services shall be vested with the same powers and authorities in relation to ambulance services and the issuance and administration of ambulance service provider contracts therefor as are vested in the Sheriff under Chapter 4.02, Sections 4.02.070, 4.02.085, 4.02.100. and 4.02.105; and Chapter 4.10, Sections 4.10.000 through 4.10.155. Any reference to the Sheriff in said sections shall be deemed to be a reference to the Director in relation to ambulance services.
Whenever the term "Director" is used in this chapter, the term shall mean the County Director of the Department of Health Services.
(SCC 578 § 8, 1983; SCC 0869 § 14, 1992; SCC 0924 § 1, 1993; SCC 1204 § 13, 2001; SCC 1618 § 34, 2018)
"Ambulance"
means any privately or publicly owned or leased vehicle specifically constructed, modified, equipped or arranged and used for the purpose of transporting sick or injured persons and which responds or may respond to medical emergency calls in this County, including any incorporated portion thereof.
(SCC 578 § 8, 1983; SCC 0923 § 1, 1993; SCC 0924 § 1, 1993)
"Ambulance service"
means the activity, business or service conducted by any person, for hire, profit or otherwise, of transporting in medical situations one or more patients by ambulance on or in any of the streets, roads, highways, alleys or any public way or place in the County, including the incorporated portion thereof.
(SCC 578 § 8, 1983; SCC 0923 § 1, 1993; SCC 0924, § 1, 1993)
"Attendant"
means a trained, qualified individual who, regardless of whether such individual also serves as driver, is responsible for the care of ambulance patients and who has met all license and other requirements established under applicable State Laws and regulations.
(SCC 578 § 8, 1983)
"Person"
means a sole proprietorship, partnership, corporation, unincorporated association, cooperative, joint venture or other individual entity carrying on an enterprise, business or service for which a Permit or License must first be procured, and shall include any officer, employee, agent or other representative by or through whom the enterprise, business or service is operated or conducted, and charitable, philanthropic and other nonprofit entities and enterprises as well as those which are for profit.
"Person"
shall also include a public agency, including but not limited to a city, fire protection district, or community services district and any officer, employee or agent thereof while acting in the capacity as such, except as otherwise provided by the Emergency Medical Systems Act.
(SCC 0923 § 2, 1993; SCC 0924 § 1, 1993)
"Emergency"
means a situation in which there is a perceived physiological or psychological need for immediate medical care, based on an injury or other unforeseen acute physical or mental disorder which apparently threatens life or function.
(SCC 578 § 8, 1983)
The Director is hereby authorized to divide the County, including the incorporated portion thereof, into service areas for the provision of emergency ambulance services, each service area to be known as an Emergency Response Zone. The Zones shall be described on a map which is maintained in the office of the Director, and is available for public inspection during regular office hours. Notwithstanding any provision to the contrary, those Emergency Response Zones established by the Director in advance of the date of enactment of this chapter shall remain in full force and effect until hereafter amended or revised.
Subject to preemptory amendment by this Board at any time following a public hearing, notice of which is given in the manner prescribed by Section 4.02.090, the Director shall be authorized from time to time, to amend, revise, create, abolish or otherwise alter the boundaries of Emergency Response Zones.
The notice of the annual public hearing relating to rates required by Section 4.18.130 shall inform the public of its right to inspect the then current Emergency Response Zone Map, and invite public comment thereon during that hearing. At the conclusion of that public hearing, the Director, in addition to the determinations required by Section 4.18.130 relating to rates, shall make a determination respecting affirmance or modification of the Emergency Response Zones in the same manner and in accordance with the same procedure as is applicable to rate determinations; provided that findings of fact and conclusions shall not be required. The Director's determination shall be appealable to the Board of Supervisors in the same manner and in accordance with the same procedures as are applicable to rate determinations under Section 4.18.135.
Emergency Response Zones shall be defined in a manner which best promotes the provision of emergency ambulance services, and in formulating such Zones, such factors as the following shall be considered: the geographical area to be served in relation to the public street system, the distribution of population, the proximity of hospitals and other health care centers, minimally necessary response times, and the economics of ambulance services.
(SCC 578 § 8, 1983; SCC 0923 § 1, 1993; SCC 0924 § 1, 1993)
A Special Business License shall not be required, and neither the provisions of Chapter 4.10 nor those of this chapter shall be applicable to:
A. 
Vehicle operated as ambulances and persons engaged in the ambulance service where ambulance services are rendered at the request of the County Communications Center or at the request of any public protection agency during and as a result of any State or local emergency, local disaster or local peril proclaimed by a public official pursuant to law;
B. 
The transportation of an individual in need of emergency medical care at the direction of any peace officer, firearm or physician licensed to practice medicine in this State, when no ambulance of a licensed ambulance service is available and such transportation is required immediately for the preservation of life;
C. 
Ambulances transporting patients through the County from locations outside the County to locations outside the County, or from outside the County to a location within the County; or
D. 
Nonemergency ambulance services provided within the County.
(SCC 578 § 8, 1983)
An Authorization for the provision of emergency ambulance services shall authorize the holder thereof to provide emergency ambulance services within the Emergency Response Zone or Zones identified in the License which the provider holds.
Notwithstanding the provisions of Section 4.02.080, the term of the Authorization issued pursuant to the provisions of this chapter shall commence on the first day of July and end on the thirtieth day of June each year, unless earlier suspended or revoked. An initial Authorization shall expire on the June 30th next following the date of issuance, and the fee prescribed pursuant to the provisions of Section 4.02.060 shall be prorated based upon the number of months within the initial term.
The amendment of an Emergency Response Zone by revision of the boundaries thereof or otherwise by the Director or Board of Supervisors pursuant to Section 4.18.045, shall become effective as to any authorized provider affected thereby 60 days following the date of service of written notice thereof upon the Licensee, and the service requirements of the License shall be deemed to be amended accordingly.
(SCC 578 § 8, 1983; SCC 1618 § 36, 2018)
The Director shall authorize emergency ambulance services within each Emergency Response Zone by such number of holders of the Authorizations as he or she, in his or her discretion, determine will best promote the public interest. The public interest shall be deemed best promoted by the apportionment of services in a manner which assures the most comprehensive, reliable and expeditious emergency ambulance service in all areas, at the lowest cost to the consumer, and with the least amount of County subsidy necessary to underwrite the uncompensated costs thereof. In determining what best promotes the public interest, the Director shall consider such factors as the economics of ambulance services; the benefits, if any, of rate competition; the socio-economic composition of the population served; the geographic population distribution within each Emergency Response Zone; the geographical characteristics of such Zone in relation to the available traffic circulation systems; the ambulance service capacity possessed by providers; the capital investment required to provide emergency ambulance services; and the practical difficulties, if any, of enforcing uneconomical service mandates.
(SCC 578 § 8, 1983; SCC 1618 § 37, 2018)
Notwithstanding the provisions of Section 4.10.025, the application for an Authorization to provide ambulance services shall be filed with the LEMSA.
An application shall contain the following:
A. 
All names under which the applicant has engaged, does engage, or proposes to engage in ambulance services;
B. 
A description of each ambulance, including the make, model, year of manufacture, motor and chassis numbers, current state license numbers;
C. 
Assurance that the applicant has obtained all licenses and permits required by the state laws or regulations for ambulances and ambulance operators;
D. 
The station location from which the ambulance will operate;
E. 
Evidence of such financial responsibility or insurance coverage as may be required by the Director in regulations issued by him or her.
(SCC 578 § 8, 1983; SCC 1618 § 38, 2018)
The applicant and permittee shall report to the Director any change in the data required in Section 4.18.070 within ten days of the effective date of the change, except that any change in the data required by Sections 4.10.030(C) or (D) and 4.18.065(D) shall be reported immediately. No change or addition of ambulance station location may be made without the prior written consent of the Director.
(SCC 578 § 8, 1983)
At his initiative, and at the request or direction of the Board of Supervisors, the Director shall conduct such investigations respecting the efficiency, adequacy and quality of the delivery of emergency ambulance services as the Director, in his or her sole discretion, or Board, in its sole discretion, determines necessary or appropriate for protection of the public welfare.
The Director may prepare and issue such written reports concerning the results of any investigations conducted as he or she deems appropriate, and shall prepare and issue such reports as may be directed by the Board of Supervisors. Any such reports shall omit the names and any other personally identifiable information concerning persons who have received emergency ambulance services, and shall also omit any data respecting the salaries or other compensation of the personnel of an ambulance service, the earnings from business operations and other financial data of an ambulance service, and any other information or data which the Director deems that the public interest requires be confidentially maintained.
(SCC 578 § 8, 1983)
Each ambulance, its equipment and the premises designated in the application, and all records relating to maintenance and operation of an ambulance service, shall be open to inspection during regular working hours by the Director or designated representative.
The refusal by an authorized provider or an officer, employee or agent thereof, to permit inspection by the Director or designated representative pursuant to the authority conferred by this section shall constitute grounds for suspension or revocation of the Authorization.
(SCC 578 § 8, 1983; SCC 1618 § 40, 2018)
Each authorized provider pursuant to this chapter shall pay to the County fees in such amounts as are annually prescribed by resolution adopted by the Board of Supervisors. Revenue from such fees shall not exceed the costs incurred by the various departments of county government in administering, regulating and monitoring the provisions of this chapter.
Authorized providers may be required to pay a monthly or annual fee, and the amount of such fee may be differentiated based upon the number of ambulances utilized by the licensee, the number of patient transports performed by the authorized provider on an annual or monthly basis, or other factors designed to reasonably apportion the cost of administration, regulation and monitoring.
(SCC 0910 § 1, 1993; SCC 1618 § 41, 2018)
It is understood that all records maintained by the Director are subject to inspection by members of the general public under those terms, conditions and limitations prescribed by Section 6250 et seq., of the Government Code. An authorized provider ambulance service may file with the Director a written request that the Director deny inspection or copying to members of the general public of specifically enumerated types of information contained in its application for an Authorization or application for renewal thereof, or collected or received by the Director or designated representative pursuant to investigations or inspections authorized by Section 4.18.085 or 4.18.090. The written request shall: (i) identify in specific detail the information to be denied inspection; (ii) shall offer to compensate the County for such administrative costs as may be incurred in the alteration of records or supervision of inspection in such a manner as to deny inspection of the materials specified and permit inspection of other material; (iii) shall offer to defend the County and any officer, employee or agent thereof against any lawsuit commenced for the purpose of obtaining a court order authorizing inspection, identifying the name and business address of the attorney who would provide the defense at the sole cost and expense of the authorized provider; and (iv) shall promise that all costs, fees or damages, including attorneys fees, incurred by the County in refusing inspection would be paid directly by the authorized provider at its sole cost and expense.
With respect to any specifically identified data or information the disclosure of which is requested by an authorized provider to be denied, which the Director finds would not be relevant as evidence in any proceeding relating to the issuance, renewal, suspension or revocation of an Authorization under the provisions of Chapter 4.10 and this chapter, the Director shall deny to a member of the general public the opportunity to inspect or copy a record containing the information from and after the date of receipt of the request filed in the manner and form prescribed above and deposit of any reimbursement required to cover the cost of implementing the denial of inspection.
In any proceeding commenced for the purpose of enforcing a right to inspect data or information covered by a request by a Licensee, the Director may elect that defense of the County, the Director or the County's other officers, employees or agents be conducted and performed by the County Counsel. In such event, the authorized provider shall pay to the County the cost of all services rendered by the County Counsel according to the standard hourly rate which the County Counsel charges for the rendition of legal services, in addition to all costs, fees and damages which the authorized provider may be required to pay directly to the party or parties who have prosecuted the litigation.
The failure of any authorized provider to comply with the promises contained in a request filed pursuant to this section, or to fulfill any financial obligations imposed by this section, shall constitute grounds for suspension or revocation of the Authorization. In addition, the County shall be authorized to recover from the authorized provider as a debt all amounts, plus interest, which an authorized provider becomes obligated to pay under this section.
(SCC 578 § 8, 1983; SCC 1618 § 42, 2018)
Each ambulance providing emergency ambulance service within the County shall be staffed by at least two persons, one driver and one attendant.
(SCC 578 § 8, 1983)
The County Communications Center shall, in response to calls for emergency ambulance services, call only Licensed ambulance services authorized to serve in the Emergency Response Zone in which the emergency exists or ambulance services operated by public agencies, unless the Center determines that there are no or inadequate services available from such a designated Licensee.
(SCC 578 § 8, 1983)
Upon receiving a call for an emergency ambulance service within an Emergency Response Zone which the Licensee is authorized to serve, the Licensee shall immediately dispatch an ambulance to the address or place given. The ambulance dispatched shall immediately start a direct run to that address or place and shall complete that run unless directed otherwise by the County Communications Center. If an ambulance is directed to make a direct run and is thereafter diverted for any reason, the Licensee shall immediately notify the County Communications Center. Upon receiving a call for an ambulance and having no ambulance available to immediately make a direct run to the address or place given, the Licensee shall immediately notify the County Communications Center.
When responding for an emergency ambulance service, the ambulance driver shall comply with all radio communications regulations, as shall be determined by the Director pursuant to administrative regulations after consultation with Licensed ambulance services.
(SCC 578 § 8, 1983)
Except with respect to rates which the Director determines are set as a result of a freely competitive service delivery system in which multiple ambulance services provide emergency services within the same geographical area under variable rates established without express or implied agreement among the providers, all emergency ambulance service rates, including rates for services and supplies incidental thereto, shall be subject to the approval of the Director. Such approval shall be given on an annual basis, following a public hearing conducted by the Director, notice of which is given in the manner prescribed by Section 4.02.090. The rates reviewed shall be those proposed by Licensed ambulance services, and the proposal shall be submitted, together with such accompanying material, data and information as may be required, pursuant to administrative regulations enacted under Section 4.18.115. The decision of the Director shall approve, approve in part, or disapprove proposed rates, and said decision shall be based upon the reasonable costs of providing the service in relation to a reasonable rate of return on investment. A licensed ambulance service desiring to increase approved rates in advance of the annual determination by the Director shall make application to do so pursuant to administrative regulations enacted under Section 4.18.115, and the Director shall act thereon following a special public hearing conducted to receive evidence thereon notice of which is given in the manner prescribed by Section 4.02.090. The Director's decision shall be based upon the same standard as with respect to his or her annual determination.
Each decision by the Director made pursuant to the provisions of this section shall be accompanied by written findings of fact and conclusions. The date on which the decision, findings and conclusions will be issued shall be announced prior to the conclusion of the public hearing. A copy of the decision, including the findings and conclusions, shall be served on each Licensee affected thereby upon issuance.
Levels of rates and charges proposed by Licensees and approvals thereof and other decisions thereon by the Director shall not become effective until fifteen days following the date announced prior to the conclusion of the public hearing for issuance of the decision, and in the event an appeal is filed pursuant to Section 4.18.135, shall not become effective until a final decision thereon by the Board of Supervisors pursuant to said appeal.
(SCC 578 § 8, 1983)
A decision by the Director under Section 4.18.130 may be appealed to the Board of Supervisors by an affected Licensee or any member of the Public who may be served by the Licensee by filing a written notice of appeal with the Clerk of the Board of Supervisors not later than fifteen days following the date announced prior to the conclusion of the public hearing by the Director for issuance of the decision. Any such appeal shall include a written statement of the reasons therefor and basis upon which the Director's decision is challenged. The Board of Supervisors shall conduct a hearing on the appeal, and in so doing, may review the decision, findings and conclusions of the Director solely; said decision, findings and conclusions in accompaniment with the record of the Hearing Officer's hearing solely; review such matters and admit supplementary evidence relating to specified issues; or conduct a de novo hearing upon the matter. The determination by the Board of Supervisors shall be final.
(SCC 578 § 8, 1983)
It is unlawful for any owner to operate an ambulance or cause or permit the ambulance to be driven or operated, unless there is on file with the Clerk of the Board of Supervisors and in full force and effect at all times such ambulance is being operated, a policy of insurance issued by a company authorized to do business in the State of California, insuring the owner against loss by reason of injury or damage that may result to persons or property from negligent operation or defective construction of such ambulance, or from violations of this chapter or of any other law of the State of California or the United States. Such policy shall also provide general public liability, and property damage and professional liability insurance. The property damage and vehicle insurance shall be in the amount of not less than a combined single limit of one million dollars for one or more persons injured and property damaged in each occurrence. The public liability insurance shall be in the amount of not less than a combined single limit of five hundred thousand dollars for one or more persons injured or property damaged in each occurrence. Professional liability insurance shall be in an amount not less than five hundred thousand dollars per occurrence. The County, and in their capacities as such, its officers, employees and agents shall be named as additional insureds in said insurance. The policy shall contain a clause prohibiting cancellation or non-renewal of such insurance, whether for failure to pay a premium or otherwise, without service by the insurer upon the Director of Health of written notice at least fifteen days in advance of the effective date thereof.
(SCC 578 § 8, 1983; SCC 663 § 1, 1986)