ORDINANCE
NO. 756
AN
ORDINANCE OF THE COUNTY OR RIVERSIDE
ESTABLISHING
REGULATIONS FOR ALS AMBULANCE
AIR
AMBULANCE, BLS AMBULANCE
AND
CRITICAL CARE TRANSPORT PROVIDERS
Pursuant hereto the Board
of Supervisors of the County of Riverside, State of California, Ordains as
follows:
Section 1. Purpose and Intent.
The County, through its EMS Agency and as identified in its Emergency Medical
Service Plan, has determined the need to enact local regulations consistent
with, and which enhance the County's responsibilities under, the
"Emergency Medical Services System and the Prehospital Emergency Medical
Act" (Health & Safety Code Sections 1797, et seq.) and which
further serve and protect the health and safety of medical patients in the
County while being transported.
Section 2. Definitions.
As used in this
ordinance unless otherwise stated, words and terms shall be defined as follows:
"Advanced
Life Support (ALS)" shall mean special services 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 or utilizing approved prehospital treatment protocols or standing
orders as part of the local EMS system at the scene of an emergency, during
transport to an acute care hospital or other approved facility, during
inter-facility transfer, and while in the emergency department of an acute care
hospital until responsibility is assumed by the emergency department or other
medical staff of that hospital.
"Air
Ambulance" means
any aircraft specially constructed, modified, or equipped, and used for the
primary purposes of responding to emergency calls and transporting critically
ill or injured patients.
"Air
Ambulance Provider" shall mean an air transportation service permitted and contracted to
operate within the County of Riverside to provide Air Ambulance services.
"ALS
Ambulance" shall mean an ambulance equipped, or arranged and staffed
for the purpose of providing ALS care. The meaning includes, but is not limited
to, privately and publicly owned ambulances operating within exclusive
operating areas while under contract with the County of Riverside.
"ALS
Ambulance Provider" shall mean an operator or permittee in possession of a written
agreement with and permitted by the County of Riverside to provide ALS care.
"Ambulance"
shall mean any
motor vehicle which meets the standards of Title 13 of the California Code of
Regulations and is specifically constructed, modified or equipped, or arranged,
used, licensed, or operated for the purpose of transporting sick, injured,
convalescent, infirmed, or otherwise incapacitated person(s) in need of medical
care. The meaning includes, but is not limited to, privately and publicly owned
ambulances operating within the County of Riverside.
"Ambulance
Service" shall
mean the activity, business, or service for hire, profit, or otherwise of
transporting one (1) or more persons by ambulance upon any of the streets,
roads, highways, alleys, or any public way or place whether ALS, BLS, CCT, or
Air Ambulance.
"Ambulance
Provider"
shall mean a person or entity that operates, or causes the operation of, an
Ambulance Service.
"Applicant" shall mean any person or entity
which makes application for a Provider Permit prescribed by this ordinance.
"Basic
Life Support (BLS)" shall mean emergency first aid and cardiopulmonary resuscitation Medical
Care procedures which, as a minimum, include recognizing respiratory and cardiac
arrest and starting proper application of cardiopulmonary resuscitation to
maintain life without invasive techniques, unless authorized by state law or
regulation, until the victim may be transported or until ALS medical care is
available.
"BLS
Ambulance"
shall mean an ambulance equipped, or arranged, and staffed for the purpose of
providing BLS care. The meaning includes, but is not limited to, privately and
publicly owned ambulances operating within the County of Riverside. BLS
Ambulances shall not be utilized in the response to Emergency Medical Services
calls.
"BLS
Ambulance Provider" shall mean an operator permitted by the County of Riverside to provide
BLS care.
"Board" shall mean the Riverside County
Board of Supervisors.
"County"
shall mean Riverside
County.
"Critical
Care Transport (CCT)" shall mean the medical transport of a patient between medical facilities
where it has been determined by the patient's treating physician that such
transport requires medical staff supervision consisting of a licensed
registered nurse (R.N.) or physician.
"CCT
Provider"
shall mean an operator permitted by the County of Riverside to provide CCT
services.
"Department" shall mean the Riverside County
Department of Public Health of the Health Services Agency.
"EMS
Agency" shall
mean the County's designated "local EMS Agency" established pursuant
to Health and Safety Code Section 17997.200.
"EMS
Plan" shall
mean that document(s) developed by the EMS Agency pursuant to Health and Safety
Code Section 1797.250.
"EMS
System" shall
mean the interrelated but separate public and private entities including, but
not limited to, ambulance providers, fire departments, and hospitals which,
optimally, work together in the timely and appropriate provision of emergency
medical services to the citizens and visitors of the County.
"Emergency
Medical Service Call" shall mean any sudden or serious illness or injury requiring immediate
medical attention, where delay in providing such services may aggravate the
medical condition or cause the loss of life. All Emergency Medical Service
calls shall be responded to by an ALS ambulance.
"Emergency
Medical Services (EMS)" shall mean care rendered to a person or persons in need of
immediate medical care.
"Emergency
Medical Technician-1 (EMT-1)" shall mean a person certified to render BLS medical care
pursuant to sections 1797, et seq., of the Health and Safety Code.
"Emergency
Medical Technician-P (EMT-P)' shall mean a person licensed and accredited to render ALS
Medical Care pursuant to sections 1797, et seq. of the Health and Safety
Code.
"Entity"
shall mean any
public or private organization, firm, partnership, association.
"Exclusive
Operating Areas"
shall mean those geographical areas of the County identified in the EMS Plan
where an ALS Ambulance Provider may be granted the exclusive right to provide
such services upon designation as required in the EMS Plan.
"Medical
Care" shall
mean any medical care rendered by an appropriately certified and/or licensed
person.
"Medical
Director"
shall mean that physician designated to serve as the Medical Director of the
EMS Agency pursuant to Section 1797.202 of the Health and Safety Code.
"Mobile
Intensive Care Nurse (MICN)" shall mean a registered nurse authorized to provide ALS
Medical care pursuant to Section 1797.56 of the Health and Safety Code.
"Non-emergency
Medical Call" shall
mean the transportation of a patient by ambulance or Air Ambulance that would
not constitute an emergency medical service call.
"Nurse"
shall mean a
registered nurse licensed in the State of California.
"Paramedic" shall mean the same as an EMT-P as
defined by this ordinance.
"Patient"
shall mean any
person in the process of receiving Medical Care.
"Permit
Holder" shall
mean a person or entity possessing a valid Provider Permit as authorized by
this ordinance.
"Permit
Officer" shall
mean the County Health Officer or his designated representative.
"Physician" shall mean the same as such defined
by Section 4033 of the Business and Professions Code.
"Provider
Unit" shall
mean each ambulance, Air Ambulance, or other vehicle, as authorized by the EMS
Agency, which a Permit Holder uses in the course of its permitted Provider
service.
"Quality
Assurance"
shall mean the sum of all activities undertaken to assure that prehospital
emergency medical transportation services and non-emergency medical
transportation services maintain established standard by appropriate regulatory
agencies.
"Quality
Improvement"
shall mean the evaluation of prehospital emergency medical services and
non-emergency transportation services to identify where personnel performance
or the system itself can be improved, the implementation of potential
improvements, and their re-evaluation and refinement in a continuous cycle. While
Quality Assurance traditionally focuses on the detection of defects, Quality
Improvement strives to prevent them. Thus a Quality Improvement program must
include, but not be limited to, Quality Assurance.
Section 3. Prohibitions. It is prohibited and shall be
unlawful for any person or entity to operate, or advertise the operation of an
ALS Ambulance, an Air Ambulance, a BLS Ambulance, or a Critical Care Transport
Provider service in the County without having obtained a Provider Permit to do
so, or as otherwise may be authorized by this ordinance, or if having a
Provider Permit, to operate or advertise in violation of the terms, conditions,
or restrictions of said Provider Permit.
Section 4. Non-Applicability.
A. A
non-permitted ALS Ambulance or Air Ambulance service provider based and
operated under the regulatory authority of a governmental entity other than the
County may operate in the County for a limited purpose of transporting patients
to or through the County if the transportation of the patient was initiated
outside the County.
B. A
non-permitted BLS Ambulance or CCT service provider based and operated under
the regulatory authority of a governmental entity other than the County may
operate in the County for limited purpose of transporting Patients to or
through the County if the transportation of the patient was initiated outside
the County.
C. In
the event of a local disaster, as declared by the County Health Officer or
his/her designee or by a local governmental entity, the requirements of this
Ordinance maybe suspended until such time as the disaster declaration is
rescinded.
Section 5. Provider Permits.
A. Initial
Issuance. Pursuant to the procedures and conditions established, or as may
be established, by this ordinance, the Permit Officer shall issue Provider
Permits and Provider Unit Permits to:
--- ALS Ambulance Provider(s) as approved pursuant
to the EMS Plan and Air Ambulance Provider(s) for operation in the County; and
--- BLS Ambulance and CCT service providers
for operation in the County.
B. Expiration.
Except as provided herein below for the issuance of temporary Provider Permits,
all Provider Permits shall expire on the date of June 30 of each year.
C. Renewal.
An application for renewal of a Provider Permit shall be submitted to the
Permit Officer at least sixty (60) days prior to the expiration of the Provider
Permit to be renewed. A Permit Holder shall have its permit renewed upon
expiration if the Permit Holder does not seek a substantial change in the
permit and there does not exist grounds for denial for renewal of the permit as
specified in subsection 5.M. For the purpose of this subsection, a
"substantial change in the permit" shall mean a change in the level,
scope or manner of service permitted under the Permit Holder's current or
previous Provider Permit or such condition as may be determined by the Permit
Officer.
1. Late
Renewal Application Penalty. If a Permit Holder makes application for the
renewal of a Provider Permit in less than sixty (60) days prior to the
expiration of the Permit Holder's Provider Permit for which renewal application
is made, the Permit Holder shall pay an additional twenty percent (20%) of the
fee due.
D. Application.
Application for a Provider Permit shall be made to the Permit Officer on
form(s) as may be prescribed by the Permit Officer. At the time the application
is made, the applicant shall provide the following minimum information:
- Name and description of applicant;
- Business address and residence address
of record of the applicant;
- Trade or firm name, or Doing Business As
(DBA) as recorded;
- If a corporation, a joint venture, or a
partnership or limited partnership, the names of all partners, or the names of
the corporate officers, their permanent addresses and their percentage of
participation in the business;
- The type(s) of service which the
Applicant proposes to provide;
- A statement of facts for initial
applicants showing the past experience of the applicant in the operation of the
Provider(s) for which it seeks a permit;
- A statement in the applications that the
applicant owns or will have under the applicant's control required equipment to
adequately conduct the Provider for which it is or proposes to be permitted and
that the applicant owns or has access to suitable and safe facilities for
maintaining service in a clean, sanitary and mechanically sound condition;
- A list for any changed, substituted,
loaned, or leased Provider Units, giving a complete description of each
operated by the applicant, including the make/model/year, license number and
vehicle identification number, and the patient capacity thereof, and, if
applicable, a copy of the most recent Ambulance Inspection Report issued by the
California Highway Patrol. Applicant shall also identify color scheme, name,
monogram, or insignia which shall be used on the Provider Units and the above
shall not conflict with or imitate any color scheme, name, monogram, or
insignia used by any other person or firm in such a manner as to be misleading
or tend to deceive or defraud the public;
- An affirmation for initial and renewal
applications that each permitted ambulance and its appurtenances conform to all
applicable provisions of this ordinance, the California Vehicle Code, the
California Code of Regulations, Federal Aviation Administration regulations,
and any other applicable federal, state or local directives;
- A statement for initial and renewal
application that the applicant employs sufficient personnel adequately trained
and available to deliver Provider of such quality which meet the minimum
standards as set by this ordinance;
- A list, amended as required during the
year, for any personnel changes, giving a description of the level of training
for each person;
- A statement signed by the applicant that
as a condition of being issued a permit, the Applicant agrees to appear and
defend all actions against the County arising out of the exercise of said
permit, and shall indemnify, defend, and save the County, its officers,
employees and agents harmless of and from all claims, demands, actions, or
causes of actions of every kind and description resulting directly or indirectly
and arising out of, or in any way connected with exercise of this permit;
- A description of the applicant's program
for vehicle maintenance;
- A copy of the continuous quality
improvement and quality assurance programs to be utilized during the normal and
customary business operation which elicits customer, both Patient and
physician, feedback and encourages employee participation. Such program shall,
as a minimum:
- Review patient care provided;
- Identify problems or issues regarding
patient care and propose solutions for corrective action;
- Include reward and disciplinary
procedures to be used when appropriate;
- Maintain a radio tape of all calls for
service received, all dispatch instructions given, and all communication
between the dispatch operator and the vehicle until the assignment is completed
for a period of not less than thirty (30) days.
- Proof of insurance which shall be
maintained in full force and effect and issued by a company authorized to do
business in the State of California during the permit period as specified by
the Permit Officer.
- A statement of the legal history of the
Applicant, registered owner(s), partner(s), officer(s), director(s), and
controlling shareholder(s), including criminal convictions and civil
judgements. Such other facts or information as the Permit Officer may require.
E. Application Review. Upon the submittal of an application,
the EMS Agency shall review the application to ensure its conformity with
subsection 5.D. within ninety (90) days of receipt, unless the Permit Officer
conducts an investigation pursuant to subsection 5.F. herein below. Where the
Permit Officer conducts such an investigation the review of an application
shall be completed within one hundred twenty (120) days of receipt. Upon the
completion of the application review, and further investigation if required,
the applicant shall immediately be notified in writing of the granting or
denial of the application by the Permit Officer.
F. Application Investigation. Upon receipt of an initial or
renewal application, the Permit Officer may conduct, or cause to be conducted,
an investigation into the applicant's proposed provision of service, if deemed
necessary.
G. Denial of Permit Upon Initial Application.
An Initial
Application for a Provider may be denied by the Permit Officer upon the
following grounds. For the purpose of this subsection an "Initial
Application" shall mean an application submitted by an applicant which is
not a Permit Holder at the time application is made or, if a Permit Holder,
makes application for a Provider Permit other than which it presently holds and
would therefore not qualify for renewal of a Provider Permit as provided in
subsection 5.C. The grounds for denial of an initial application shall be:
- The applicant, previously the holder of
a permit issued under this ordinance, which has been denied, revoked or
suspended and the terms or conditions which lead to such action has not been
fulfilled or corrected.
- The applicant knowingly made false,
misleading, or fraudulent statement(s) of a material fact in the application or
in any reports or other documents required to be filed with the Permit Officer
pursuant to this ordinance.
- The applicant has committed any act
involving dishonesty, fraud, or deceit whereby another is injured or where the
Applicant has benefitted.
- The applicant has acted in violation of
this ordinance.
- The applicant has entered a plea of
guilty to, or been found guilty of, or been convicted of a felony, or a crime
involving moral turpitude, and the time for appeal has elapsed or the judgment
of conviction has been affirmed on appeal, irrespective of an order granting
probation following such conviction suspending the imposition of sentence, or
of a subsequent order under the provisions of Section 1203.4 of the California
Penal Code allowing such person to withdraw his plea of guilty and to enter a
plea of not guilty, or setting aside the plea of the verdict of guilty, or the
dismissal of the accusation.
1. Notification. The Permit Officer shall provide the
applicant with written notification that its application has been denied and
stating the grounds upon which the denial is based as provided hereinabove and
a brief statement of the facts and circumstances upon which Permit Officer has
made his/her determination that the grounds for the denial of the application
exists. Said notification shall also advise the applicant of its right to have
the decision to deny the application reviewed by the Permit Officer pursuant to
procedures prescribed herein below.
2. Procedure for Review.
a. Within
fifteen (15) days of receipt of written notification that its initial application
has been denied, the applicant may file a written request for review of the
Permit Officer's decision to deny its application. The applicant's request for
review shall briefly state basis and/or reasons that the Permit Officer's
decision to deny the initial application should be reversed. The applicant may
accompany the request for review with documentation relevant to its basis for
requesting the review.
b. The
Permit Officer, upon timely receipt of a request for review of denial of an
initial application, shall within thirty (30) days conduct such further
investigation as may be warranted after due consideration of the applicant's
request. Thereupon the Permit Officer may vacate his decision to deny the
application for initial permit and grant said application.
c. If
upon further consideration of the request for review the Permit Officer does
not reverse his decision to deny the application, he shall so notify the
applicant in writing and further advise the applicant that he will personally
hear the request, if requested by the applicant, to ensure that the request and
all relevant information is given due consideration by the Permit Officer.
d. In
no event shall the Permit Officer's review of the request exceed a period of
sixty (60) days after the applicant's written request is received, unless the
applicant and Permit Officer so stipulate to an extension of this time period
for review of the request.
e. The
decision of Permit Officer to deny an initial Provider Permit shall be final.
H. Conditions of Permit. The acceptance of a Provider Permit
shall obligate the Permit Holder to meet or otherwise fulfill each condition
set forth herein below. At the time of issuance of a Provider Permit, the
Permit Holder shall be given written notice, by reference to this section, of
said conditions. Each Provider Permit shall be issued with the following
conditions:
- That during a "state of
emergency," or "local emergency," as defined in the California
Emergency Services Act (Chapter 7 of Division 1 of Title 2 of the Government
Code), as amended, each permitted Provider shall, within reason, provide
equipment, facilities, and personnel as requested by the Permit Officer.
- That all applicable provisions of this
ordinance and regulations policies and protocols established to carry out its
provisions are complied with.
- That all applicable county, state and
federal vehicular and aircraft certificates, licenses, and permits shall be on
each permitted Provider Unit in operation under the permit.
- That authorized personnel have
applicable and required certificates and licenses readily available during duty
hours.
- That the transportation of a patient to
or between a medical facility occur in conformance with applicable state,
federal and local laws and regulations to the extent the provider is
responsible to said Patient transport.
- That the Permit Holder shall maintain
all transaction records of the permitted service operation for a period of not
less than three (3) years and shall produce such records upon demand for
inspection by the Permit Officer.
- That if for any reason the Permit Holder
stops providing the permitted level or levels of service it shall immediately
stop any advertisement of such services and notify the EMS Agency in writing.
- That in the event of any substantial
change in the Provider, which causes, or threatens to cause, the service to be
carried out different from that specified in the Permit Holder's permit, the
Permit Holder shall immediately notify the EMS agency in writing and therein
stating the facts of such change.
- That all permitted Providers shall meet
such operating standards as may be established by the EMS Agency including but
not limited to the following.
Each ALS Ambulance
shall:
- Be equipped and staffed to provide EMS
as prescribed by the EMS Plan; or as may be established by the EMS Agency in
accordance with the EMS Plan; or this Ordinance; or as specified by written
agreement;
- In the absence of a physician on board
responsible for patient care, the staff shall provide care as directed by
standing orders designated by the Medical Director or direct voice contact with
a physician or MICN at a designated County Base Hospital;
- Establish and maintain radio contact as
prescribed by the EMS Agency and in compliance with F.C.C. regulations;
- Conform to Federal Specification
KKK-A-1822-C, which is promulgated by the U.S. General Services Administration,
in effect as of the date of the vehicle's manufacture. An exception(s), or
additional requirement, may be allowed, or required, at the discretion of the
Permit Officer, provided that such an exception(s) does not compromise safety
and is not in conflict with applicable California laws and regulations.
Each Air Ambulance shall:
- Contain no less than the equipment and
supplies as established by the EMS Agency policies, protocols and regulations;
- Be staffed with 2 licensed registered
nurses, or 2 licensed physicians, or a licensed nurse and a licensed physician,
or a licensed nurse and an EMT-P or a licensed physician and an EMT-P;
- In the absence of a physician on board
the aircraft, the medical flight crew is to provide patient care as directed by
specific written orders from the transferring or receiving physician for the
person being transported or standardized procedures approved by the Air
Ambulance Provider's Medical Director and as reviewed by the EMS Agency's
Medical Director; and
- Conform to all Federal Aviation Administration
(FAA) and Association of Air Medical Services (AAMS) standards applicable to
the aircraft being utilized and the nature of the mission; and
- Every pilot in command shall have, in
their possession, a valid medical certificate and appropriate current type
rating and applicable certificates
Each BLS Ambulance
shall:
- Contain no less than the equipment and
supplies as established by EMS Agency policies, protocols and regulations for
BLS Medical Care;
- Be staffed with two (2) EMT-1, each
possessing a current certificate of completion of an approved cardiopulmonary
resuscitation course.
In
the absence of a physician on board or otherwise in communication with the
ambulance staff, who has accepted responsibility for Patient care, the staff
shall provide care as directed by protocols designated by the Medical Director;
and
- Shall conform to Federal Specification
KKK-A-1822-C, which is promulgated by the U.S. General Services Administration,
in effect as of the date of the vehicle's manufacture. An exception(s), or
additional requirement, may be allowed, or required, at the discretion of the
Permit Officer, provided that such an exception(s) does not compromise safety
and is not in conflict with applicable California laws and regulations.
Each Critical Care Transport Unit shall:
- Contain no less than the equipment and
supplies as established by the EMS Agency policies, protocols and regulations
for BLS Medical Care;
- Be staffed with an EMT-1 or an EMT-P and
a licensed registered nurse (R.N.) or a physician. R.N.'s must have a current
certificate of completion of an Advanced Cardiac Life Support course;
- In the absence of a physician on the
ambulance, the licensed registered nurse is to provide patient care as directed
by specific written orders from the transferring or receiving physician for the
person being transported or standardized procedures, approved by the CCT
Medical Director, reviewed by the EMS Agency's Medical Director and authorized,
in writing, by the transferring physician.
I. Form
and Content of Permits. Provider and Provider Unit permits shall be issued
in a form as may be prescribed by the Permit Officer. The content of a Provider
Permit shall include, but not be limited to, the Provider authorized under the
permit, the number and type of permitted Provider Units authorized for use
under the Provider Permit, any special conditions or restrictions as authorized
by this ordinance and, as to ALS Ambulance Provider, the Exclusive Operating
Area(s) as prescribed by the EMS Plan within which such provider shall operate.
J. Permit
Variance. Upon written request by a Permit Holder, the Permit Officer may
grant a variance in writing from the conditions specified in a Permit Holder's
permit if the Permit Officer finds that such change is in substantial
compliance with the minimum provider operation requirements established by this
ordinance.
K. Provider
Permit Transfer Prohibition. The transfer of a Provider Permit from a
Permit Holder to another person or entity shall be prohibited. The transfer of
a Permit Holder's ownership interest in part or whole in a permitted Provider
shall require the filing of an initial application for a Provider Permit by the
person or entity to whom ownership will be transferred.
L. Provider
Unit Permit Transfer Prohibition. The transfer of a Provider Unit Permit
from one Provider Unit to another Provider Unit is prohibited. For any
permitted Provider Unit which ceases to be operational, the Permit Holder shall
give written notice of this fact to the Permit Officer. The Permit Holder shall
file a written request for Provider Unit permit which the Permit Holder intends
to operate under a Provider Permit but which has not been previously issued a
Provider Unit Permit. The Permit Holder shall pay the established Provider Unit
fee at the time of such request.
M. Denial
of Renewal, Suspension and Revocation of Provider Permit. The Permit
Officer, after conducting an investigation or upon such facts or circumstances
as may be known to him, may deny the renewal of, suspend or revoke a Provider
Permit issued under the provisions of this ordinance when it has been found
that the Permit Holder:
- Has violated any provision of this
ordinance, or any rules or regulations that are promulgated pursuant to its
provisions.
- Has been convicted of any felony.
- Has been convicted of any misdemeanor
involving moral turpitude.
- Has been convicted of any offense
relating to the use, sale, possession, or transportation of narcotics or
habit-forming drugs.
- Has committed any act involving
dishonesty, fraud, or deceit whereby another is injured, or whereby the
permittee has benefitted, or any act involving moral turpitude.
- Has misrepresented a material fact in
obtaining a Provider Permit, or is no longer adhering to the conditions
specified in its Provider Permit or by this ordinance.
- Has aided or abetted an unlicensed or
uncertified person to evade the provisions of this ordinance.
- Has failed to make and keep records
showing Provider operation transactions as provided by this ordinance, or fails
to have such records available for inspection by the Permit Officer or his duly
authorized representative or refuses to comply with a written request of the
Permit Officer to make such records available for inspection.
- Has accepted an assignment as authorized
by its Provider Permit when the Permit Holder knowingly is either unable or
unwilling to provide the requested service or fails to inform the person
requesting such service of any delay;
- Has failed to pay required fees,
administrative fines, or penalties established by this ordinance.
- Has knowingly made false, misleading, or
fraudulent statement(s) of a material fact in the application or information
provided for the obtaining of any Provider Permit.
In
addition to the foregoing grounds, the Permit Officer may deny renewal, suspend
or revoke a Provider Permit when the continued operation of the permitted
provider causes, or threatens to cause, harm to the health and safety of the
public as determined by the Permit Officer.
1. Notification.
a. Upon
the Permit Officer's denial of renewal, suspension or revocation of a Provider
Permit, he shall give the Permit Holder written notice of such determination by
registered or certified U.S. Mail. The written notice shall advise the Permit
Holder of the grounds upon which the action is being taken, a brief statement
of the facts or circumstances in support of such grounds, and the effective
date(s) of the adverse action.
b. The denial of renewal of a Provider Permit shall be made no
more than thirty (30) days after the Permit Holder makes application for
renewal of a Provider Permit.
c. The
suspension or revocation of a Provider Permit shall be effective no less than
fourteen (14) days after receipt of notification, unless the Permit Officer
makes a determination that the protection of the public health and safety
warrants the immediate suspension or revocation of a Provider Permit in which
case the suspension or revocation will be effective upon the Permit Holder's
receipt of the notification.
2. Administrative Review.
a. Within
seven (7) days of receiving notification of denial of renewal, suspension or
revocation of its Provider Permit, the Permit Holder may request that the
Permit Officer review the adverse action. The administrative review request
shall be in writing.
b.
Absent a determination by the Permit Officer that the
immediate imposition of an adverse action as provided in this subsection is
warranted, the Permit Officer shall set a date, time and location for the
requested review prior to the date(s) set for the proposed adverse action and
shall give written notice of same to the Permit Holder. The date set for the
administrative review shall not be continued beyond the date set for imposition
of the adverse action unless such continuation is mutually agreed to by the
Permit Officer and the Permit Holder.
c. In
the review the Permit Holder shall have the burden of presenting all arguments
and/or information relevant to the Permit Officer's action or mitigation
thereof.
d. After
the administrative review the Permit Officer may affirm, modify or set aside
the original adverse action. The Permit Officer shall give written notice of
such decision to the Permit Holder, as soon as possible. However, in not event
shall such notice be given more than seven (7) days after the administrative review.
e. As
may be appropriate, the Permit Officer shall notify all public safety agencies,
permitted Providers and public safety communication centers, hospitals and
other agencies and organizations of any adverse action taken against a
permitted Provider pursuant to this subsection.
3. Appeal to the Board. If after an administrative review
as provided hereinabove the Permit Officer imposes adverse action against a
Permit Holder, the Permit Holder may appeal such action to the Board and the
Board shall consider the appeal pursuant to the following procedures. Such
appeal shall not suspend the imposition of any adverse action taken by the
Permit Officer.
a. Request for Appeal Hearing. The Permit Holder shall request
for a hearing in writing to the Clerk of the Board within twenty (20) days
following the denial of renewal, suspension, or revocation of a Provider
Permit. The Board shall hear the appeal directly, or in its sole discretion,
may appoint a neutral hearing officer to hear the appeal and make findings of
fact on behalf of, and recommendations thereupon, to the Board.
b. Hearing Appeal Procedures. The Board or its appointed hearing
officer shall hear the matter within sixty (60) days of receipt of the Permit
Holder's request for appeal pursuant to the following procedures:
- Witnesses shall swear or affirm to tell
the truth.
- Each party may present oral testimony
and documentary evidence or other exhibits.
- The appealing Permit Holder shall
present its case first.
- Each party shall have the right to be
represented by counsel, and shall have the right of cross-examination of
witnesses.
- After both sides have completed
presenting evidence, each party may, by closing argument, comment on the
evidence.
c. Appeal Decision. Upon completion of the appeal
hearing the Board shall make findings of fact, or where appropriate, adopt the
findings of fact of its appointed Hearing Officer, and make such determination
thereupon. The decision of the Board shall be final for purposes of Judicial
Review under Code of Civil Procedure Section 1094.5 and County Ordinance No.
628.
N. Permit Fees. Upon application made for a
Provider Permit the applicant shall pay a non-refundable permit fee in
accordance with the following schedule and shall pay a fee for each Provider
Unit which the applicant proposes to operate under the Provider Permit for
which application is made in the amount of $250.00:
- ALS Ambulance and Aircraft Provider
Permit fee shall be $6,000.00.
- BLS Ambulance Provider Permit fee shall
be $3,000.00.
- Critical Care Transport (CCT) Ambulance
Provider Permit fee shall be $6,000.00.
1. Non-Payment of Fee, Grounds for Rejection
of Application. Failure
of the Applicant to submit an application with the appropriate Provider(s) Permit
and Provider Unit(s) fees may serve as grounds for the Permit Officer to refuse
the receipt of an initial or renewal Provider Permit application.
2. Late Fee Penalty. If upon review of an accepted
application the Permit Officer determines that a Provider Permit or a Provider
Unit fee due at the application is made was not paid in full, the applicant
shall pay the additional amount due within thirty (30) days of written notice
of same and shall pay a penalty in the amount of twenty percent (20%) of the fee(s)
due.
3. Prorated Fee. Provider Permit fees may be
prorated on a quarterly basis on such permits which are issued for a period of
less than a year.
4. Publicly
owned and operated provider entities are exempt from all fees specified by this
ordinance.
5. Public Interest Fee Exemption. The Permit Officer may, upon
investigation and determination that it is in the public interest, waive all,
or part of, Provider and/or Provider Unit fees which would be due prior to the
issuance of a Provider Permit.
O. Temporary Provider Permit. The Permit Officer may issue a
Provider Permit as authorized by this ordinance on a temporary basis which
shall not exceed a period of sixty (60) days in response to extraordinary
conditions where the Permit Officer determines that the public health and
safety necessitates the issuance of such a temporary permit and that the
proposed temporary Permit Holder possesses the minimum standards as prescribed
by the ordinance. Provider permits issued under this subsection may be revoked
on such grounds specified in subsections 5.A. and 5.M. on twenty-four hour
notice to the Permit Holder. The decision of the Permit Officer to revoke a
Provider Permit issued under this section shall be final without rights of
administrative review to the Permit Officer or the Board.
Section 6. Ordinance Administration.
The EMS agency shall be responsible for the administration of this ordinance,
including, but not limited to, promulgating such policies, protocols, and
regulations as expressly required herein or as may be necessary to effectuate
other provisions of the ordinance subject to the approval of the Permit Officer
and, where appropriate, the Medical Director.
Section 7. Enforcement
By Permit Officer. This ordinance and policies, protocols and regulations established
pursuant to it shall be enforced by the Permit Officer.
Section 8. Violation.
A. Administrative Fines.
1. Permitted Provider. A Permit Holder that violates, or
causes the violation of, any provision of this ordinance shall pay a fine for
each such violation in the amount of five hundred dollars ($500.00) for each
violation to the County.
2. Penalty for Late Payment of
Administrative Fine.
The administrative fines established hereinabove shall be paid within thirty
(30) days of written notification being mailed in the U.S. Postal Service and
deemed delinquent thirty (30) days after they are due and payable and deemed to
be a debt to the County. If any fine is not paid prior to becoming delinquent,
there shall be a penalty added to such fee and such penalty shall be equal to
twenty percent (20%) of the fee normally due.
B. Public Nuisance. Any continued violation of any
provision of this ordinance is deemed a public nuisance dangerous to the health
and safety of the public and may be enjoined or summarily abated in the manner
provided by law.
C. Criminal Penalties. Any person who violates provisions
of this ordinance shall be guilty of an infraction, and upon conviction thereof
shall be punished by: (1) a fine not to exceed One Hundred Dollars ($100.00)
for the first violation of this ordinance; (2) a fine not to exceed Two Hundred
Dollars ($200.00) for a second violation of the ordinance within one (1) year;
(3) a fine not to exceed Five Hundred Dollars ($500.00) for each additional
violation of this ordinance after second violation within one (1) 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.
D. Remedies.
1. An
action may be commenced in the name of the County in any court of competent
jurisdiction for payment of the amount of any delinquent administrative fee or
fine and penalty thereon.
2. All
remedies available to the County shall be cumulative and the use of one or more
remedies by the County shall not bar the use of any other remedy for the
purpose of enforcing the provisions of this ordinance. Nor shall the payment of
any administrative fee or fine prevent criminal prosecution for violation of
the provisions s of this ordinance.
3. The
additional remedies, penalties and procedures for violation of this ordinance
and for recovery of costs related to enforcement provided for in Ordinance No.
725 are incorporated herein by this reference.
Section 9. Severability. If any section, subsection,
sentence, clause, or phrase of this ordinance as herein acted or the
application thereof to any person or circumstances is held invalid or
unconstitutional by decision of any court of competent jurisdiction, such
invalidity shall not affect the other provisions or applications of this
ordinance, or any section or portion of section hereof, which can be given
effect without the invalid provisions where application and to this in the
provision so this ordinance are and are intended to be, severable. The Board of
Supervisors hereby declares that it would have passed this ordinance and each
section, subsection, clause, or phrase thereof irrespective of the fact that
any one or more other sections, subsections, clauses, or phrases may be
declared invalid or unconstitutional.
Section 10. Repeal. Ordinance No.
577.2 is hereby repealed.
Section 11. Effective Date. The
provisions of this ordinance shall become effective thirty (30) days after its
adoption.
ADOPTED: 8-15-95 (Eff.: 9-14-95)