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.
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.
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)