Monterey County Municipal Code Ch. 15.40 Emergency Medical Services System

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Editor's note— Ord. No. 5138, § 1, adopted September 22, 2009, amended Chapter 15.40 in its entirety to read as herein set out. Formerly, Chapter 15.40 pertained to emergency medical services system and medical transport services, and derived from Ord. No. 3318, §§ 1, 2, 4, 8, 9, adopted 1988; Ord. No. 3461, §§ 2, 4, 8, 9, adopted 1990; Ord. No. 3702, §§ 1, 2, adopted 1993; Ord. No. 4137, adopted 2002, and Ord. No. 4241, § 1, adopted 2004.

It is the intent of the Board of Supervisors of the County of Monterey through this Chapter to provide an emergency medical services program pursuant to Health and Safety Code Sections 1797.200, et seq.

(Ord. No. 5138, § 1, 9-22-2009)

This chapter is adopted under all authority provided by State law, including but not limited to Health and Safety Code Sections 1797, et seq., Government Code Section 26227, and Welfare and Institutions Code Section 14136.

(Ord. No. 5138, § 1, 9-22-2009)

A. General Definitions. For the purpose of this Chapter, the following terms, phrases, words and their derivations shall have the meaning given herein. When not inconsistent with the context, words used in the present tense include the future, words used in the plural include the singular and words used in the singular include the plural, words in the masculine gender include the feminine gender and words in the feminine gender include the masculine gender. The words "include," "including," or other similar words of inclusion shall mean without limitation or restriction. The word "shall" as used herein is not merely directory but is considered mandatory.

B. Specific Definitions. Unless otherwise specified, the following terms are defined as follows:

"Advanced life support" (ALS) means special services designed to provide definitive pre-hospital emergency medical care as defined in Health and Safety Code Section 1797.52, 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 as part of the local EMS System at the scene of an emergency, during transport to an acute care hospital, during inter-facility transfer, and while in the emergency department of an acute care hospital until responsibility is assumed by the emergency or other medical staff of that hospital.

"Aircraft" means an aircraft which is specially designed, constructed, modified, or equipped for transporting sick, injured, convalescent, infirm, or otherwise incapacitated persons and which is capable of supporting BLS or a higher level of care.

"Attendant" means a qualified person who is responsible for the care of the patient(s) and who currently meets all license, certification, accreditation, and other requirements of state laws and regulations, and local policies, protocols, ordinances, and regulations in the appropriate service category.

"Base hospital" means a hospital designated by and under contract with the EMS Agency to be responsible for directing the advanced life support system or limited advanced life support system and pre-hospital care system assigned to it by the EMS Agency.

"Basic life support (BLS)" means the level of care defined in Health and Safety Code Section 1797.60.

"Basic life support unit" means a ground or aircraft unit capable of providing the BLS level of care.

"Board" means the Monterey County Board of Supervisors.

"Business" means any trade, business, occupation, practice or profession.

"Certificate" means a specific document issued to an individual denoting competence in the named area of pre-hospital service.

"Computer aided dispatch (CAD)" means a computer-aided dispatch system consisting of associated hardware and software that facilitates call taking, system status management, unit I selection, emergency ambulance coordination, resource dispatch and deployment, event time stamping, the creation and maintenance of an incident database, and the provision of management information.

"Contractor" means an emergency ambulance, aircraft or critical care transport provider with whom the EMS Agency has contracted for the provision of services under this Chapter.

"Convalescent transport provider" means any person who, as owner or principal manager, furnishes or offers to furnish transport by a convalescent transport vehicle or wheel chair van. For purposes of this Chapter, "convalescent transport provider" has the same meaning as "wheel chair van transport provider."

"Convalescent transport vehicle" means any vehicle which is specially designed, constructed, modified or equipped for transporting patients who require wheel chairs and can travel in an upright, sitting position, and who do not require medical care, assistance, or monitoring during the transport. Convalescent transport vehicles are not authorized to advertise as emergency ambulances or emergency response vehicles, represent themselves or appear as emergency vehicles (e.g., emergency lights, sirens, or signage), or be configured with any medical equipment (e.g., oxygen or monitors) for their passengers. For the purposes of this Chapter, "convalescent transport vehicle" has the same meaning as "wheel chair van transport vehicle."

"County" means the County of Monterey, State of California.

"Critical care transport" means any transport of a patient by emergency ambulance when the emergency ambulance staff on board includes a physician, a registered nurse, or other medical personnel, including critical care paramedics, authorized to provide a level of care that exceeds the paramedic scope of practice.

"Critical care transport provider" means a person who furnishes or offers to furnish critical care transport.

"Designated facility" means a hospital which has been designated by the local EMS Agency to perform specified EMS system functions, pursuant to authorized guidelines.

"Driver" means an individual who drives a response unit.

"Emergency" means a condition or situation in which an individual has a need for immediate medical or psychiatric attention, or where the potential for such need is perceived by emergency medical personnel a physician, or a public safety agency, or may reasonably be perceived by a prudent lay person.

"Emergency ambulance" means any vehicle or aircraft which is specially designed, constructed, maintained, supplied, or equipped for transporting sick, injured, infirm or otherwise incapacitated persons, and which is capable of supporting BLS or a higher level of care. For purposes of this Chapter "ambulance" shall have the same meaning as "emergency ambulance."

"Emergency ambulance provider" means a person who, as owner or principal manager, furnishes or offers to furnish emergency ambulance service.

"Emergency ambulance provider's license" means written authorization by the County to provide emergency ambulance or critical care transport service within the County.

"Emergency ambulance service" means an emergency ambulance operator or provider operating within an organized EMS system capable of providing services on a twenty-four (24) hour a day basis.

"Emergency ambulance service operator" means any person who operates an emergency ambulance service.

"Emergency ambulance unit" means an emergency ambulance staffed with qualified personnel and equipped with appropriate medical equipment and supplies.

"Emergency communications center" means the County Emergency Communications Center or Public Safety Answering Point (PSAP) operated by the Monterey County Emergency Communications Department.

"Emergency level of care" means pre-hospital care provided at the BLS or higher level of care, including critical care.

"Emergency Medical Care Committee (EMCC) means the committee appointed by the Board in accordance with Health and Safety Code Sections 1797.270, et seq.

"Emergency medical dispatch" means the dispatch procedures that require personnel trained to State and national standards on emergency medical dispatch techniques including call screening, resource priority and pre-arrival instruction.

"Emergency Medical Technician I (EMT-I)" means an individual trained to provide basic life support according to standards prescribed by the California Code of Regulations and who has a valid certificate for such scope of practice issued pursuant to Health and Safety Code Sections 1797, et seq.

"Emergency Medical Technician-Defibrillator (EMT-D)" means an individual trained to initiate automatic or semi-automatic defibrillator procedures and who has a valid certificate for such scope of practice issued pursuant to Health and Safety Code Sections 1797, et seq.

"Emergency Medical Technician-P (EMT-P)" means a paramedic trained to provide advanced life support according to standards prescribed by the California Code of Regulations and who has a valid license for such scope of practice issued pursuant to Health and Safety Code Section 1797, et seq.

"EMS Agency" means the administrative agency designated by the County pursuant to Health and Safety Code Section 1797.200.

"EMS area" means the County of Monterey, including all incorporated and unincorporated areas.

"EMS Director" means the Director of the EMS Agency.

"Exclusive operating area" means an EMS area or subarea defined by the EMS plan for which the EMS Agency, upon the recommendation of the County, restricts operations to one (1) or more emergency ambulance services or providers of limited advanced life support or advanced life support.

"First responder" means an agency with equipment and personnel capable of responding immediately to emergency medical calls, arriving promptly thereafter on the scene of the medical crisis, and providing appropriate first responder pre-hospital care before the arrival of any emergency ambulance. First responder services do not include providing medical transport.

"Limited advanced life support" means special services designed to provide pre-hospital emergency medical care limited to techniques and procedures that exceed basic life support but are less than advanced life support and are those procedures specified pursuant to Health and Safety Code Section 1797.171.

"Medical control" means the medical management of the EMS system in accordance with State and County laws and regulations.

"Medical Director" means the person designated by the EMS Director to act as the Medical Director of the EMS Agency.

"Paramedic unit" means an emergency ambulance or first-responder unit which is staffed and equipped to provide advanced life support to patients at the scene of a medical emergency or during transport in an ambulance and which has been designated as a paramedic unit by the Medical Director.

"Patient" means a person who is wounded, injured, sick, invalid, convalescent, or otherwise incapacitated.

"Person" means any individual, firm, corporation, partnership, or association; any Federal, State, or local governmental entity, public agency, or political subdivision; or any other group or combination acting as a unit.

"Public safety agency" means any public law enforcement, fire protection, communication, and park or forest department operating in Monterey County.

"Response unit" means a vehicle (ambulance, fire, or law enforcement unit) operated by a first responder or emergency ambulance service, which meets all applicable State and local laws and regulations.

"Special event" means any event (including, but not limited to, a concert, sporting event or contest) that brings a large gathering of people to the site of the event or that involves hazardous activities, so as to justify or require the stationing of one (1) or more emergency ambulances at the site of the event for all or part of the event's duration, in advance of any actual need for the ambulance services.

"Standby service" means the service provided by an emergency ambulance service operator or an emergency ambulance provider when it stations an emergency ambulance for immediate availability at a specific location, for a specific period of time, at the request of the EMS Agency, County dispatch, fire or law enforcement agencies, or the manager of a special event, in advance of any actual need for a medical transport. Standby service is "non-dedicated" when the emergency ambulance units stationed for standby service at a particular location may respond to calls from any other location without an immediate replacement.

(Ord. No. 5138, § 1, 9-22-2009)

A. Designation of EMS Agency. The Monterey County Department of Health is designated as the Monterey County Emergency Medical Services (EMS) Agency as provided in Health and Safety Code Section 1797.200.

B. Designation of EMS Director. An EMS Director shall be appointed by the County Director of Health. The EMS Director shall be responsible for overseeing the EMS Agency as it fulfills the duties and responsibilities as set forth herein. If there is a vacancy in the position of EMS Director or if the EMS Director is unable to fulfill his or her responsibilities, the County Director of Health is authorized to appoint an Interim EMS Director until a permanent EMS Director is appointed or the current EMS Director is able to reassume his or her duties and responsibilities.

C. Duties of EMS Agency. The EMS Agency shall serve as the lead agency for the EMS system in the County and shall be responsible for coordinating all system participants in the EMS area. The EMS Agency shall plan, coordinate, monitor and evaluate the implementation of the EMS system. The EMS Agency shall perform duties and responsibilities as set forth in California State laws, regulations and guidelines with input from all EMS system participants to include hospitals, medical organizations, cities, and fire districts in order to ensure the coordination of the EMS system.

D. Staffing. The EMS Agency shall at a minimum, have a part-time Medical Director to ensure medical control and accountability throughout the system, as well as to assist in planning and evaluating the system. Additional staffing to carry out the EMS Agency's responsibilities shall be determined by the EMS Director as required to fulfill the duties and responsibilities of the EMS Agency under California codes and regulations, this Chapter, and County mandates.

E. EMS System Development Process. In the development of all aspects of the EMS system, system providers will be asked to participate by attending standing or ad hoc committee meetings. The EMS Agency may develop protocols, policies and procedures covering the EMS system in accordance with State law, regulations and guidelines. The EMS Agency shall enforce local ordinances, policies, and procedures and State laws and regulations.

F. Emergency Medical Care Committee (EMCC). The Emergency Medical Care Committee (EMCC) shall be appointed by the Board to advise the Board and the EMS Director on EMS system issues. The EMCC membership and terms of office shall be established in the EMCC bylaws approved by the Board. The EMCC shall perform the duties set forth in Health and Safety Code Sections 1797.274 and 1797.276.

G. The EMS Director may appoint standing committees or ad hoc task forces to advise the EMS Director. EMS Medical Director, and the EMCC on medical control or operational issues involving pre-hospital emergency medical services. Membership and terms shall be determined by the EMS Director in consultation with the EMCC.

H. Ambulance User Complaints. Any user of emergency ambulance service who contends that he or she has been required to pay an excessive charge for service or that he or she has received inadequate services may file a written complaint with the EMS Agency setting forth such allegations. The EMS Agency shall notify the emergency ambulance operator or provider of such complaint, and shall investigate the matter. The EMS Agency shall establish procedures for the handling of such complaints. The procedure may provide for the submission of such complaints to the EMS Director or to a hearing officer and may provide that the decision of the EMS Director shall be final. The emergency ambulance provider shall comply with any applicable decisions.

(Ord. No. 5138, § 1, 9-22-2009)

A. Required. It shall be unlawful for any person either as owner, agent or otherwise, to advertise or offer to provide to the public, to engage in the business of providing to the public, or to provide ground or air medical transport to any person with the express or implied representation that one is engaged in the business of providing to the public, any of the following services in Monterey County, without either a license or variance issued by the EMS Agency or a contract with the EMS Agency authorizing such services to be provided:

1. Emergency ambulance services;

2. Advanced, limited advanced, or basic life support services or programs; or

3. Base hospital.

B. Exceptions. The provisions of this Section shall not apply to:

1. The above listed services operated at the request of local authorities during any "state of war emergency," "state of emergency" or "local emergency," as defined in the State Emergency Services Act (Government Code Sections 8550, et seq.);

2. Ambulances legally transporting a patient from a location outside the County regardless of destination; or

3. Ambulances operated by a Federal Agency originating from a Federal reservation, for purposes of responding to or transporting patients under Federal responsibility.

C. Conformity with terms of contracts, licenses and variances. No person may provide or advertise emergency ambulance services that are subject to this Section except as authorized by and in compliance with the terms and conditions of the contract, license, or variance executed or issued by the EMS Agency.

D. Contracts, Licenses and Variances Non-Transferable. No license, variance or contract subject to this Chapter may be transferred by operation of law or otherwise without approval by the EMS Agency.

E. Exclusive Operating Areas. The EMS Agency shall provide for emergency ambulance services under an EMS plan which creates one (1) or more exclusive operating areas. A competitive process shall be utilized at periodic intervals to select the emergency ambulance providers for each exclusive operating area or subareas. The EMS Agency shall identify and prepare exclusive operating areas or subareas for emergency ambulance services.

F. Performance Standards. All emergency ambulance services, ALS providers, and medical first responders shall be contracted with the EMS Agency and have specific, measurable performance standards established by the EMS Agency.

G. Designated Operating Areas. All emergency ambulance service contracts shall specify the area within the County within which the operator or provider may furnish emergency ambulance services. No provider may furnish emergency ambulance service for requests originating outside the area designated in the contract unless requested to do so by the County or EMS Agency under provisions outlined in County approved written mutual-aid agreements.

(Ord. No. 5138, § 1, 9-22-2009)

A. Development and Approval of RFP. The EMS Agency shall develop a request for proposals (RFP) as part of the competitive process to select an emergency ambulance provider for the exclusive operating area. The EMS Agency shall develop and submit to the California EMS Authority for approval, its competitive process for selecting providers and determining their scope of operations. The RFP shall include provisions for a competitive process held at periodic intervals.

B. Issuance of RFP. The EMS Director shall cause the RFP to be posted on the Solicitation Center website maintained by the Contracts/Purchasing Division of the County Administrative Office or such other County website for solicitation of RFPs. The EMS Director shall also send notice of the issuance of the RFP to each current emergency ambulance service operator and emergency ambulance provider in the County, to all EMCC members, and any other interested parties who have filed with the EMS Agency a written request for such notice, shall make copies of the RFP available to all interested parties, and shall post the RFP on the EMS Agency's website. The EMS Agency may authorize a charge for copies of the RFP. The RFP shall specify a deadline for submittal of proposals. Any proposals received after the time set for submitting proposals shall not be considered.

C. Review Panel. The EMS Director shall appoint a review panel to evaluate the proposals received in response to the RFP. The review panel shall be selected by the EMS Director in order to ensure that as a whole, the review panel includes members who are familiar with or oriented to various aspects of EMS systems, members who are knowledgeable with EMS needs of Monterey County, and members who have expertise in various EMS disciplines. Members may not have a conflict of interest. The review panel shall review all proposals and submit a written report and recommendations to the EMS Director. The EMS Director shall forward his or her recommendations for the award of the RFP, together with the recommendations of the review panel, to the Board.

D. Award of Contract. The Board shall review the recommendations of the RFP Review Panel and the EMS Director. The Board shall either accept or reject the recommendations, and on that basis, either award the contract or decline to award the contract.

(Ord. No. 5138, § 1, 9-22-2009; Ord. No. 5289, § 1, 10-10-2017)

Scheduled emergency ambulance rates shall be established by contract with the emergency ambulance service operator or provider awarded an exclusive operating area or subarea, and reflects the maximum emergency ambulance rates that may be charged by other emergency ambulance service operators or providers. Emergency ambulance rate adjustments require the modification of the Primary EMS Provider contract by the Board. The EMS Director may request the service or provider supply a financial audit of their business in order to verify any request for an adjustment to the schedule of emergency ambulance rates. The Board may adjust the contract's scheduled emergency ambulance rates county-wide if the Board determines that the current rates support the request. The decision of the Board is final.

(Ord. No. 5138, § 1, 9-22-2009)

A. Emergency Ambulance Drivers and Attendants. Any emergency ambulance attendant or emergency ambulance driver utilized by an operator or provider shall be at least eighteen (18) years of age; shall be trained and competent in the proper use of all emergency ambulance equipment; shall hold current certification as an Emergency Medical Technician I-Ambulance (EMT-I) or Emergency Medical Technician-P (EMT-P); or be licensed as a physician or registered nurse in the State of California, and shall demonstrate compliance with all applicable State laws and regulations.

B. Uniform and Appearance. Each person providing emergency ambulance transportation service subject to this Chapter shall staff each emergency ambulance with appropriate personnel who shall wear clean uniforms that identify the employer or sponsoring agency, have visible identification of name and certification level, and comply with the requirement of this Chapter.

C. Dispatchers. Each person providing emergency ambulance transportation service subject to this Chapter shall assign at least one (1) person or an agency to be responsible for receiving calls and dispatching emergency ambulances. Such person or agency shall be located in Monterey County, unless otherwise specified by contract.

D. Inspection. The emergency ambulance transport operator or provider shall allow the EMS Agency or its designee to inspect, on an announced or unannounced basis, all operational areas and equipment used to provide services in the County. The inspections should be held, whenever possible, during normal business hours; provided, however, that the inspection of an ambulance will be stopped should the ambulance be needed to respond to a request for immediate service. The purpose of such inspections may include, but need not be limited to, determining whether:

1. The emergency ambulance is properly maintained and equipped for the provision of emergency ambulance service;

2. The emergency ambulance and its equipment comply with the requirements of law for the level of service provided;

3. The emergency ambulance contains two-way radios; the radios are in good working order and the radios are compatible with the County's Emergency Medical Communications and Dispatch System; and

4. If the emergency ambulance is used for critical care transport, the communication system allows the emergency ambulance driver and emergency ambulance attendant to communicate with the medical staff at both the discharging and receiving facilities.

E. Service Requirements.

1. Each emergency ambulance service operator or provider shall provide service on a continuous twenty-four (24) hours per day basis, excluding circumstances beyond the control off the operator or provider.

2. If for any reason an emergency ambulance service operator or provider stops or suspends providing service on a continuous twenty-four (24) hours per day basis, the operator or provider shall immediately stop all advertisement of the emergency services and notify the EMS Agency that the 24-hour service has been terminated or suspended.

3. Operator or providers that are authorized to provide only special event services shall be exempt from the requirement of twenty-four (24) hours per day provision of service.

F. Investigations. Each holder of an emergency ambulance operator or provider's license, a variance to provide emergency ambulance services, or a contract to provide emergency ambulance services under this Chapter shall cooperate with the EMS Agency or its designee in any investigations of possible violations of this Chapter and shall make all dispatch logs and similar dispatch records, including audio recordings, available for inspection and copying at reasonable times at the licensee's regular place of business.

G. Policies, Procedures and Protocols. The EMS Agency may make necessary and reasonable policies, procedures and protocols covering medical care and transportation services (including but not limited to ground, aircraft, inter-facility, and critical care transport service operations), equipment, personnel, and dispatch, in order to ensure the effective and reasonable administration of this Chapter.

H. General Requirements. Emergency ambulance operators and providers shall comply with the following requirements:

1. The operator or provider shall refer to County Emergency Communications Center all private calls of life threatening nature and all private calls requiring BLS; inter-facility or critical care transport; or ALS or Limited ALS level of care.

2. If the operator or provider is authorized to furnish immediate response service, the operator or provider, in concert with Emergency Medical Dispatch (EMD), shall dispatch an appropriate emergency ambulance to respond to private call requests.

3. For all calls in which the operator or provider transports a patient, the operator or provider shall provide prompt transportation of the patient to the closest and most appropriate medical facility that is licensed, equipped, and staffed to meet the needs of the patient in accordance with applicable laws, rules, regulations and policies.

4. The operator or provider shall electronically record all data, telephone and radio communications for emergency ambulance service and shall maintain such audio and data recordings for such period of time as prescribed by the EMS Agency.

I. Prohibitions. Emergency ambulance operators and providers are hereby prohibited from engaging in the following activities:

1. The operator or provider may not use a scanner or radio monitoring device for the purpose of responding to a call when the operator or provider has not been requested to respond by the person requesting that service or by the appropriate public safety dispatch center.

2. The operator or provider may not cause or allow an emergency ambulance to respond to a location without first receiving a specific request for emergency ambulance service at that location or notifying Emergency Medical Dispatch.

3. The operator or provider may not operate or permit the operation of an emergency ambulance in any manner contrary to the provisions of this Chapter or contrary to any applicable statute, rule, policy, or regulation.

(Ord. No. 5138, § 1, 9-22-2009)

A. Scope. All licenses to provide emergency ambulance services in Monterey County shall be issued under this Chapter.

B. Application Procedure and Information Required. In order to obtain a license for emergency ambulance service, the applicant shall file with the EMS Agency an application in writing, which includes the following information:

1. Name and description of applicant.

2. Business address, business telephone number, and residence of record of the applicant.

3. Trade or firm name, or D.B.A. as recorded.

4. If a corporation, a joint venture or a general or limited partnership, the names of all partners and officers, their permanent addresses and their percentage of participation in the business.

5. A statement of facts showing the applicant is qualified to render efficient emergency ambulance service. The statement shall include days and hours of service availability and rates charged.

6. A photocopy of the license, if applicable, issued by the Commissioner of the California Highway Patrol to privately-owned emergency ambulance companies (in accordance with California Vehicle Code Section 2501 or other applicable sections) shall be appended to the applications.

7. A statement that the applicant owns or has under their control, in good mechanical condition, required equipment to adequately conduct emergency ambulance services, and that the applicant owns or has access to suitable facilities for maintaining all such equipment in a clean and sanitary condition.

8. An affirmation that each emergency ambulance vehicle and its appurtenances conform to all applicable provisions of this Chapter and applicable provisions of State laws and regulations.

9. Proof of liability insurance as outlined in this Chapter.

10. A statement that the applicant at all times employs sufficient personnel adequately trained to deliver emergency ambulance services of good quality, according to personnel provisions of this Chapter.

11. A list, amended as required during the year for any personnel changes, giving the name and a description of the training for each emergency ambulance service employee, and a copy of each certificate or license.

12. Such other facts or information as the EMS Agency may require.

C. Insurance Requirements for Emergency Ambulance Licenses and Variances.

1. Liability Insurance. The licensee shall obtain and keep in force, during the term of said license, comprehensive vehicle liability insurance and professional liability insurance issued by a company or companies authorized to do business in the State of California, insuring the owner of the licensee, the licensee, and their officers, agents and employees against loss by reason of injury or damage that may result to persons or property from negligent operation or defective construction of such emergency ambulance vehicle, or from violation of this Chapter or any State or Federal law. Said comprehensive vehicle liability policy shall be in the sum of not less than three million dollars ($3,000,000.00) for combined single limit, bodily injury and property damage. Said professional liability insurance shall be in the sum of not less than three million dollars ($3,000,000.00) per person and three million dollars ($3,000,000.00) annual aggregate. Every applicant for a license shall obtain and maintain in full force and effect liability insurance, including, but not limited to, comprehensive auto liability, each with a combined single limit of not less than three million dollars ($3,000,000.00) per occurrence, and general liability, with a limit of not less than five million dollars ($5,000,000.00) per claim. The EMS Agency shall not grant a license unless such insurance is in full force and effect. Such insurance must remain in full force and effect throughout the license period.

2. Workers Compensation. Workers Compensation Insurance shall be carried covering all employees of the license holder. Copies of the policies or certificates evidencing such policies shall be filed with the EMS Agency. The EMS Agency shall not grant a license unless the applicant files with the EMS Agency a policy of Workers' Compensation Insurance or a Certificate of Consent to Self Insure issued by the California State Director of Industrial relations, applicable to all employees of the applicant. The Licensee shall thereafter maintain in full force and effect such coverage during the term of the license. Certificates or copies evidencing such coverage shall be provided to and maintained by the EMS Agency.

3. Common Policy Provisions. All policies shall contain a provision requiring not less than a thirty (30) calendar day notice to be given to the EMS Agency prior to cancellation, modification or reduction in limits. The amount of comprehensive vehicle and professional liability insurance shall be subject to review and adjustment by the Monterey County Board of Supervisors annually.

D. Time Limit for Decision. Within ninety (90) calendar days after receipt of an application for a license under this Chapter, the EMS Director shall determine whether to issue or deny the license.

E. Investigations. Whenever, in this Chapter, the EMS Director is required to make or cause to be made such investigation as the EMS Director deems necessary to determine if certain facts or conditions exist, the EMS Director may accept written declaration by any EMS officer or employee, any County officer or employee, any officer or employee of the State of California, or any officer or employee of any law enforcement or fire protection agency acting within the course and scope of their official duties or employment, as evidence that such facts or conditions do or do not exist.

F. Denial. The EMS Director may deny an application for an emergency ambulance license or a renewal thereof if the EMS Director finds:

1. The applicant, or any partner, officer, director, representative or agent thereof has knowingly made a false, misleading or fraudulent statement of a material fact in the application or in any reports or other documents required to be filed with the EMS Agency pursuant to this Chapter;

2. The applicant is not the real owner or operator of the emergency ambulance service;

3. The applicant was previously the holder of a contract, license, or variance issued under this Chapter, which contract, license, or variance has been suspended or revoked and the terms or conditions of the suspension or revocation have not been fulfilled;

4. The applicant has acted as a duly authorized operator or provider under this Chapter without having a valid contract, license, or variance;

5. The applicant has entered a plea of guilty to, or has been found guilty of, or has been convicted of a felony or a crime involving moral turpitude, including any offense relating to the use, sale, possession or transportation of narcotics, habit forming drugs or any other controlled substances, and the time for appeal has elapsed or the judgment of conviction has been affirmed on appeal, irrespective of any order granting probation following such conviction or suspending the imposition of sentence, and irrespective of any order under Penal Code Section 1203.4 allowing such person to withdraw his or her plea of guilty and to enter a plea of not guilty, or setting aside the plea or verdict of guilty, or dismissing the accusation of information; or,

6. The applicant has violated any provisions of this Chapter or any provision of any other ordinance or law relating to emergency ambulance services.

7. The service is not likely to be operated in conformity with the requirements of this Chapter and applicable State laws.

G. Notice/Hearings.

1. The EMS Director shall notify the applicant in writing of the granting or denial of an application. Such notice shall be either sent by mail to the applicant's last address provided in the application or be personally delivered.

2. If the application is denied, the notice shall set forth the reasons for such denial.

3. Whenever an application for a License is denied, the applicant may request a hearing from the EMS Director. Such requests shall be made in writing and filed with the EMS Director within ten (10) calendar days of personal delivery of the notice of denial. If the notice of denial is mailed, applicant has an additional five (5) business days to file a hearing request. The hearing shall be held not more than thirty (30) calendar days from the date of receipt of said request for hearing. The EMS Director shall notify the applicant of the time and place of such hearing. The hearing shall be conducted in the manner prescribed in Section 15.40.070.C. If the applicant is dissatisfied with the decision, the applicant may appeal as provided in Section 15.40.070F.

H. Decisions—Finality. The decisions of the EMS Director rendered pursuant to this Chapter shall be final, unless an appeal is filed with the EMS Agency.

I. Term. Licenses issued under this Chapter shall be valid for a period of two (2) years unless earlier suspended, revoked or terminated.

J. Subsequent Change of Data Submitted in Application. Each applicant and licensee shall report to the EMS Agency any change in the data required in Section 15.40.060 not later than ten (10) calendar days after the effective date of the change.

K. Transfer of License. The licensee must notify the EMS Agency of any request to transfer a license to another person at least thirty (30) business days before the requested effective date of such transfer. Upon receipt of such notification, the EMS Director will determine if the request will require the processing of a new application for licensure. Notice of a requirement for a new application must be sent by certified mail to the proposed license transferee within twenty (20) business days after the receipt by the EMS Agency of the transfer notice.

L. Renewal of License. Applicants for renewal of licenses under this Chapter shall file with the EMS Director an application in writing, on a form furnished by the EMS Director, which shall include any changes in the information required in Section 15.40.060 hereof from the current application on file. The application for renewal shall be filed with the EMS Director at least thirty (30) calendar days prior to the expiration date of the current license, and be accompanied by a renewal fee. Renewal of a license shall require conformance with all requirements of this Chapter as upon issuance of an initial license. Nothing in this Chapter shall be construed as allowing or requiring the automatic renewal of license upon its expiration. The burden of proof respecting compliance with all the requirements of this Chapter shall be with the applicant for renewal.

M. License Fees. The Board shall by resolution set the fees for issuance of licenses for emergency ambulance services. The fees shall not exceed the reasonable costs of administering and enforcing this Chapter, as determined by the Board.

(Ord. No. 5138, § 1, 9-22-2009)

A. License Suspension or Revocation. In the event that any person holding a license issued pursuant to this Chapter shall violate or cause or permit to be violated any of the provisions of this Chapter, including insurance requirements, or any provisions of any other ordinance or law relating to emergency ambulance services, or for any reason for which the license application could have been denied, the EMS Director may suspend or revoke the license after the licensee has been given the opportunity for a hearing as provided for in this Chapter.

B. Posting. The EMS Director shall post for a period of ten (10) business days the name and business address of any licensee receiving a notice of suspension or revocation along with the fact that any interested member of the general public can submit information regarding the proposed suspension or revocation. Such information shall be submitted in writing and shall be delivered to the office of the EMS Director within five (5) business days of the last day of posting. The names and business addresses shall be posted in the office of the EMS Director.

C. Hearings.

1. In any case where the EMS Director determines that a License issued pursuant to this Chapter should be suspended or revoked, the EMS Director shall prepare a written notice of suspension or revocation, which includes a statement of the proposed action, a concise explanation of the reasons for the proposed action, the statutory basis relied upon for such action, and an explanation of the licensee's right to request a hearing from the EMS Director. Such notice shall be sent by certified mail to the licensee's last address provided in the application or be personally delivered, at least ten (10) calendar days prior to the effective date of such action.

2. If within five (5) business days after receipt of such mailing or delivery the licensee or an authorized representative requests in writing a hearing from the EMS Director, the EMS Director shall immediately set a hearing and shall set forth in writing and send to the licensee by means of the mail or hand delivery, notice of the time, date, and place of such hearing.

3. The hearing shall be held not more than thirty (30) calendar days from the date of receipt of said request for hearing. The hearing shall be conducted by a person designated by the EMS Director. The person designated as Hearing Officer shall not have been connected in any manner with the proposed action. No hearing shall be continued except upon good cause. The hearing shall be conducted to determine the existence of any facts which constitute grounds for the suspension, denial, or revocation of the license. The licensee or applicant may have the assistance of legal counsel or may appear by legal counsel and shall have the right to present evidence and cross-examine witnesses. In the event that the licensee or applicant or legal counsel representing the licensee or applicant fails to appear at the hearing, any admitted evidence, on behalf of the EMS Director, of the existence of facts which constitute grounds for the suspension, denial or revocation of the license, shall be considered unrefuted.

4. The decision of the Hearing Officer shall be based solely on the evidence presented at the hearing. Upon conclusion of the hearing, the Hearing Officer may give an oral decision; provided, however, that in the discretion of the Hearing Officer the decision may be delayed and given in writing within two (2) days. In any case where an oral decision is given at the close of the hearing, the Hearing Officer shall confirm the decision in writing within two (2) business days. The written decision shall set forth the findings of fact and the reasons for the decision and a copy shall be mailed to the licensee or an authorized representative. The decision of the Hearing Officer shall be posted in the office of the EMS Director for a period of five (5) business days along with the available procedures for appeal.

5. The decision may be appealed as provided below in Subsection F.

D. Stay of Suspension or Revocation. The effect of a decision of the Hearing Officer to suspend or revoke a license shall be stayed while an appeal to the EMS Agency is pending or until the time for filing such an appeal has expired. There shall be no stay of the effect of the decision of the Hearing Officer upholding the denial of any license.

E. Exception to Hearing Procedure.

1. When, in the opinion of the EMS Director, there is a clear and immediate threat to the safety and protection of the public, the EMS Director may suspend a license without first holding a hearing. The EMS Director shall prepare a written notice of suspension, which includes a statement of the action, the statutory basis relied upon for such action, and an explanation of the licensee's right to request a hearing from the EMS Director. Such notice shall either be sent by certified mail to the licensee's last address provided in the application or be personally delivered.

2. The licensee may request a hearing from the EMS Director within five (5) business days of receipt of notification that the license has been suspended. The EMS Director shall notify the licensee of the time and place of such hearing and the hearing shall bee conducted in the manner prescribed in this Chapter. The hearing shall be held no more than fifteen (15) business days from the date of receipt of said request for hearing.

3. Following the hearing, either party affected may appeal the decision in the manner prescribed in this Chapter. The decision shall not be stayed during pendency of such hearing or appeal.

F. Appeal.

1. Within ten (10) business days after receipt of the decision of the Hearing Officer any licensee or applicant affected by the decision may appeal such decision by filing with the EMS Agency a written appeal briefly setting forth the reasons why such denial, suspension, revocation or other decision is not proper.

2. Upon receipt of such written appeal, the EMS Agency shall refer the appeal to an administrative law judge provided by the State of California Office of Administrative Hearings pursuant to Chapter 14 of Part 3 of Division 2 of Title 3 of the Government Code. The State of California Office of Administrative Hearings shall schedule a date for hearing as soon as reasonably possible. The hearing shall be a de novo review of the licensing decision of the EMS Director. At least ten (10) business days prior to the date of the hearing on the appeal, the EMS Agency shall notify the appellant and the EMS Director of the date and place of the hearing. The EMS Agency shall also have posted in its office the time and place set for the appeal for a period of not less than five (5) business days prior to the date of such appeal. The administrative law judge is authorized to issue subpoenas, to administer oaths and to conduct the hearing on the appeal. The hearing may be transcribed by a certified court reporter. At such hearings the EMS Director and the appellant may present evidence relevant to the denial, suspension, revocation or other decision of the EMS Director. The administrative law judge shall receive evidence and shall rule on the admissibility of evidence and on questions of law.

3. At the conclusion of the hearing, the administrative law judge may uphold the denial, suspension, revocation or other decision of the EMS Director, or the administrative law judge may allow that which has been denied, reinstate that which has been suspended or revoked, or modify or reverse any other decision which is subject to the appeal. The decision of the administrative law judge is final when filed with the EMS Agency.

G. Conduct of Hearings.

1. Oral evidence shall be taken only on oath or affirmation.

2. Each party shall have these rights: to call and examine witnesses; to introduce evidence and exhibits; to cross examine opposing witnesses on any matter relevant to the issues even though that matter was not covered in the direct examination; to impeach any witness regardless of which party first called the witness to testify; and to rebut the evidence against the party. If respondent does not testify in his or her own behalf, the respondent may be called and examined as if under cross examination.

3. The hearing need not be conducted according to technical rules relating to evidence and witnesses. Any relevant evidence shall be admitted if it is the sort of evidence on which responsible persons are accustomed to relay in the conduct of serious affairs, regardless of the existence of any common law or statutory rule which might make improper the admission of such evidence over objection in civil actions. Hearsay evidence may be used for the purpose of supplementing or explaining any direct evidence but shall not be sufficient itself to support a finding unless it would be admissible over objection in civil actions. The rules of privilege shall be effective to the same extent that they are now or hereafter may be recognized in civil actions and irrelevant and unduly repetitious evidence shall be excluded.

4. The hearing shall be conducted in the English language. The proponent of any testimony to be offered by a witness who does not proficiently speak the English language shall provide an interpreter, approved by the Hearing Officer or administrative law judge conducting the proceeding as proficient in the English language and the language in which the witness will testify, to serve as interpreter during the hearing. The EMS Agency may compile and publish a list of interpreters known to be proficient in various languages. Any person whose name appears upon such list shall be deemed to be approved by the Hearing Officer or administrative law judge hearing the case.

(Ord. No. 5138, § 1, 9-22-2009)

All contracted emergency ambulance services shall comply with all applicable provisions of State and local laws.

(Ord. No. 5138, § 1, 9-22-2009)

The EMS Director may grant a variance from the terms of this Chapter if he or she finds such action is necessary to protect the public health, safety, or welfare. Such action may include the issuance of temporary emergency ambulance service contracts and licenses. Such variance shall remain in effect for the period indicated by the EMS Director.

(Ord. No. 5138, § 1, 9-22-2009)