Seal Beach Municipal Code Ch. 5.25 Ambulance Service

For the purposes of this chapter, the following words and phrases shall mean:

Advanced Life Support (ALS) and Basic Life Support (BLS):

as defined in the Health and Safety Code.

Ambulance:

a motor vehicle, helicopter, or similar vehicle, specifically constructed, modified, equipped or arranged and operated for the purpose of transporting patients requiring immediate or ongoing medical services excluding the transportation of such persons to or from locations not providing services as defined in this chapter.

Ambulance Service:

the activity, business or service, for hire, profit, or otherwise, of transporting one or more persons by ambulance; provided, however, ambulance service shall not include the transportation by ambulance by an employer of his or her own employees in an ambulance owned and operated by the employer solely for this purpose.

Ambulance Service Operator:

any person who operates or owns an ambulance service.

Attendant:

a trained, qualified individual who, regardless of whether he or she also serves as driver, is responsible for the care of patients.

Department:

the Emergency Medical Services Agency of the county, or the Health Care Agency of the county, or such other agency as may be designated by the board of supervisors.

Dispatcher:

an individual employed by an ambulance service operator who is responsible for sending an ambulance to provide ambulance service to a patient.

Driver:

an attendant who drives or pilots an ambulance.

Emergency:

a sudden, unforeseen event giving rise to a need for ambulance service with basic or advanced life support services and is a condition in which an individual has a need for immediate medical attention, or where the potential for such need is perceived by emergency medical personnel or a public safety agency.

Exclusive Operating Area (EOA):

as defined in Section 1797.85 of the Health and Safety Code, and which is established pursuant to Section 1797.224 of the Health and Safety Code.

Emergency Service:

ambulance service performed in response to an emergency.

Fire Chief:

fire chief of the Orange County Fire Authority.

Health Officer:

the county health officer or other official designated by the board of supervisors to perform the health officer's functions.

Licensee:

an ambulance service operator that has been granted a license under this chapter to provide ambulance service.

Medical Services:

services provided by health care professionals licensed pursuant to the Business and Professions Code or as specified by regulations adopted pursuant to this chapter.

Paramedic:

as defined in the Health and Safety Code.

Patient:

a wounded, injured, sick, invalid, or otherwise incapacitated person.

Physician:

a medical doctor or osteopath holding the appropriate license or certificate to practice as such within the state pursuant to the Business and Professions Code.

Public Safety Agency:

any public law enforcement agency, fire protection agency, or forest ranger operating in the county.

(Ord. 1515; Ord. 1525)

A. It shall be unlawful for any person to be an ambulance service operator, or to act in such a capacity either directly or indirectly, without obtaining a license pursuant to this chapter. A license may specify the geographical area within the city in which it is valid; provided, however, with respect to EOAs, reference to EOA by a specific number or similar identification shall be sufficient description of geographic limitation. A license shall be valid for not more than one calendar year or the expiration of the calendar year in which it was issued, whichever is shorter.

B. The provisions of this chapter shall not apply to:

1. Ambulance operated at the request of a public safety agency during any "state of war emergency," "state of emergency" or "local emergency" as defined in the Government Code.

2. Ambulance service transporting a patient from a location outside of the county, regardless of destination.

3. Ambulance service transporting a patient by a fixed wing airplane.

(Ord. 1515; Ord. 1525)

A. No license issued pursuant to this chapter shall be transferred by operation of law or otherwise. The following shall be considered transfers for purposes of this section.

1. Any change in the business structure of a licensee, including, but not limited to, changes from or to:

a. A sole proprietorship.

b. A partnership, including any change in the partners.

c. A corporation, including any change in the shareholders, whether by operation of law or otherwise.

2. Bankruptcy, an assignment for the benefit of creditors, or the appointment of a receiver.

3. A sale or transfer of 10% or more of the assets of a licensee.

B. A licensee may apply to the health officer for an amendment to the terms of the license, which request shall be processed in the same manner as an original application. Notwithstanding anything in this section to the contrary, licenses may be suspended, revoked, or terminated prior to the expiration date, pursuant to the provisions of this chapter.

(Ord. 1515; Ord. 1525)

A. Each application for a license shall be accompanied by such application fee as may be set by the board of supervisors, and shall be made upon forms prescribed by the health officer.

B. Each applicant shall submit the following:

1. The name and address of the applicant; the name and address of any person having any interest in the applicant's business; and the name and address of the owner or owners of any ambulance proposed to be used.

2. The applicant's training and experience in the transportation and care of patients.

3. The names under which the applicant has engaged, does, or proposes to engage in ambulance service.

4. A description of each ambulance including the make, model, year of manufacture, vehicle identification number, current state license number, the length of time the vehicle has been in use, and the color scheme, insignia, name, monogram and other distinguishing characteristics of the vehicle, a description of the applicant's program for maintenance of the vehicle, and a description of each vehicle's radio.

5. Proof that the applicant has obtained all licenses and permits required by state or local law or regulation for the type of ambulance service proposed, excluding only a license to provide the service for which application is made.

6. The names and qualifications of each attendant, driver, or dispatcher employed, or to be employed, in providing ambulance service.

7. Proof that the applicant possesses and maintains currently valid California Highway Patrol inspection reports for each vehicle listed in the application.

8. A description of the applicant's training and orientation programs for attendants, drivers and dispatchers.

9. Evidence of such financial responsibility and insurance coverage as may be required by the health officer pursuant to regulations adopted by the county.

10. Identification of the geographical area to be served by the applicant, if required by the department.

11. As to new applications or applications for transfer, a fingerprint receipt for each principal of the applicant issued by the county sheriff-coroner indicating each principal of the applicant has undergone a complete criminal history check, followed by a report from the county sheriff-coroner showing no conviction of crimes for which a license may be denied.

12. A list of all substations or offices where equipment and personnel are, or will be based, including hours of operations.

13. A description of whether the service proposed by the applicant will include basic life support or advanced life support services, and, if so:

a. The number of basic life support or advanced life support service units to be deployed on each shift.

b. The emergency response area or areas to receive basic life support or advanced life support service.

c. The provisions, if any, for continuing education of attendants.

14. Such other information as the health officer may require in regulations adopted by the county.

C. Renewal applications shall be submitted on such forms as may be prescribed by the health officer.

(Ord. 1515; Ord. 1525)

Upon receipt of a completed application and the required fee, if any, the health officer shall make, or cause to be made, such investigation as the health officer deems necessary to determine if:

A. The applicant is a responsible and proper person to conduct, operate or engage in the provision of ambulance services.

B. The applicant meets the requirements of this chapter and of other applicable laws, ordinances or regulations.

(Ord. 1515; Ord. 1525)

A. The health officer shall issue a license to an applicant if the health officer, after completing any investigation required pursuant to this chapter, determines all requirements of this chapter have been met and the license fee, if any, set by the board of supervisors, has been paid.

B. In the event of denial, the applicant shall be informed in writing of the reasons therefor.

C. The licensee shall obtain and keep in force, during the term of a license, comprehensive automobile liability insurance and professional liability insurance issued by a company authorized to do business in the state, acceptable to the health officer, insuring the owner against loss by reason of injury or damage that may result to persons or property from negligent operation or defective construction of any ambulance operated by licensee, or from violation of this chapter or any law of the state, or the federal government. The comprehensive automobile liability policy shall be in the sum of not less than $500,000 for combined single limit, bodily injury and property damage. The professional liability insurance shall be in the sum of not less than $1,000,000 per person and $1,000,000 annual aggregate. Worker's compensation insurance shall be carried covering all employees of the licensee. Before the health officer shall issue a license, copies of the policies, or certificates evidencing such policies, shall be filed with the health officer. All policies shall contain a provision requiring a 30-day notice to be given to the department prior to cancellation, modification, or reduction in limits. The amount of comprehensive automobile liability insurance shall be subject to review and adjustment by the health officer pursuant to regulations adopted by the county. In the use of helicopters, the equivalent insurance requirements shall apply.

D. Grounds for denial of a license application shall be:

1. Failure to meet the requirements of any provisions of this chapter.

2. Violation by any principal of an applicant of Penal Code Section 290.

3. Habitual or excessive use of narcotics or dangerous drugs.

4. Conviction during the preceding 7 years of any crime relating to the use, sale, possession or transportation of narcotics, or additive or dangerous drug.

5. Habitual or excessive use of intoxicating beverages.

6. Conviction during the preceding 7 years of any crime punishable as a felony in the state.

7. Conviction of any crime involving moral turpitude, including fraud or intentional dishonesty for personal gain.

E. In determining the effect of any criminal acts on the issuance or denial of a license, the health officer shall consider whether the criminal acts are related to the activities of an ambulance service and shall evaluate the rehabilitation of the persons involved. The health officer shall not consider crimes of which the applicant is, or was, accused but not convicted.

(Ord. 1515; Ord. 1525)

A. The health officer may suspend or revoke a license for failure by the licensee to comply, and maintain compliance with, or for violation of, any applicable provisions, standards or requirements of state law or regulation, of this chapter, or of any regulations promulgated by the county. Suspension of a license is not a condition precedent to revocation of a license.

B. Before suspension or revocation, the health officer shall give written notice to the licensee. The notice shall:

1. Specify the reasons for which the action is to be taken.

2. Set a hearing for not more than 15 days nor less than 7 days after the date of the notice.

3. Specify the date, time and place of the hearing.

4. Be served on the licensee either by delivery to its principal place of business or to its designated agent for services of such notices, if any.

C. If the licensee, subsequent to service of a suspension or revocation notice under this section, remedies some or all of the conditions to which the notice refers, the health officer may rescind a notice of suspension or revocation at any time.

D. At the hearing, the health officer has the burden of proof and may present evidence as to why such action should be taken and to answer the evidence presented by the license.

E. The health officer may reduce the period of time for hearing under a suspension or revocation notice to no less than 24 hours when the health officer makes written preliminary findings that such action is necessary to protect the public health, safety and welfare. When, as a result of such an emergency proceeding, a license is suspended or revoked, the licensee will have the burden of establishing renewed compliance justifying reinstatement of the license. Such additional hearing will be commenced within 5 days of the licensee's request. The request for, and the scheduling of, an additional hearing shall not stay operation of the suspension or revocation order.

F. Hearings conducted pursuant to this section shall be conducted before a hearing officer designated by the department. At the conclusion of the hearing, the hearing officer shall expeditiously prepare a written summary of the evidence and proposed findings and conclusions for consideration by the director of the department.

G. The director of the department shall issue a written decision within 30 days after receiving the hearing officer's findings and conclusions.

(Ord. 1515; Ord. 1525)

In the event of denial, suspension, or revocation of a license, the applicant or licensee shall have the right to request a hearing before the board of supervisors, which hearing shall be requested and conducted in the manner specified in Section 5-2-19 of the county code.

(Ord. 1515; Ord. 1525)

The licensee shall notify the health officer within 24 hours after any change in ownership of more than 24 hours duration, or any substantial change in staffing or equipment. For purposes of this section the term "substantial change" shall be as defined by regulation adopted by the county.

(Ord. 1515; Ord. 1525)

A. A licensee shall only employ personnel performing tasks described in this chapter who comply with the requirements of this section.

B. Attendants shall be at least 18 years of age and trained and competent in the proper use of all equipment, and shall hold current Emergency Medical Technician-1A ("EMT-1A") or state educational equivalent certification in compliance with all state laws, rules and regulations. Additionally, each attendant shall hold a license from the health officer indicating compliance with this section. Applications for such licenses shall be in a form required by the health officer and shall be accompanied by the fee, if any, established therefor. All applicants for licenses as an attendant shall be subject to the same criminal history review as required by principals of ambulance companies no less than once every 4 years. Certificates may be denied, suspended, or revoked in the same manner as that specified for ambulance service licensees in this chapter. Licenses shall be valid for 2 years from the date of issuance or certification as an Emergency Medical Technician-1A, whichever is less. Renewal of a license shall be in the same manner as issuance of a new license.

C. Each licensee shall have at least one dispatcher. Emergency ambulance service licensee shall have a dispatcher on a 24-hour-per-day basis and shall adequately train the dispatcher in radio operation and protocols and in the emergency response area served before said dispatcher begins dispatching emergency calls. For purposes of this section, "adequate" training of a dispatcher shall be that which meets state standards, if any, or county requirements.

D. Ambulance drivers shall, in addition to the requirements of this chapter for attendants, maintain an appropriate license issued by the California Department of Motor Vehicles and, if applicable, the Federal Aviation Administration.

(Ord. 1515; Ord. 1525)

No licensee shall charge more than the maximum BLS rates approved by the board of supervisors. No licensee shall charge more than the maximum ALS rates approved by the board of supervisors or the Orange County fire authority ("authority").

(Ord. 1515; Ord. 1525)

A. The authority shall administer the competitive process for the award of EOA contracts within the city. The authority shall select and enter into contracts with licensees for the provision of ambulance service in response to emergencies in each EOA. The contracts shall provide for one primary contractor per EOA, with such other back-up service by other emergency ambulance service providers as may be deemed necessary by the fire chief. In awarding these contracts, the authority shall consider the comparative value of competing proposals in the same fashion as would be the case were the county evaluating proposals from prospective service providers for other governmental activities, including consideration of:

1. The quality of service to be provided.

2. The level of service to be provided.

3. The rates charged for services to be provided.

4. The cost, if any, to the awarding agency.

B. The fire chief shall administer the contracts for ambulance service. The fire chief shall also prepare and keep current EOA lists specifying contract providers for each EOA. The fire chief shall include on the list for each EOA the provider that has entered into an ambulance service agreement as the primary contractor as well as any other emergency ambulance service provider who will provide back-up emergency ambulance service for that area.

C. In the event no proposals acceptable to the authority are received for one or more EOAs, the authority shall designate one or more licensees to provide emergency ambulance service for that EOA. From the date of such designation until a contract is awarded for the affected area, provision of emergency ambulance service shall be an express condition of the license and unreasonable or unjustified refusal of any emergency calls shall be a violation of this chapter.

D. No person shall provide ambulance service in response to, or as a result of, an emergency, unless that person is a licensee and is specified in each instance by a physician or public safety agency. A licensee thus specified by a physician or a public safety agency need not be a contractor selected by the city pursuant to this section. Any ambulance service operator receiving a request for emergency ambulance service from other than a public safety agency shall immediately, by telephone, notify a public safety agency designated by regulation of the request.

E. No licensee responding to an emergency shall transport a patient unless at least one of the following is true:

1. A paramedic is present at the location of the patient.

2. A physician is present at the location of the patient and directs transportation in the absence of a paramedic.

3. A safety qualified employee of the county fire authority, or an appropriate employee of a public safety agency designated by county regulation, directs transportation in the absence of a paramedic.

F. Unless otherwise directed by a physician present at the location of the patient, a licensee shall transport a patient pursuant to regulations adopted by the county.

(Ord. 1515; Ord. 1525)

A. Rules and regulations to implement the provisions of this chapter may be adopted by the health officer, the fire chief, or other officers designated by the county in accordance with procedures specified by the county, and all licensees shall be bound by such rules and regulations.

B. The health officer or the fire chief or their designees may inspect the records, facilities, transportation units, equipment and method of operations of each licensee whenever necessary and, by the health officer, at least annually.

(Ord. 1515; Ord. 1525)

The city, the department, any user, subscriber, public safety agency or consumer who believes, or has reason to believe, that it or another party has been required to pay an excessive charge for services, received inadequate services or that services provided were not in compliance with the provisions of this chapter, may file a written complaint with the department setting forth such allegations. The department shall notify the ambulance service operator of such complaint. The ambulance service operator shall file a written response within 15 days after receipt of notification.

(Ord. 1515; Ord. 1525)

As to all but the selection of ambulance service licensees, the health officer may grant variances from the requirements of this chapter if such action is necessary to protect the public health, safety or welfare. As to the selection of ambulance service licensees, the fire chief may grant variances from the terms thereof if such action is necessary to protect the public health, safety or welfare. Variances granted by the health officer may include the issuance of a temporary license. No variance shall exceed 180 days in duration.

(Ord. 1515; Ord. 1525)