Tulare Municipal Code Ch. 7.40 Emergency Ambulance Operator Franchise

The purpose of this chapter is to provide for the regulation of all emergency medical transportation services and the emergency medical services connected therewith in order to protect the health, safety and welfare of the residents of the city and to ensure that competent and adequate care is provided to the residents in need of the services. Further, it is the purpose of this chapter to regulate the provision of such services where there is a sudden need of immediate medical attention requiring basic or advanced life support services as defined by the California Health and Safety Code.

(1995 Code, § 7.40.010) (Ord. 96-1786, passed - -1996)

It is declared that in order to provide adequate pre-hospital medical care and transportation of the sick and injured, it is in the best interest of the city and its citizens, to limit the number of ambulance franchises. The number of franchises issued for the emergency operation of an ambulance service within the city limits shall be limited to a single provider who shall, except for extenuating circumstances requiring additional resources, have exclusive rights for the provision of ambulance services.

(1995 Code, § 7.40.020) (Ord. 96-1786, passed - -1996)

The Permit Officer or, in his or her absence, the City Manager, may modify the terms of the exclusive franchise and operating area on a temporary basis at any time, for any time not to exceed 30 days, upon any of the following conditions or occurrences:

(A) A labor action disrupting or ending the ambulance service;

(B) The closing, bankruptcy or dissolution of the ambulance company;

(C) Any other circumstance which disrupts or ends ambulance service without sufficient notice to allow Council action; and

(D) Suspension, revocation or termination of the ambulance provider’s license under this chapter.

(1995 Code, § 7.40.030) (Ord. 98-1821, passed - -1999)

Except as specified in § 7.40.120 of this chapter, no person shall operate for hire, profit or otherwise provide emergency transportation services by ambulance on any street, road, highway, alley or any public place within the Tulare City limits without first obtaining an ambulance franchise from the City Council, as hereinafter provided.

(1995 Code, § 7.40.040) (Ord. 96-1786, passed - -1996)

The following words and terms when used in this chapter have the meanings herein ascribed to them.

ADVANCED LIFE SUPPORT. Those special services defined by Cal. Health and Safety Code § 1797.52 and any amendments thereto and referred to in the Emergency Medical Service (EMS) System and the prehospital Medical Care Personnel Act, Cal. Health and Safety Code §§ 1797 et seq., and any amendments thereto, or regulation promulgated thereunder.

AMBULANCE. A vehicle specially constructed, modified or equipped and used for the purpose of transporting sick, injured, convalescent, infirmed or otherwise incapacitated persons. AMBULANCE also includes the transportation of persons confined to wheelchairs.

(A) A primary ambulance shall be one used regularly in service by the grantee.

(B) A backup ambulance shall be an ambulance only used occasionally to fill in while a primary ambulance is temporarily out of service.

AMBULANCE ATTENDANT. Any person accompanying an ambulance to provide pre-hospital medical care for a sick, injured or otherwise incapacitated person.

AMBULANCE DRIVER. A person who is licensed by the California Department of Motor Vehicles to operate an ambulance.

AMBULANCE PROVIDER. A firm, partnership, corporation or other organization which furnishes or offers to furnish an ambulance service within the city limits of Tulare.

AMBULANCE SERVICE. The activity, business or service for hire, profit or otherwise, of transporting one or more persons by ambulance on any of the streets, roads, highways, alleys or any public way or place within the city limits of Tulare.

AMBULANCE STATION. The premises (including living quarters) located within a zone from which the ambulance provider renders service.

BASIC LIFE SUPPORT. Those special services defined by Cal. Health and Safety Code § 1797.60 and any amendments thereto and referred to in the Emergency Medical Service (EMS) System and the prehospital Medical Care Personnel Act, Cal. Health and Safety Code §§ 1797 et seq., and any amendments thereto, or regulation promulgated thereunder.

CALL-UP PROTOCOL. A systematic procedure for providing adequate ambulance coverage, within the city limits of Tulare, on those occasions when ambulances of the grantee are unavailable for additional emergency assistance.

EMERGENCY CALL. A request for the dispatch of an ambulance to transport or provide other assistance to persons in sudden need of immediate medical attention, including the transport of all persons identified in the Cal. Welfare and Institutions Code § 5150.

EMERGENCY MEDICAL TECHNICIAN-I or EMT-I. An individual defined in the Cal. Health and Safety Code § 1797.80, with a scope of service set forth in the Cal. Health and Safety Code § 1797.170, trained in basic life support according to standards set forth in the Cal. Code of Regulations, Title 22, Chapter 2, §§ 100005 et seq., and certified as such by the Medical Director.

EMERGENCY MEDICAL TECHNICIAN- PARAMEDIC, EMT-P or MOBILE INTENSIVE CARE PARAMEDIC. An individual whose scope of practice is to provide advanced life support in accordance to standards prescribed by Cal. Health and Safety Code § 1797.84 and who has a valid certificate issued pursuant to the division.

EMS. Emergency medical services which include all services required to identify, respond to, stabilize and treat all medical and psychiatric emergencies.

EXCLUSIVE OPERATING AREA. The service area within the City of Tulare designated by the City Council where the provision of emergency ambulance service is restricted to a single provider.

GRANTEE. A firm, partnership or corporation granted a franchise to operate an ambulance service within the city limits of Tulare.

MEDICAL DIRECTOR. A physician serving as the Medical Director/Health Officer of the Tulare County Emergency Medical Service Agency.

PERMIT OFFICER. The Fire Chief of the City of Tulare or his or her designee.

(1995 Code, § 7.40.050) (Ord. 06-2024, passed 6-20-2006; Ord. 96-1786, passed - -1996)

Any person desiring to obtain the emergency ambulance franchise required by § 7.40.040 of this chapter shall pay a fee, established by resolution by the City Council, of $100 to the Clerk, and shall make application for the franchise to the Council, which application shall set forth the following:

(A) The name and address of the applicant, and if the same be a corporation, partnership, association or company, the name of its principal officers, with the address of each, and the names, addresses and percentage of ownership of all owners of the business;

(B) A description of every motor vehicle which the applicant proposes to operate. The description should include make, year of manufacture (and in case of type I and type III, the year of manufacture of the patient compartment), motor and chassis numbers, California state license number for the current year, and the color scheme, insignia, name, monogram or other distinguishing characteristics used to identify the vehicle;

(C) List the address of each proposed ambulance station;

(D) The distinctive color scheme, name, monogram or insignia applied to each vehicle;

(E) The training and experience of the applicant in the transportation and care of patients; and

(F) A statement of financial status and responsibility in a form acceptable to the Permit Officer.

(1995 Code, § 7.40.060) (Ord. 96-1786, passed - -1996)

Editor’s note:

For the most recent fee, please see the Rates and Fees Resolution passed by the city and on file in the city offices.

Applications for ambulance franchise shall be processed in the following manner:

(A) The Permit Officer shall develop and make available a document setting forth the information to be included in the official request for proposal (RFP) to provide ambulance service to the city.

(B) Applications shall be delivered to the Permit Officer by the first Monday in April of the year the existing franchise expires.

(C) The following documents shall accompany the application:

(1) Evidence that all vehicles proposed to be used have been properly licensed and inspected by the State of California; and

(2) Evidence that each employee possesses a valid certificate or license as required by state laws and regulations, this chapter and the Medical Director.

(D) Applications will be reviewed by the Permit Officer, who shall recommend the award of franchise to the City Council during the first Council meeting in May. Council shall schedule a public hearing for their second meeting in May.

(E) During the second meeting in May, the Council shall conduct a public hearing and award the franchise.

(F) The term of this exclusive franchise, which shall become effective July 1, shall be for the period of five years, unless sooner terminated, and shall be subject to the right of the city to terminate, alter or amend the franchise at any time, as hereinafter provided.

(1995 Code, § 7.40.070) (Ord. 96-1786, passed - -1996)

Before the franchise shall be issued by the Clerk, the applicant to whom this permit shall be awarded by the Council shall deliver to the Clerk a policy of insurance executed by a company duly authorized under the laws of the state to do an insurance business. The policy shall include the following information:

(A) Grantee shall assume all responsibility for damages to property or injuries to persons, including accidental death, which may be caused by the grantee’s performance of a contract, whether such performance be by himself or herself, his or her subcontractor, or anyone directly or indirectly employed by him or her and whether such incurred damage is discovered before or after termination of contract.

(B) The grantee shall take out and maintain during the life of the contract a comprehensive liability policy, including contractual liability, as shall protect him or her and the city from claims for such damages. The policy shall name the City of Tulare, California, its agents, officers and employees as additional insured under the policy, in the following amounts:

(1) Public liability insurance; in an amount not less than $1,000,000 per occurrence for personal injuries, including accidental death to any one person;

(2) Property damage insurance; in an amount not less than $1,000,000; and

(3) Subject to the above limits, as combined single limit of insurance in an amount not less than $2,000,000.

(C) In addition, the policy shall contain a severability of interest clause and provide that the coverage shall be primary for losses arising out of the contractor’s performance of the contract. Neither the city nor any of its insurers shall be required to contribute to any such loss.

(D) The grantee shall furnish a certificate of insurance countersigned by an authorized agent of the insurance carrier on a form of the insurance carrier setting forth the general provisions of the insurance coverage. This countersigned certificate shall verify that the City of Tulare, California, its agents, officers and employees are named as additional insured under the policy. The certificate of insurance carrier shall contain a statement of obligation on the part of the carrier to notify the city of any material change, cancellation or termination of the coverage at least 30 days in advance of the effective date of any such material change, cancellation or termination.

(1995 Code, § 7.40.080)

The franchise may be suspended or revoked if the provider or any of his or her employees or agents have:

(A) Violated any of the provisions of this chapter;

(B) Violated any of the provisions of this ordinance code or the laws of the city, county, the state or federal government pertaining to the operation of an ambulance, failed to comply with the county’s EMS Agency Policies and Procedures Manual, or breached any written agreement with the city;

(C) Misrepresented a material statement of fact in the application for this ambulance franchise;

(D) Violated any of the terms or conditions of his or her license;

(E) Committed any act or failed to perform any duty which adversely affects the health, safety and welfare of patients or the public need and necessity for efficient ambulance services;

(F) Deliberately provided false information or data to the Permit Officer; and

(G) If any term or condition of this franchise shall be or become invalid or unenforceable, the City Council may by ordinance terminate this franchise, provided the City Council shall find and declare that the invalid or unenforceable term or condition constituted a consideration material to the granting of this franchise.

(1995 Code, § 7.40.090)

The grantee shall be responsible for providing adequate notification and dispatching of appropriate ambulances to emergency calls.

(A) In all cases, the grantee shall dispatch the nearest ambulance to the scene of any emergency reported to ambulance personnel.

(B) The grantee shall provide, as determined by the Permit Officer, in each ambulance and at one or more of the ambulance stations, a radio capable of communications with the Tulare police dispatcher and Tulare Fire Department.

(C) The grantee shall maintain direct telephone and radio communications with the Tulare Police Department dispatchers, 24 hours/day, seven days/week, 365 days/year.

(D) The grantee shall provide radio communications over the fire frequency to alert fire and police officials of any ambulance en route and arriving on scene to provide for the safe arrival of all responding units.

(1995 Code, § 7.40.100) (Ord. 06-2024, passed 6-20-2006)

All vehicles used under this franchise shall be operated and maintained in accordance with the laws of the State of California and ordinances of the County of Tulare and the City of Tulare.

(A) The city hereby expressly reserves the right to modify, amend, alter, change or eliminate any of the provisions of this franchise during its life, for the following purposes, to wit:

(1) To eliminate or delete from such conditions as prove obsolete or impractical;

(2) To impose such additional conditions upon the grantee as may be just and reasonable, for the purpose of insuring adequate service to the public;

(3) To make reasonable orders respecting character, extent, quality and standard of service; and

(4) To make such other rules and regulations as may be reasonably necessary to facilitate the service to be rendered to the public under this franchise.

(B) The grantee must have a valid permit and the drivers, operators and attendants of the authorized ambulance shall, at all times, be qualified pursuant to the requirements of the Vehicle Code of the state and the Medical Director.

(C) The allowable fees for service charged by the ambulance provider shall be no greater than the rates approved in the grantee’s request for proposal. Grantee may, however, petition the City Council no more than annually, except for extraordinary circumstances, for a review and revision of the rates. The City Council may approve the revisions with or without conducting a public hearing as it deems appropriate. A schedule of fees for services shall be made available, by the grantee, upon request to any person.

(D) In the interest of public health, safety and welfare, the grantee shall not operate any ambulance unless and until the following conditions have been met:

(1) All vehicles to be operated as ambulances must meet all state and federal standards.

(2) Each ambulance shall be equipped with all safety equipment and supplies required by the California Highway Patrol, California Welfare and Institutions Code, California Health and Safety Code, County EMS Agency and the Medical Director.

(3) Ambulances may be inspected at irregular intervals at the discretion of the Permit Officer or the Chief of Police.

(E) A driver and attendant shall respond to all calls. The drivers and attendants shall comply with the following:

(1) Shall meet all state and federal standards concerning the licensing and certification of ambulance drivers and attendants and be of good moral character;

(2) Shall wear clean uniforms bearing the county and provider agency standard insignia indicating the person’s class of service, be neat and clean, and conduct themselves in a professional manner; and

(3) Have a set of fingerprints on file with the Tulare Police Department.

(F) Except as provided by county’s EMS protocol, grantee shall not provide ambulance service utilizing vehicles or personnel which are based outside the city limits.

(G) Grantee shall maintain a distinctive color scheme with the company name and identification number on each side and rear of each ambulance, lettering to be not less than four inches high.

(H) Prior to January 1, 2007, a minimum of two ambulances shall be fully staffed, 24 hours/day, seven days/week by: one EMT-I and one EMT-II. Beginning January 1, 2007, all ambulances must be staffed to the Advanced Life Support (ALS) level, which requires at least one EMT-1 and one EMT-P Paramedic in each ambulance. BLS ambulances may be utilized for the purpose of BLS interfacility transfers. However, at no time on or after January 1, 2007, will it be acceptable to respond a BLS staffed ambulance to a prehospital request for ambulance service unless no ALS is available and the BLS ambulance is the closest available ambulance to the call. All BLS ambulances must be staffed with a minimum of two Emergency Medical Technician I personnel and be equipped with an automated external defibrillator (AED).

(I) One or more separate ambulance stations, as determined by the City Council, shall be maintained and occupied by the ambulance service provider. All such locations shall be approved by the City Council and are intended to meet minimum response times, considering traffic, street patterns and other ambulance station locations. Each ambulance station shall be equipped with all communication equipment required by the Permit Officer.

(J) The delivery of pre-hospital emergency medical care provided by the grantee shall be reviewed and approved by the Permit Officer in consultation with the Medical Director.

(K) All ambulance personnel, employed by the grantee, shall meet or exceed the training standards required by the Medical Director.

(L) The grantee shall maintain each ambulance in good serviceable condition, meeting all state and federal laws applicable to the performance of such vehicles and in no case shall the motor or chassis be older than ten years.

(M) The grantee shall provide, and abide by the direction established in accordance with policies established by the Tulare County Emergency Medical Services Committee, a “call-up” protocol of additional ambulance(s) as may be required during mass casualties or other unusual circumstances.

(1995 Code, § 7.40.110) (Ord. 06-2024, passed 6-20-2006)

The provisions of this chapter shall not apply to the following:

(A) Any person operating an ambulance in the line of duty as a salaried, regular, full-time police officer, Deputy Sheriff or member of the Fire Department;

(B) Any ambulance and personnel operating such ambulance rendering assistance to patients during any declared “state of war emergency”, “state of emergency” or “local emergency”, as defined in the California Government Code, or as otherwise requested by the Medical Director or public safety agency for mutual aid response;

(C) Any ambulance company located outside of the city when one of the following applies:

(1) A patient is being transported to a residence or facility within the city from a residence or facility outside the city;

(2) A patient is being transported through the city from a point of origin outside the city to a destination outside the city; and

(3) A patient whose condition requires transportation to another facility utilizing specialized equipment or personnel not available from the local provider.

(1995 Code, § 7.40.120)

Neither this franchise, nor any interest therein shall be sold, assigned or disposed of, either by merger or consolidation, or otherwise without the consent of the city expressed by ordinance.

(1995 Code, § 7.40.130)

The grantee shall comply with the provisions of the “Tulare County Ambulance Ordinance”, the Tulare County “Emergency Medical Services Policies and Procedures” and the Tulare County “limited and advanced life support” agreements.

(1995 Code, § 7.40.140)

(A) All ambulance calls initiated by the Police or Fire Department of the city shall be directed to the grantee in all cases except when such agencies are advised by the grantee that the grantee is unable to provide service at that time because of prior commitments for service.

(B) The grantee shall be responsible for replacing all chargeable supplies, identified in the agreement between the city and ambulance franchise operator, used by Tulare Fire Department personnel for victims/patients transported by ambulance.

(1995 Code, § 7.40.150) (Ord. 06-2024, passed 6-20-2006)

The granting of the franchise is conditional upon the grantee filing with the City Clerk, at least ten days before the effective date of the issuance of the franchise, a written acceptance thereof and agreement to comply with the terms and conditions set forth in this chapter.

(1995 Code, § 7.40.160)

Any person who has received services from a person licensed or certified under the provisions of this chapter and who has any complaint regarding the quality or adequacy of the service, or compliance with this chapter, may file a written complaint with the Permit Officer setting forth in detail the reasons for the complaint. The Permit Officer shall investigate all written complaints and take appropriate actions as provided within this chapter.

(A) The Permit Officer shall conduct an investigation of the allegations contained in the complaint.

(B) If there is substantial evidence to verify the allegation, the Permit Officer shall notify the provider of his or her findings and the measures to be taken pursuant to the provisions of this chapter.

(C) Measures regarding suspension or revocation of the franchise shall be reported to the City Council for consideration and final determination of appropriate action.

(1995 Code, § 7.40.170)

Upon receipt of the Permit Officer’s notice of serious violation of any of the provisions of this chapter, the City Council shall set a date and time for a hearing before the Council to receive evidence offered by all interested parties. The provider may be represented by counsel and all persons shall be sworn before testifying. The provider may employ a shorthand reporter to record the hearing. If, at the conclusion of the hearing, the Council finds that the ambulance service provider violated any of the provisions of this chapter, the Council may suspend, modify or revoke the ambulance franchise or take any other action which it deems necessary for the best interests of the residents of the city.

(1995 Code, § 7.40.180)

Any person violating any of the provisions of the chapter which are declared to be unlawful shall be guilty of a misdemeanor which is punishable as provided in this chapter.

(1995 Code, § 7.40.190)

The determination of the City Council, after the conclusion of any hearing, pursuant to this chapter shall be final. An applicant or ambulance service provider may not submit a new application for a franchise to serve the city for a period of one year after the determination has been made by the Council, unless the Council finds that the public interest requires a reconsideration of the matter with a shorter period of time.

(1995 Code, § 7.40.200)

A judicial review of a decision of the Council made after a hearing pursuant to this chapter, if the decision suspends or revokes an ambulance service franchise, shall be made pursuant to Cal. Code of Civil Procedure § 1094.6. The method of judicial review, the time limits for judicial review, and all of § 1094.6 shall govern the judicial review. When giving written notice to the ambulance service provider that the franchise has been suspended or revoked, the Council shall notify the provider that the time within which judicial review must be sought is governed by § 1094.6.

(1995 Code, § 7.40.210)