Wildomar Municipal Code Ch. 8.08 Ambulance Services

The City, through its EMS agency and as identified in its emergency medical service plan, has determined the need to enact local regulations consistent with, and which enhance the City's responsibilities under, the Emergency Medical Services System and the Prehospital Emergency Medical Act (Health and Safety Code Sections 1797, et seq.) and which further serve and protect the health and safety of medical patients in the City while being transported.

(Ord. 18 § 2, 2008, RCC § 8.08.010)

As used in this chapter unless otherwise stated, words and terms shall be defined as follows:

"Advanced life support (ALS)"

means special services designed to provide definitive prehospital emergency medical care including, but not limited to, cardiopulmonary resuscitation, cardiac monitoring, cardiac defibrillation, advanced airway management, intravenous therapy, administration of specified drugs, and other medicinal preparations, and other specified techniques and procedures administered by authorized personnel under the direct supervision of a base hospital or utilizing approved prehospital treatment protocols or standing orders as part of the local EMS system at the scene of an emergency, during transport to an acute care hospital or other approved facility, during interfacility transfer, and while in the emergency department of an acute care hospital until responsibility is assumed by the emergency department or other medical staff of that hospital.

"Air ambulance"

means any aircraft specially constructed, modified or equipped, and used for the primary purposes of responding to emergency calls and transporting critically ill or injured patients.

"Air ambulance provider"

means an air transportation service permitted and contracted to operate within the City to provide air ambulance services.

"ALS ambulance"

means an ambulance equipped, or arranged and staffed for the purpose of providing ALS care. The meaning includes, but is not limited to, privately and publicly owned ambulances operating within exclusive operating areas while under contract with the City.

"ALS ambulance provider"

means an operator or permittee in possession of a written agreement with and permitted by the City to provide ALS care.

"Ambulance"

means any motor vehicle which meets the standards of Title 13 of the California Code of Regulations and is specifically constructed, modified or equipped, or arranged, used, licensed or operated for the purpose of transporting sick, injured, convalescent, infirmed, or otherwise incapacitated person(s) in need of medical care. The meaning includes, but is not limited to, privately and publicly owned ambulances operating within the City.

"Ambulance provider"

means a person or entity that operates, or causes the operation of, an ambulance service.

"Ambulance service"

means the activity, business or service for hire, profit, or otherwise of transporting one or more persons by ambulance upon any of the streets, roads, highways, alleys, or any public way or place whether ALS, BLS, CCT or air ambulance.

"Applicant"

means any person or entity which makes application for a provider permit prescribed by this chapter.

"Basic life support (BLS)"

means emergency first aid and cardiopulmonary resuscitation medical care procedures which, as a minimum, include recognizing respiratory and cardiac arrest and starting proper application of cardiopulmonary resuscitation to maintain life without invasive techniques, unless authorized by state law or regulation, until the victim may be transported or until ALS medical care is available.

"BLS ambulance"

means an ambulance equipped, or arranged, and staffed for the purpose of providing BLS care. The meaning includes, but is not limited to, privately and publicly owned ambulances operating within the City. BLS ambulances shall not be utilized in the response to emergency medical services calls.

"BLS ambulance provider"

means an operator permitted by the City to provide BLS care.

"CCT provider"

means an operator permitted by the City to provide CCT services.

"City"

means the City of Wildomar.

"City Council"

means the City of Wildomar City Council.

"Critical care transport (CCT)"

means the medical transport of a patient between medical facilities where it has been determined by the patient's treating physician that such transport requires medical staff supervision consisting of a licensed registered nurse (R.N.) or physician.

"Department"

means the Department of Public Health of the Health Services Agency.

"Emergency medical service call"

means any sudden or serious illness or injury requiring immediate medical attention, where delay in providing such services may aggravate the medical condition or cause the loss of life. All emergency medical service calls shall be responded to by an ALS ambulance.

"Emergency medical services (EMS)"

means care rendered to a person or persons in need of immediate medical care.

"Emergency medical technician-1 (EMT-1)"

means a person certified to render BLS medical care pursuant to Sections 1797, et seq., of the Health and Safety Code.

"Emergency medical technician-P (EMT-P)"

means a person licensed and accredited to render ALS medical care pursuant to Sections 1797, et seq. of the Health and Safety Code.

"EMS agency"

means the City's designated local EMS Agency established pursuant to Health and Safety Code Section 1797.200.

"EMS plan"

means that document(s) developed by the EMS Agency pursuant to Health and Safety Code Section 1797.250.

"EMS system"

means the interrelated but separate public and private entities including, but not limited to, ambulance providers, fire departments, and hospitals which, optimally, work together in the timely and appropriate provision of emergency medical services to the citizens and visitors of the City.

"Entity"

means any public or private organization, firm, partnership, association.

"Exclusive operating areas"

means those geographical areas of the City identified in the EMS plan where an ALS ambulance provider may be granted the exclusive right to provide such services upon designation as required in the EMS plan.

"Medical care"

means any medical care rendered by an appropriately certified and/or licensed person.

"Medical director"

means that physician designated to serve as the medical director of the EMS agency pursuant to Section 1797.202 of the Health and Safety Code.

"Mobile intensive care nurse (MICN)"

means a registered nurse authorized to provide ALS medical care pursuant to Section 1797.56 of the Health and Safety Code.

"Nonemergency medical call"

means the transportation of a patient by an ambulance or air ambulance that would not constitute an emergency medical service call.

"Nurse"

means a registered nurse licensed in the State of California.

"Paramedic"

means the same as an EMT-P as defined by this section.

"Patient"

means any person in the process of receiving medical care.

"Permit holder"

means a person or entity possessing a valid provider permit as authorized by this chapter.

"Permit officer"

means the City health officer or designated representative.

"Physician"

means the same as such defined by Section 4033 of the Business and Professions Code.

"Provider unit"

means each ambulance, air ambulance, or other vehicle, as authorized by the EMS agency, which a permit holder uses in the course of its permitted provider service.

"Quality assurance"

means the sum of all activities undertaken to assure that prehospital emergency medical transportation services and nonemergency medical transportation services maintain established standards by appropriate regulatory agencies.

"Quality improvement"

means the evaluation of prehospital emergency medical services and non-emergency transportation services to identify where personnel performance or the system itself can be improved, the implementation of potential improvements, and their re-evaluation and refinement in a continuous cycle. While quality assurance traditionally focuses on the detection of defects, quality improvement strives to prevent them. Thus a quality improvement program must include, but not be limited to, quality assurance.

(Ord. 18 § 2, 2008, RCC § 8.08.020)

It is prohibited and shall be unlawful for any person or entity to operate, or advertise the operation of an ALS ambulance, an air ambulance, a BLS ambulance, or a critical care transport provider service in the City without having obtained a provider permit to do so, or as otherwise may be authorized by this chapter, or if having a provider permit, to operate or advertise in violation of the terms, conditions or restrictions of the provider permit.

(Ord. 18 § 2, 2008, RCC § 8.08.030)

A. A nonpermitted ALS ambulance or air ambulance service provider based and operated under the regulatory authority of a governmental entity other than the City may operate in the City for a limited purpose of transporting patients to or through the City if the transportation of the patient was initiated outside the City.

B. A nonpermitted BLS ambulance or CCT service provider based and operated under the regulatory authority of a governmental entity other than the City may operate in the City for limited purpose of transporting patients to or through the City if the transportation of the patient was initiated outside the City.

C. In the event of a local disaster, as declared by the City health officer or designee or by a local governmental entity, the requirements of this chapter may be suspended until such time as the disaster declaration is rescinded.

(Ord. 18 § 2, 2008, RCC § 8.08.040)

A. Initial Issuance. Pursuant to the procedures and conditions established, or as may be established, by this chapter, the permit officer shall issue provider permits and provider unit permits to:

1. ALS ambulance provider(s) as approved pursuant to the EMS plan and air ambulance provider(s) for operation in the City; and

2. BLS ambulance and CCT service providers for operation in the City.

B. Expiration. Except as provided in this chapter for the issuance of temporary provider permits, all provider permits shall expire on the date of June 30th of each year.

C. Renewal.

1. An application for renewal of a provider permit shall be submitted to the permit officer at least 60 days prior to the expiration of the provider permit to be renewed. A permit holder shall have its permit renewed upon expiration if the permit holder does not seek a substantial change in the permit and there does not exist grounds for denial for renewal of the permit as specified in subsection M of this section. For the purpose of this subsection, a "substantial change in the permit" means a change in the level, scope or manner of service permitted under the permit holder's current or previous provider permit or such condition as may be determined by the permit officer.

2. Late Renewal Application Penalty. If a permit holder makes application for the renewal of a provider permit in less than 60 days prior to the expiration of the permit holder's provider permit for which renewal application is made, the permit holder shall pay an additional 20% of the fee due.

D. Application. Application for a provider permit shall be made to the permit officer on form(s) as may be prescribed by the permit officer. At the time the application is made, the applicant shall provide the following minimum information:

1. Name and description of applicant;

2. Business address and residence address of record of the applicant;

3. Trade or firm name, or doing business as (DBA) as recorded;

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

5. The type(s) of service which the applicant proposes to provide;

6. A statement of facts for initial applicants showing the past experience of the applicant in the operation of the provider(s) for which it seeks a permit;

7. A statement in the applications that the applicant owns or will have under the applicant's control required equipment to adequately conduct the provider for which it is or proposes to be permitted and that the applicant owns or has access to suitable and safe facilities for maintaining service in a clean, sanitary and mechanically sound condition;

8. A list for any changed, substituted, loaned or leased provider units, giving a complete description of each operated by the applicant, including the make/model/year, license number and vehicle identification number, and the patient capacity thereof, and, if applicable, a copy of the most recent ambulance inspection report issued by the California Highway Patrol. Applicant shall also identify color scheme, name, monogram or insignia which shall be used on the provider units and the above shall not conflict with or imitate any color scheme, name, monogram or insignia used by any other person or firm in such a manner as to be misleading or tend to deceive or defraud the public;

9. An affirmation for initial and renewal applications that each permitted ambulance and its appurtenances conform to all applicable provisions of this chapter, the California Vehicle Code, the California Code of Regulations, Federal Aviation Administration regulations, and any other applicable federal, state or local directives;

10. A statement for initial and renewal application that the applicant employs sufficient personnel adequately trained and available to deliver provider of such quality which meet the minimum standards as set by this chapter;

11. A list, amended as required during the year, for any personnel changes, giving a description of the level of training for each person;

12. A statement signed by the applicant that as a condition of being issued a permit, the applicant agrees to appear and defend all actions against the City arising out of the exercise of the permit, and shall indemnify, defend and save the City, its officers, employees and agents harmless of and from all claims, demands, actions or causes of actions of every kind and description resulting directly or indirectly and arising out of, or in any way connected with exercise of this permit;

13. A description of the applicant's program for vehicle maintenance;

14. A copy of the continuous quality improvement and quality assurance programs to be utilized during the normal and customary business operation which elicits customer, both patient and physician, feedback and encourages employee participation. Such program shall, as a minimum:

a. Review patient care provided,

b. Identify problems or issues regarding patient care and propose solutions for corrective action,

c. Include reward and disciplinary procedures to be used when appropriate,

d. Maintain a radio tape of all calls for service received, all dispatch instructions given, and all communication between the dispatch operator and the vehicle until the assignment is completed for a period of not less than 30 days;

15. Proof of insurance which shall be maintained in full force and effect and issued by a company authorized to do business in the State of California during the permit period as specified by the permit officer;

16. A statement of the legal history of the applicant, registered owner(s), partner(s), officer(s), director(s), and controlling shareholder(s), including criminal convictions and civil judgments;

17. Such other facts or information as the permit officer may require.

E. Application Review. Upon the submittal of an application, the EMS agency shall review the application to ensure its conformity with subsection D of this section within 90 days of receipt, unless the permit officer conducts an investigation pursuant to subsection F of this section. Where the permit officer conducts such an investigation the review of an application shall be completed within 120 days of receipt. Upon the completion of the application review, and further investigation if required, the applicant shall immediately be notified in writing of the granting or denial of the application by the permit officer.

F. Application Investigation. Upon receipt of an initial or renewal application, the permit officer may conduct, or cause to be conducted, an investigation into the applicant's proposed provision of service, if deemed necessary.

G. Denial of Permit Upon Initial Application. An initial application for a provider may be denied by the permit officer upon the following grounds. For the purpose of this subsection an "initial application" means an application submitted by an applicant which is not a permit holder at the time application is made or, if a permit holder, makes application for a provider permit other than which it presently holds and would therefore not qualify for renewal of a provider permit as provided in subsection C of this section. The grounds for denial of an initial application shall be:

1. The applicant, previously the holder of a permit issued under this chapter, which has been denied, revoked or suspended and the terms or conditions which lead to such action has not been fulfilled or corrected;

2. The applicant knowingly made false, misleading or fraudulent statement(s) of a material fact in the application or in any reports or other documents required to be filed with the permit officer pursuant to this chapter;

3. The applicant has committed any act involving dishonesty, fraud or deceit whereby another is injured or where the applicant has benefitted;

4. The applicant has acted in violation of this chapter;

5. The applicant has entered a plea of guilty to, or been found guilty of, or been convicted of a felony, or a crime involving moral turpitude, and the time for appeal has elapsed or the judgment of conviction has been affirmed on appeal, irrespective of an order granting probation following such conviction suspending the imposition of sentence, or of a subsequent order under the provisions of Section 1203.4 of the California Penal Code allowing such person to withdraw his or her plea of guilty and to enter a plea of not guilty, or setting aside the plea of the verdict of guilty, or the dismissal of the accusation.

a. Notification. The permit officer shall provide the applicant with written notification that its application has been denied and stating the grounds upon which the denial is based as provided hereinabove and a brief statement of the facts and circumstances upon which permit officer has made his or her determination that the grounds for the denial of the application exists. The notification shall also advise the applicant of its right to have the decision to deny the application reviewed by the permit officer pursuant to the procedures prescribed in this section.

b. Procedure for Review.

i. Within 15 days of receipt of written notification that its initial application has been denied, the applicant may file a written request for review of the permit officer's decision to deny its application. The applicant's request for review shall briefly state basis and/or reasons that the permit officer's decision to deny the initial application should be reversed. The applicant may accompany the request for review with documentation relevant to its basis for requesting the review.

ii. The permit officer, upon timely receipt of a request for review of denial of an initial application, shall within 30 days conduct such further investigation as may be warranted after due consideration of the applicant's request. Thereupon the permit officer may vacate his or her decision to deny the application for initial permit and grant the application.

iii. If upon further consideration of the request for review the permit officer does not reverse his or her decision to deny the application, he or she shall so notify the applicant in writing and further advise the applicant that he or she will personally hear the request, if requested by the applicant, to ensure that the request and all relevant information is given due consideration by the permit officer.

iv. In no event shall the permit officer's review of the request exceed a period of 60 days after the applicant's written request is received, unless the applicant and permit officer so stipulate to an extension of this time period for review of the request.

v. The decision of the permit officer to deny an initial provider permit shall be final.

H. Conditions of Permit. The acceptance of a provider permit shall obligate the permit holder to meet or otherwise fulfill each condition set forth in this subsection. At the time of issuance of a provider permit, the permit holder shall be given written notice, by reference to this section, of these conditions. Each provider permit shall be issued with the following conditions:

1. That during a "state of emergency," or "local emergency," as defined in the California Emergency Services Act (Chapter 7 of Division 1 of Title 2 of the Government Code), as amended, each permitted provider shall, within reason, provide equipment, facilities and personnel as requested by the permit officer;

2. That all applicable provisions of this chapter and regulations policies and protocols established to carry out its provisions are complied with;

3. That all applicable City, state and federal vehicular and aircraft certificates, licenses, and permits shall be on each permitted provider unit in operation under the permit;

4. That authorized personnel have applicable and required certificates and licenses readily available during duty hours;

5. That the transportation of a patient to or between a medical facility occur in conformance with applicable state, federal and local laws and regulations to the extent the provider is responsible to the patient transport;

6. That the permit holder shall maintain all transaction records of the permitted service operation for a period of not less than three years and shall produce such records upon demand for inspection by the permit officer;

7. That if for any reason the permit holder stops providing the permitted level or levels of service it shall immediately stop any advertisement of such services and notify the EMS agency in writing;

8. That in the event of any substantial change in the provider, which causes, or threatens to cause, the service to be carried out different from that specified in the permit holder's permit, the permit holder shall immediately notify the EMS agency in writing and therein stating the facts of such change;

9. That all permitted providers shall meet such operating standards as may be established by the EMS agency including but not limited to the following.

a. Each ALS ambulance shall:

i. Be equipped and staffed to provide EMS as prescribed by the EMS plan; or as may be established by the EMS agency in accordance with the EMS plan; or this chapter; or as specified by written agreement,

ii. In the absence of a physician on board responsible for patient care, the staff shall provide care as directed by standing orders designated by the medical director or direct voice contact with a physician or MICN at a designated City hospital,

iii. Establish and maintain radio contact as prescribed by the EMS agency and in compliance with FCC regulations,

iv. Conform to Federal Specification KKK-A-1822-C, which is promulgated by the U.S. General Services Administration, in effect as of the date of the vehicle's manufacture. An exception(s), or additional requirement, may be allowed, or required, at the discretion of the permit officer; provided, that such an exception(s) does not compromise safety and is not in conflict with applicable California laws and regulations.

b. Each air ambulance shall:

i. Contain no less than the equipment and supplies as established by the EMS agency policies, protocols and regulations,

ii. Be staffed with two licensed registered nurses, or two licensed physicians, or a licensed nurse and a licensed physician, or a licensed nurse and an EMT-P or a licensed physician and an EMT-P,

iii. In the absence of a physician on board the aircraft, the medical flight crew is to provide patient care as directed by specific written orders from the transferring or receiving physician for the person being transported or standardized procedures approved by the air ambulance provider's medical director and as reviewed by the EMS agency's medical director,

iv. Conform to all Federal Aviation Administration (FAA) and Association of Air Medical Services (AAMS) standards applicable to the aircraft being utilized and the nature of the mission, and

v. Every pilot in command shall have, in their possession, a valid medical certificate and appropriate current type rating and applicable certificates.

c. Each BLS ambulance shall:

i. Contain no less than the equipment and supplies as established by EMS agency policies, protocols and regulations for BLS medical care,

ii. Be staffed with two EMT-1, each possessing a current certificate of completion of an approved cardiopulmonary resuscitation course,

iii. In the absence of a physician on board or otherwise in communication with the ambulance staff, who has accepted responsibility for patient care, the staff shall provide care as directed by protocols designated by the medical director, and

iv. Shall conform to Federal Specification KKK-A-1822-C, which is promulgated by the U.S. General Services Administration, in effect as of the date of the vehicle's manufacture. An exception(s), or additional requirement, may be allowed, or required, at the discretion of the permit officer; provided, that such an exception(s) does not compromise safety and is not in conflict with applicable California laws and regulations.

d. Each critical care transport unit shall:

i. Contain no less than the equipment and supplies as established by the EMS agency policies, protocols and regulations for BLS medical care,

ii. Be staffed with an EMT-1 or an EMT-P and a licensed registered nurse (R.N.) or a physician. The R.N. must have a current certificate of completion of an advanced cardiac life support course,

iii. In the absence of a physician on the ambulance, the licensed registered nurse is to provide patient care as directed by specific written orders from the transferring or receiving physician for the person being transported or standardized procedures, approved by the CCT medical director, reviewed by the EMS agency's medical director and authorized, in writing, by the transferring physician.

I. Form and Content of Permits. Provider and provider unit permits shall be issued in a form as may be prescribed by the permit officer. The content of a provider permit shall include, but not be limited to, the provider authorized under the permit, the number and type of permitted provider units authorized for use under the provider permit, any special conditions or restrictions as authorized by this chapter and, as to ALS ambulance provider, the exclusive operating area(s) as prescribed by the EMS plan within which such provider shall operate.

J. Permit Variance. Upon written request by a permit holder, the permit officer may grant a variance in writing from the conditions specified in a permit holder's permit if the permit officer finds that such change is in substantial compliance with the minimum provider operation requirements established by this chapter.

K. Provider Permit Transfer Prohibition. The transfer of a provider permit from a permit holder to another person or entity shall be prohibited. The transfer of a permit holder's ownership interest in part or whole in a permitted provider shall require the filing of an initial application for a provider permit by the person or entity to whom ownership will be transferred.

L. Provider Unit Permit Transfer Prohibition. The transfer of a provider unit permit from one provider unit to another provider unit is prohibited. For any permitted provider unit which ceases to be operational, the permit holder shall give written notice of this fact to the permit officer. The permit holder shall file a written request for provider unit permit which the permit holder intends to operate under a provider permit but which has not been previously issued a provider unit permit. The permit holder shall pay the established provider unit fee at the time of such request.

M. Denial of Renewal, Suspension and Revocation of Provider Permit.

1. The permit officer, after conducting an investigation or upon such facts or circumstances as may be known to him or her, may deny the renewal of, suspend or revoke a provider permit issued under the provisions of this chapter when it has been found that the permit holder:

a. Has violated any provision of this chapter, or any rules or regulations that are promulgated pursuant to its provisions;

b. Has been convicted of any felony;

c. Has been convicted of a misdemeanor involving moral turpitude;

d. Has been convicted of any offense relating to the use, sale, possession or transportation of narcotics or habit-forming drugs;

e. Has committed any act involving dishonesty, fraud or deceit whereby another is injured, or whereby the permittee has benefitted, or any act involving moral turpitude;

f. Has misrepresented a material fact in obtaining a provider permit, or is no longer adhering to the conditions specified in its provider permit or by this chapter;

g. Has aided or abetted an unlicensed or uncertified person to evade the provisions of this chapter;

h. Has failed to make and keep records showing provider operation transactions as provided by this chapter, fails to have such records available for inspection by the permit officer or his/her duly authorized representative or refuses to comply with a written request of the permit officer to make such records available for inspection;

i. Has accepted an assignment as authorized by its provider permit when the permit holder knowingly is either unable or unwilling to provide the requested service or fails to inform the person requesting such service of any delay;

j. Has failed to pay required fees, administrative fines, or penalties established by this chapter;

k. Has knowingly made false, misleading or fraudulent statement(s) of a material fact in the application or information provided for the obtaining of any provider permit.

In addition to the foregoing grounds, the permit officer may deny renewal, suspend or revoke a provider permit when the continued operation of the permitted provider causes, or threatens to cause, harm to the health and safety of the public as determined by the permit officer.

l. Notification.

i. Upon the permit officer's denial of renewal, suspension or revocation of a provider permit, he or she shall give the permit holder written notice of such determination by registered or certified U.S. Mail. The written notice shall advise the permit holder of the grounds upon which the action is being taken, a brief statement of the facts or circumstances in support of such grounds, and the effective date(s) of the adverse action.

ii. The denial of renewal of a provider permit shall be made no more than 30 days after the permit holder makes application for renewal of a provider permit.

iii. The suspension or revocation of a provider permit shall be effective no less than 14 days after receipt of notification, unless the permit officer makes a determination that the protection of the public health and safety warrants the immediate suspension or revocation of a provider permit in which case the suspension or revocation will be effective upon the permit holder's receipt of the notification.

m. Administrative Review.

i. Within seven days of receiving notification of denial of renewal, suspension or revocation of its provider permit, the permit holder may request that the permit officer review the adverse action. The administrative review request shall be in writing.

ii. Absent a determination by the permit officer that the immediate imposition of an adverse action as provided in this subdivision is warranted, the permit officer shall set a date, time and location for the requested review prior to the date(s) set for the proposed adverse action and shall give written notice of same to the permit holder. The date set for the administrative review shall not be continued beyond the date set for imposition of the adverse action unless such continuation is mutually agreed to by the permit officer and the permit holder.

iii. In the review the permit holder shall have the burden of presenting all arguments and/or information relevant to the permit officer's action or mitigation thereof.

iv. After the administrative review the permit officer may affirm, modify or set aside the original adverse action. The permit officer shall give written notice of such decision to the permit holder, as soon as possible. However, in not event shall such notice be given more than seven days after the administrative review.

v. As may be appropriate, the permit officer shall notify all public safety agencies, permitted providers and public safety communication centers, hospitals and other agencies and organizations of any adverse action taken against a permitted provider pursuant to this subdivision.

n. Appeal to the City Council. If after an administrative review as provided hereinabove the permit officer imposes adverse action against a permit holder, the permit holder may appeal such action to the City Council and the Council shall consider the appeal pursuant to the following procedures. Such appeal shall not suspend the imposition of any adverse action taken by the permit officer.

i. Request for Appeal Hearing. The permit holder shall make a request for a hearing in writing to the City Clerk within 20 days following the denial of renewal, suspension or revocation of a provider permit. The Council shall hear the appeal directly, or in its sole discretion, may appoint a neutral hearing officer to hear the appeal and make findings of fact on behalf of, and recommendations thereupon, to the Council.

ii. Hearing Appeal Procedures. The Council or its appointed hearing officer shall hear the matter within 60 days of receipt of the permit holder's request for appeal pursuant to the following procedures:

(A) Witnesses shall swear or affirm to tell the truth.

(B) Each party may present oral testimony and documentary evidence or other exhibits.

(C) The appealing permit holder shall present its case first.

(D) Each party shall have the right to be represented by counsel, and shall have the right of cross-examination of witnesses.

(E) After both sides have completed presenting evidence, each party may, by closing argument, comment on the evidence.

iii. Appeal Decision. Upon completion of the appeal hearing the Council shall make findings of fact, or where appropriate, adopt the findings of fact of its appointed hearing officer, and make such determination thereupon. The decision of the Council shall be final for purposes of Judicial Review under Code of Civil Procedure Section 1094.5.

N. Permit Fees. Upon application made for a provider permit the applicant shall pay a nonrefundable permit fee in accordance with the following schedule and shall pay a fee for each provider unit which the applicant proposes to operate under the provider permit for which application is made in the amount of $250.00:

1. ALS ambulance and aircraft provider permit fee shall be $6,000.00.

2. BLS ambulance provider permit fee shall be $3,000.00.

3. Critical care transport (CCT) ambulance provider permit fee shall be $6,000.00.

a. Nonpayment of Fee—Grounds for Rejection of Application. Failure of the applicant to submit an application with the appropriate provider(s) permit and provider unit(s) fees may serve as grounds for the permit officer to refuse the receipt of an initial or renewal provider permit application.

b. Late Fee Penalty. If upon review of an accepted application the permit officer determines that a provider permit or a provider unit fee due at the application is made was not paid in full, the applicant shall pay the additional amount due within 30 days of written notice of same and shall pay a penalty in the amount of 20% of the fee(s) due.

c. Prorated Fee. Provider permit fees may be prorated on a quarterly basis on such permits which are issued for a period of less than a year.

d. Publicly owned and operated provider entities are exempt from all fees specified by this chapter.

e. Public Interest Fee Exemption. The permit officer may, upon investigation and determination that it is in the public interest, waive all, or part of, provider and/or provider unit fees which would be due prior to the issuance of a provider permit.

O. Temporary Provider Permit. The permit officer may issue a provider permit as authorized by this chapter on a temporary basis which shall not exceed a period of 60 days in response to extraordinary conditions where the permit officer determines that the public health and safety necessitates the issuance of such a temporary permit and that the proposed temporary permit holder possesses the minimum standards as prescribed by this chapter. Provider permits issued under this subsection may be revoked on such grounds specified in subsections A and M of this section on 24-hour notice to the permit holder. The decision of the permit officer to revoke a provider permit issued under this section shall be final without rights of administrative review to the permit officer or the Council.

(Ord. 18 § 2, 2008, RCC § 8.08.050)

The EMS agency shall be responsible for the administration of this chapter, including, but not limited to, promulgating such policies, protocols, and regulations as expressly required in this chapter or as may be necessary to effectuate other provisions of this chapter subject to the approval of the permit officer and, where appropriate, the medical director.

(Ord. 18 § 2, 2008, RCC § 8.08.060)

This chapter and policies, protocols and regulations established pursuant to it shall be enforced by the permit officer.

(Ord. 18 § 2, 2008, RCC § 8.08.070)

A. Administrative Fines.

1. Permitted Provider. A permit holder that violates, or causes the violation of, any provision of this chapter shall pay a fine for each such violation in the amount of $500.00 for each violation to the City.

2. Penalty for Late Payment of Administrative Fine. The administrative fines established here-inabove shall be paid within 30 days of written notification being mailed in the U.S. Postal Service and deemed delinquent 30 days after they are due and payable and deemed to be a debt to the City. If any fine is not paid prior to becoming delinquent, there shall be a penalty added to such fee and such penalty shall be equal to 20% of the fee normally due.

B. Public Nuisance. Any continued violation of any provision of this chapter is deemed a public nuisance dangerous to the health and safety of the public and may be enjoined or summarily abated in the manner provided by law.

C. Criminal Penalties. Any person who violates provisions of this chapter shall be guilty of an infraction, and upon conviction thereof shall be punished by: (1) a fine not to exceed $100.00 for the first violation of this chapter; (2) a fine not to exceed $200.00 for a second violation of this chapter within one year; (3) a fine not to exceed $500.00 for each additional violation of this chapter after second violation with-in one year. Notwithstanding the above, a first offense may be charged and prosecuted as a misdemeanor. Payment of any penalty in this section shall not relieve a person from the responsibility for correcting the violation.

D. Remedies.

1. An action may be commenced in the name of the City in any court of competent jurisdiction for payment of the amount of any delinquent administrative fee or fine and penalty thereon.

2. All remedies available to the City shall be cumulative and the use of one or more remedies by the City shall not bar the use of any other remedy for the purpose of enforcing the provisions of this chapter. Nor shall the payment of any administrative fee or fine prevent criminal prosecution for violation of the provisions of this chapter.

3. The additional remedies, penalties and procedures for violation of this chapter and for recovery of costs related to enforcement provided for in Chapter 1.16 are incorporated in this chapter by this reference.

(Ord. 18 § 2, 2008, RCC § 8.08.080)