CHAPTER 7. AMBULANCE AND EMERGENCY MEDICAL SERVICES

ARTICLE 1. GENERAL PROVISIONS

6-07-1000 APPLICATION OF GENERAL PROVISIONS:

Unless the provisions of this Chapter provide otherwise, all of the provisions of Chapter 1 of this Part are applicable to the licenses referred to in this Chapter.

(Added by Ord. No. 3490, effective 2-25-16)

6-07-1005 PURPOSES: LIBERAL CONSTRUCTION:

The purposes of this Chapter are 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 County, and to ensure that competent and adequate care is provided to those residents in need of such 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 or, in non-emergency situations, a need for basic or limited advanced life support services as defined by the Health and Safety Code. This Chapter shall be liberally construed for the accomplishment of these purposes.

(Added by Ord. No. 3390, effective 8-20-09; amended by Ord. No. 3490, effective 2-25-16. Formerly 6-07-1000)

6-07-1010 NOT EXCLUSIVE REGULATION:

This Chapter shall supplement and be in addition to other regulating statues and ordinances heretofore or hereafter enacted by the State, the County, or any other legal entity or agency having jurisdiction.

(Added by Ord. No. 3390, effective 8-20-09)

6-07-1020 DEFINITIONS:

Except where the context otherwise requires, the following definitions shall govern the construction of this Chapter:

(a)    "Advanced Life Support" means those special services defined by Health and Safety Code section 1797.52 and referred to in the Emergency Medical Services System and the Prehospital Medical Care Personnel Act, Health and Safety Code section 1797 et seq., or regulations promulgated thereunder.

(b)    "Ambulance" means any vehicle that is specifically constructed, modified, equipped, and designed for the provision of emergency medical transportation services to sick, injured, or otherwise incapacitated persons, including air ambulances.

(c)    "Ambulance company" means any person, entity, corporation, partnership, association, trust, or estate who owns, leases or operates one or more ambulances for the purpose of providing ambulance services within the County.

(d)    "Ambulance services" means any ambulance services as defined by this section provided through an ambulance response to an emergency call.

(e)    "Air Ambulance" means any authorized and approved fixed wing or helicopter aircraft that is equipped and operated for transportation of sick, injured, or otherwise incapacitated persons and emergency medical supplies.

(f)    "Attendant" means any person accompanying an ambulance to provide prehospital medical care for a sick, injured or otherwise incapacitated person.

(g)    "Basic Life Support" means those services defined by Health and Safety Code section 1797.60 and referred to in the Emergency Medical Services System and the Prehospital Medical Care Personnel Act, Health and Safety Code section 1797 et seq., or regulations promulgated thereunder.

(h)    "Board" means the Board of Supervisors of the County of Tulare.

(i)    "County" means the County of Tulare.

(j)    "Day" means calendar day.

(k)    "Driver" means a person who is licensed by the California Department of Motor Vehicles to operate an ambulance.

(l)    "EMS" means Emergency Medical Services, which include all services required to identify, respond to, stabilize and treat all medical and psychiatric emergencies.

(m)    "EMS Agency Policies and Procedures Manual" means the County manual containing the policies and procedures of the County Emergency Medical Services System and approved by the Local EMS Agency in accordance with Health and Safety Code section 1798 et seq.

(n)    "Emergency call" means 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 Welfare and Institutions Code section 5150.

(o)    "Emergency service" means any service performed in response to an emergency call.

(p)    "Emergency Medical Technician-I" or "EMT-I" means an individual defined in Health and Safety Code section 1797.80, trained in basic life support according to standards set forth in the California Code of Regulations, Title 22, section 100056 et seq., and certified as such by the local EMS Agency.

(q)    "Emergency Medical Technician-II" or "EMT-II" means an individual defined in Health and Safety Code section 1797.82 with a scope of practice as set forth in Health and Safety Code section 1797.171, trained in accordance with the California Code of Regulations, Title 22, section 100101 et seq., and certified as such by the local EMS Agency.

(r)    "Exclusive Operating Area" means an EMS area or subarea defined by the emergency medical services plan for which a local EMS agency, upon the recommendation of the County, restricts operations to one or more emergency ambulance services or providers of limited advanced life support or advanced life support in accordance with Health and Safety Code section 1797.85.

(s)    "Health Director" means the Director of the Department of Health Services of the County or his or her authorized representative or designee.

(t)    "Health Officer" means the Health Officer of the County.

(u)    "Local EMS Agency" means the County Department of Health Services as designated by the County under Health and Safety Code section 1797.200, unless otherwise designated.

(v)    "Mobile Intensive Care Nurse" or "MICN" means a registered nurse meeting the requirements set out in the definition of Health and Safety Code section 1797.56, and currently certified as such by the local EMS Agency.

(w)    "Paramedic" or "EMT-P" or "mobile intensive care paramedic" means an individual defined in Health and Safety Code section 1797.84 whose scope of practice and training to provide advanced life support is according to standards set forth in California Code of Regulations, Title 22, section 100135 et seq., and certified as such by the local EMS Agency.

(x)    "Patient" means an injured, sick, or otherwise incapacitated person.

(y)    "Person" means any individual, corporation, partnership, association, trust, estate, municipal corporation, city, or special district.

(z)    "Service area" means the geographic area designated by the Board in which ambulance services are to be provided.

(Added by Ord. No. 3390, effective 8-20-09; amended by Ord. No. 3490, effective 2-25-16)

6-07-1030 ADMINISTRATION AND ENFORCEMENT:

Except as otherwise specifically provided in this Chapter, the Health Director or license collector, as appropriate, shall be responsible for the administration and enforcement of this Chapter.

(Added by Ord. No. 3390, effective 8-20-09; amended by Ord. No. 3490, effective 2-25-16)

ARTICLE 2. LICENSE AND CERTIFICATES REQUIRED

6-07-2000 PROHIBITION:

It shall be unlawful for any person, either as owner, agent, employee, or otherwise, to operate, conduct, advertise, or otherwise be engaged in the business of providing ambulance services, or the transportation of patients within the County by means of an ambulance, or air ambulance, or operate an ambulance upon any public road, or provide any medical services associated therewith, without first having obtained the current applicable licenses or certificates as hereinafter provided.

(a)    Ambulance Service Provider License: Every ambulance company located in the County and/or authorized to operate in a service area pursuant to section 6-07-3000 of this Chapter shall obtain an ambulance service provider license to operate within the County in accordance with the provisions of this Chapter, unless otherwise provided.

(b)    Ambulance Certificates: Every ambulance or air ambulance shall have a current inspection certificate as issued by the California Highway Patrol or applicable air carrier operating certificate from the Federal Aviation Administration.

(c)    Driver’s License: Every driver operating an ambulance shall hold a currently valid California State Ambulance Driver’s License. Persons operating an ambulance in the line of duty as salaried, regular, full-time police officers, deputy sheriffs, or members of a fire department of a public agency are not subject to this requirement.

(d)    Attendant: Every attendant accompanying an ambulance shall be at least eighteen (18) years of age and currently certified or authorized as an EMT-I, EMT-II, Paramedic, or, when determined by an attending physician to be necessary in the case of an inter-facility transfer, by a physician, registered nurse, or MICN.

(Added by Ord. No. 3390, effective 8-20-09)

6-07-2010 SAME: EXCEPTIONS:

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

(a)    Any ambulance owned or operated by the United States, or the State of California, and the personnel operating such ambulance.

(b)    Any ambulance and personnel operating such ambulance which is only temporarily within the County at the request of a hospital or physician for the purpose of providing specialized care for transport of a patient to a facility which will provide specialized medical services to the patient, and is owned by an ambulance company located outside the County.

(c)    Any ambulance and personnel operating such ambulance rendering assistance to patients during any "state of war emergency," "state of emergency," or "local emergency," as those terms are defined in the Government Code, or as otherwise requested by the Health Director, Health Officer, or public safety agency for a mutual aid response.

(d)    Any ambulance company located outside of the County and authorized to operate in a service area within the County, to the extent the ambulance company is exempted from all or any part of the provisions of this Chapter pursuant to a Memorandum of Understanding with the local EMS Agency reviewed and approved by the Board of Supervisors.

(e)    Any ambulance company based outside the County when one of the following applies:

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

(2)    A patient is being transported through the County to a destination outside the County; or

(3)    A patient was transported into the County by the same ambulance company and is being transported back to the county of origin.

(f)    Any ambulance owned and operated by a municipal corporation, city, or special district, if specifically exempted by resolution of the Board of Supervisors upon such conditions as the Board may find to be appropriate.

(Added by Ord. No. 3390, effective 8-20-09; amended by Ord. No. 3490, effective 2-25-16)

6-07-2020 NUMBER OF LICENSES AND CERTIFICATES:

The number of licenses and certificates issued or recognized by the County shall be totally within the discretion of the County as set forth in this Chapter.

(Added by Ord. No. 3390, effective 8-20-09)

ARTICLE 3. SERVICE AREAS

6-07-3000 DESIGNATION OF COUNTY SERVICE AREAS:

The Board shall, by resolution, divide the County into service areas for the purpose of designating areas within which ambulance companies shall provide primary emergency service and the most timely and effective response in compliance with emergency dispatch policies provided from time to time by the EMS Agency Policies and Procedures Manual. The service areas shall be shown on a map of the County kept on file with the Health Director. In order to carry out the policy of this Chapter, the Board may, in its sole discretion, modify, enlarge, divide or otherwise apportion service areas at any time after notice and public hearing.

(Added by Ord. No. 3390, effective 8-20-09)

6-07-3010 EXCLUSIVE OPERATING AREAS:

Upon recommendation by the Board, the local EMS Agency may designate one or more service areas as exclusive operating areas. A competitive process shall be utilized at appropriate intervals to select one or more ambulance companies to provide exclusive ambulance services in any exclusive operating area as required by Health and Safety Code section 1797.224, unless the Board finds by resolution that an existing ambulance company located within an exclusive operating area is continuing to operate within such area by providing ambulance services in the manner and scope in which such services have been provided without interruption since January 1, 1981.

(Added by Ord. No. 3390, effective 8-20-09)

6-07-3020 EMERGENCY MODIFICATION OF EXCLUSIVE OPERATING AREAS AND SERVICE AREAS:

The Health Director or, in his or her absence, the Health Officer may modify, enlarge, divide, overlap, or otherwise apportion exclusive operating areas and service areas on a temporary basis at any time for any length of time not to exceed 30 days upon any of the following conditions or occurrences:

(a)    A labor action disrupting or ending ambulance service in all or part of such areas.

(b)    The closing, bankruptcy or dissolution of an ambulance service company, disrupting or ending ambulance service by that company in all or part of such areas.

(c)    Any other circumstance which disrupts or ends ambulance service in all or part of such areas and occurs without sufficient notice to allow Board action.

(d)    Suspension, revocation, or termination of an ambulance service provider’s license under this Chapter. Upon request by the Health Director or Health Officer under this section, an ambulance service provider shall cooperate fully and assume on a temporary basis service responsibility in the expanded areas. Such service shall not be a license violation.

(Added by Ord. No. 3390, effective 8-20-09)

6-07-3030 EXCLUSIVE OPERATING AREAS: PROHIBITIONS:

It shall be unlawful for any ambulance service provider licensee to provide any ambulance services within the exclusive operating area of another ambulance service provider licensee, except as provided in this Chapter.

(Added by Ord. No. 3390, effective 8-20-09)

6-07-3040 EXCLUSIVE OPERATING AREAS: EXCEPTIONS:

An ambulance service provider licensee may provide emergency ambulance services in an exclusive operating area not authorized by its license under the following circumstances:

(a)    Upon request by the Health Director or Health Officer, a public safety agency, or another ambulance service provider licensee when an ambulance licensed in the service area from which the request originates is not immediately available as provided for in EMS Agency Policies and Procedures.

(b)    To provide ambulance services to a destination outside of the ambulance service provider licensee’s authorized and designated exclusive operating area when the patient was picked up within the authorized and designated exclusive operating area, and to provide return ambulance services to any such patient.

(c)    Upon request by the Health Director or Health Officer, a public safety agency, or another ambulance service provider licensee when an ambulance licensed in the exclusive operating area from which the request originates is not the closest ambulance unit, and in accordance with EMS Agency Policies and Procedures.

(d)    When requested by the Health Director, the Health Officer, another ambulance service provider licensee, or a public safety agency to supplement services during a multiple victim incident, or as otherwise provided under EMS Policies and Procedures.

(Added by Ord. No. 3390, effective 8-20-09)

6-07-3050 COMPETITIVE PROCESS:

As required, the local EMS Agency shall recommend, and the Board by resolution shall adopt, a competitive process for selecting licensees to operate in exclusive operating areas conforming to EMSA Guideline. Where a competitive process is required, the Board may award an exclusive operating area to an ambulance company after considering the following:

(a)    The quality of the service to be provided.

(b)    The level of service to be provided.

(c)    The cost, if any, to the County.

(d)    Evidence of ability to work effectively with local agencies.

(e)    Experience in the provision of ambulance services.

(f)    The financial viability of the company.

(g)    Such other criteria as shall be relevant to the issue of which applicant is most likely to provide the best service to the County and its residents and visitors.

(Added by Ord. No. 3390, effective 8-20-09)

ARTICLE 4. ISSUANCE OF CERTIFICATES

6-07-4000 MICN CERTIFICATE:

Any person desiring to act as or be employed as a Mobile Intensive Care Nurse or MICN for a Base Station Hospital within the County shall apply for and obtain a registered nurse certificate in accordance with the Nursing Practice Act, Business and Professions Code section 2700 et seq., and shall apply for and obtain an MICN certificate in accordance with the EMS Agency Policies and Procedural Manual.

(Added by Ord. No. 3390, effective 8-20-09; amended by Ord. No. 3490, effective 2-25-16)

6-07-4010 EMT-I CERTIFICATE:

Any person desiring to act as or be employed as an EMT-I or provide EMT-I services for an Ambulance Service Provider within the County shall apply for and obtain an EMT-I certificate in accordance with Health & Safety Code sections 1797.210 and 1797.212 and in accordance with the EMS Agency Policies and Procedures Manual.

(Added by Ord. No. 3390, effective 8-20-09)

6-07-4020 EMT-II CERTIFICATE:

Any person desiring to act as or be employed as an EMT-II or provide EMT-II services for an Ambulance Service Provider within the County shall apply for and obtain an EMT-II certificate in accordance with Health & Safety Code sections 1797.210 and 1797.212 and in accordance with the EMS Agency Policies and Procedures Manual.

(Added by Ord. No. 3390, effective 8-20-09)

6-07-4030 PARAMEDIC ACCREDITATION CERTIFICATE:

Any person desiring to act as or be employed as a Paramedic or provide paramedic services for an Ambulance Service Provider within the County shall apply for and obtain a Paramedic accreditation certificate in accordance with Health & Safety Code sections 1797.185 and 1797.194 and in accordance with the EMS Agency Policies and Procedures Manual.

(Added by Ord. No. 3390, effective 8-20-09)

ARTICLE 5. ISSUANCE OF AMBULANCE SERVICE PROVIDER LICENSES

6-07-5000 APPLICATION; FEES:

Any person desiring an ambulance service provider license shall file with the Health Director an application upon a form provided by the Health Director. Such application shall be accompanied by an application fee in the amount set from time to time by resolution of the Board of Supervisors to defray the expenses of processing the application and shall be verified under penalty of perjury. The application shall include the following information:

(a)    The name and address of the applicant and all owners and officers of the business and their percentage of ownership.

(b)    The business address and, if different, any and all addresses where any ambulance, operating equipment and supplies are located or will be kept.

(c)    The fictitious name, if any, under which the applicant does business or proposes to do business.

(d)    The training and experience of the applicant in the transportation and care of patients.

(e)    A complete description of each vehicle the applicant proposes to operate. Such description should include make, year of manufacture (and in the case of type I and type III, the year of manufacture of 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 such vehicle.

(f)    A statement of financial status and responsibility in a form acceptable to the Health Director.

(Added by Ord. No. 3390, effective 8-20-09; amended by Ord. No. 3490, effective 2-25-16)

6-07-5010 SAME: EXEMPTION:

Any person providing ambulance services on a nonprofit volunteer basis shall be exempt from the fee requirement set forth in this Article. All other application requirements of this Article shall apply.

(Added by Ord. No. 3390, effective 8-20-09)

6-07-5020 DOCUMENTS TO ACCOMPANY APPLICATION:

The application for an ambulance service provider license shall be accompanied by the following documents, where applicable:

(a)    Evidence that all vehicles proposed to be used to provide services have been properly licensed and inspected by the State of California.

(b)    Evidence that each person employed by or working for the applicant as an ambulance driver or ambulance attendant possesses a valid certificate as required by state laws and regulations, this Chapter, and the EMS Agency Policies and Procedures Manual.

(c)    A map or other description of the service area in which the applicant proposes to provide ambulance services.

(d)    Certificates or evidence of insurance verifying compliance with this Article.

(e)    Such other information or documentation as the Health Director determines is reasonably necessary to determine whether the provisions of this Chapter have been and/or will be complied with.

(Added by Ord. No. 3390, effective 8-20-09; amended by Ord. No. 3490, effective 2-25-16)

6-07-5030 HEALTH DIRECTOR’S INVESTIGATION AND RECOMMENDATION:

The Health Director shall review all applications for licenses and make such investigation of the applicant and the vehicles, equipment and employees to be used by the applicant, as he or she deems necessary and appropriate. Upon the basis of the application, evidence submitted, and results of any investigations and audits, the Health Director shall make a finding on the qualifications of the applicant under this Chapter, the EMS Agency Policies and Procedures Manual, and any applicable State and Federal laws and regulations, and whether additional services or equipment should be provided. On the basis of his or her findings, the Health Director shall recommend to the Board whether or not the license should be granted, and any conditions on which the license should be issued.

(Added by Ord. No. 3390, effective 8-20-09)

6-07-5040 NOTICE AND HEARING:

(a)    The Board shall hold a public hearing to consider the application and the Health Director’s recommendation, which hearing shall be held not later than forty-five (45) days after a completed application has been filed.

The Clerk of the Board shall set a date and time for the hearing and shall send a notice thereof by regular mail at least ten (10) days before the date of the hearing to the applicant and to any interested party requesting such notice. The clerk shall also give notice of the hearing to the general public by publishing a notice of the hearing once, at least seven (7) days prior to the date of the hearing, in a newspaper of general circulation which is circulated in the service area(s) which would be affected by the results of the hearing.

(b)    At the hearing, the Board shall hear all pertinent evidence offered by all interested persons. The Board may continue the hearing from time to time if it finds that the continuance is necessary or desirable.

(Added by Ord. No. 3390, effective 8-20-09; amended by Ord. No. 3559, effective 6-20-19)

6-07-5050 ACTION BY BOARD:

At the conclusion of the hearing, the Board shall issue or deny the license, with or without such conditions as it may find necessary to promote and safeguard the health, safety and welfare of the residents and visitors of the County, and otherwise carry out the purposes and provisions of this Chapter. The license shall designate the service area(s) within which the licensee shall provide primary emergency service in compliance with the EMS Agency Policies and Procedures Manual. The Board may also recommend to the EMS Agency an exclusive operating area within which the licensee shall be authorized to operate, in accordance with Article 3 of this Chapter.

(Added by Ord. No. 3390, effective 8-20-09)

6-07-5060 INSURANCE: LIMITS: TERMINATION:

Prior to the issuance or renewal of any ambulance service provider license, an applicant shall file or have on file with the Clerk of the Board of Supervisors, with copies to the Health Director and the County Risk Manager policies or certificates of insurance issued by an insurance company authorized to do business in California in form satisfactory to the County. The coverage shall be at least One Million Dollars ($1,000,000) combined single limit per occurrence to include professional liability, automobile liability, and commercial general liability with no annual aggregate limitation. Ambulance companies using air ambulances shall provide in addition at least Twenty Million Dollars ($20,000,000) combined single limit liability coverage to include aircraft liability and general liability. Such policies shall be issued at the expense of the applicant and maintained by him/her during the entire term of the license. The license shall be deemed automatically suspended during any period when such insurance is not in full force and effect. The County, its officers, agents and employees shall be named as additional insureds. Such insurance shall include a deductible amount acceptable to the County. The policies shall provide that the County shall be notified in writing by the insurance company thirty (30) days in advance of the termination or material alteration of such policies from whatever cause. Alternatively, an applicant may file a verification of self-insurance, or pooling arrangement, subject to review and approval by the Health Director and the Risk Manager.

(Added by Ord. No. 3390, effective 8-20-09)

6-07-5070 TEMPORARY LICENSES:

If the Board finds that the need for service to a service area or portion thereof, or to specific customers, justifies action before a complete investigation and final determination can be made pursuant to this Chapter, the Board may issue a temporary ambulance service provider license, which shall be valid only for a stated period, not to exceed six (6) months, on such conditions as the Board deems appropriate. Such ambulance service provider licenses may be issued without complying with the provisions of this Chapter governing notice and hearing.

(Added by Ord. No. 3390, effective 8-20-09)

6-07-5080 EMERGENCY ISSUANCE OF TEMPORARY LICENSES:

If ambulance service is disrupted or ended for any of the reasons set out in Article 3, or additional ambulance service is needed to prevent endangerment to the public health and safety, the Health Director or, in his or her absence, the Health Officer may issue temporary licenses so that service is provided in any service area or service is increased to two or more ambulance service providers in any area on a joint or rotating basis. Such emergency issuance of a temporary license shall be effective for a period not to exceed thirty (30) days

(Added by Ord. No. 3390, effective 8-20-09)

6-07-5090 LICENSES: TRANSFERABILITY:

(a)    No ambulance service provider license shall be transferred by sale, assignment, change of ownership, corporate reorganization, merger, or otherwise, without the consent of the Board. Applicants for such transfers shall first file an application for the Board’s consent with the Health Director, together with such information and documentation, as he shall require.

(b)    The Health Director shall investigate the proposed transfer and shall file a report and recommendation with the Board regarding consent to the proposed transfer. The Board shall thereafter hold a hearing on the proposed transfer as provided in this Chapter.

(c)    For purposes of this section, "transfer" shall not include changes of ownership not substantially effecting a change of control of an ambulance company.

(Added by Ord. No. 3390, effective 8-20-09)

6-07-5100 LICENSE: FEES:

Ambulance service provider licenses shall be issued by the license collector upon order of the Board. The fee for each annual ambulance service provider license shall be set from time to time by resolution of the Board of Supervisors. Each provider shall also pay an additional fee in the amount set from time to time by resolution of the Board of Supervisors for each vehicle proposed to be used by the ambulance service provider licensee. This fee shall be paid to the license collector for the balance of the initial calendar year, without proration, prior to the issuance of the ambulance service provider license. If such fee is not paid within thirty (30) days after the order of issuance by the Board, the application shall be deemed withdrawn and the license collector shall not issue an ambulance service provider license thereunder. Any applicant for a license for an exclusive operating area to be issued after a competitive procedure pursuant to Article 3 shall also pay an application fee in the amount set from time to time by resolution of the Board of Supervisors upon filing the application for the license, and in addition shall pay the annual fee specified in this section during each year of the exclusive operating area license. There shall be no refund or waiver of any part of any fee provided in this section except in accordance with sections 130 or 135 of this Ordinance Code.

(Added by Ord. No. 3390, effective 8-20-09; amended by Ord. No. 3490, effective 2-25-16)

6-07-5110 SAME: EXEMPTIONS:

Any person providing ambulance services on a nonprofit volunteer basis shall be exempt from the fee requirements set forth in this Article.

(Added by Ord. No. 3390, effective 8-20-09)

6-07-5120 TERM OF LICENSE:

The term of all ambulance service provider licenses issued pursuant to the provisions of this Chapter shall be for one (1) year, except that all licenses issued for an exclusive operating area selected by competitive procedure pursuant to Article 3 of this Chapter shall be for a term of five (5) years.

(Added by Ord. No. 3390, effective 8-20-09)

ARTICLE 6. RENEWAL OF AMBULANCE SERVICE PROVIDER LICENSES

6-07-6000 RENEWAL OF LICENSE:

Any person holding a valid ambulance service provider license issued pursuant to this Chapter, other than a temporary ambulance service provider license, may renew said ambulance service provider license by filing an application with the Health Director on a form acceptable to the Director not later than ninety (90) days prior to, nor earlier than one hundred and twenty (120) days prior to, the expiration of the existing ambulance service provider license. The Health Director shall review the application for compliance with this Chapter, and if approved shall forward the application to the license collector, who shall issue the license upon payment of the applicable fee. If a renewal application is not timely filed, the ambulance service provider license shall automatically terminate on December 31 of the applicable year, and the former ambulance service provider licensee must thereafter file for a new ambulance service provider license if he or she desires to do so. The license collector shall immediately forward a copy of all renewal licenses to the Health Director.

(Added by Ord. No. 3390, effective 8-20-09)

ARTICLE 7. RESPONSIBILITIES AND DUTIES

6-07-7000 RESPONSIBILITIES AND DUTIES OF EMT-I’S, EMT-II’S, PARAMEDICS, AND MICN’S:

In addition to the other requirements and obligations set forth in this Chapter, each EMT I, EMT-II, Paramedic, or MICN shall comply with the provisions of the Emergency Medical Services System and the Prehospital Emergency Medical Care Act, Health and Safety Code section 1797 et seq.; California Code of Regulations, Title 22, section 100000 et seq.; and the EMS Agency Policies and Procedures Manual. Failure to comply with this section shall result in disciplinary action as provided in Health and Safety Code section 1798.200 and the EMS Policies and Procedures Manual.

(Added by Ord. No. 3390, effective 8-20-09)

6-07-7010 RESPONSIBILITIES AND DUTIES OF AMBULANCE SERVICE PROVIDER LICENSEES:

Each Ambulance Service Provider Licensee shall comply with the provisions of the Emergency Medical Service System and the Prehospital Emergency Medical Care Act, Health and Safety Code section 1797 et seq.; California Code of Regulations, Title 22, section 100000 et seq.; the EMS Agency Policies and Procedures Manual; and any written agreement with the County.

In addition to the other requirements and obligations set forth in this Chapter, each ambulance service provider licensee shall:

(a)    Render services required under this Chapter on a twenty-four (24) hour a day basis throughout the entire service area specified by the license in accordance with the EMS Agency Policies and Procedures Manual and any written agreement with the County. Such service shall commence within five (5) days after the issuance of the license unless the Board extends such time limitation upon the showing of good cause by the licensee.

(b)    Not voluntarily discontinue any services to the service area or any portion thereof without first giving written notice to the Health Director at least ninety (90) days prior to the proposed discontinuance.

(c)    Notify the local EMS Agency in writing within five (5) days after the receipt of the results of all vehicle inspections conducted by the State and of any disciplinary action taken by any State agency regarding any ambulance license.

(d)    Notify the Health Director in writing within five (5) days after being informed of any disciplinary action taken against any ambulance driver or attendant employed by the licensee which could result in suspension or revocation of a certificate pursuant to California Code of Regulations, Title 22, Division 9, Chapter 4, section 100135 et seq., and Chapter 6, section 100201 et seq.

(e)    Notify the Health Director in writing within thirty (30) days of any other changes in the information set forth in any application, certification, or document required by this Chapter.

(f)    Immediately notify the local EMS Agency and other affected public safety agencies beforehand of any or foreseeable interruptions, suspensions, or delays in services which may endanger the health, safety, and welfare of the residents of the service area, or portion thereof, covered by the license.

(g)    Immediately notify the local EMS Agency and other affected public safety agencies of any unforeseeable interruptions, suspensions, or delays in service as they occur which result in the licensee being unable to put the required number of ambulances in the field in accordance with its ambulance service provider license and the EMS Agency Policies and Procedures Manual.

(h)    Staff each ambulance with at least two (2) persons at all times, including a driver and attendant, each of whom must be an EMT-I, EMT-II, Paramedic, and/or MICN as specified in individual ambulance provider agreements.

(i)    Participate in the 9-1-1 telephone system of the County.

(Added by Ord. No. 3390, effective 8-20-09; amended by Ord. No. 3490, effective 2-25-16)

6-07-7020 AMBULANCE SERVICE PROVIDER LICENSEES LOCATED OUTSIDE OF COUNTY:

Any ambulance service provider licensee located outside of the County, but authorized to operate within a service area, shall be subject to medical control, and comply with medical protocol, of its local EMS Agency of origin. In all other respects, it shall comply with all applicable Tulare County EMS policy and procedures, unless modified by written agreement with the Tulare County local EMS agency.

(Added by Ord. No. 3390, effective 8-20-09)

6-07-7030 AUTOMATIC SUSPENSION:

Failure of any ambulance service provider licensee to comply with the notification requirements of subdivision (f) or (g) of section 6-07-7010 shall result in the automatic suspension of its ambulance service provider license effective immediately upon interruption of service. If notification under the applicable subdivision does not occur in time for Board action before an interruption of service occurs, the Health Director or, in his or her absence, the Health Officer may arrange for services to be provided under the emergency provisions of Article 3 and/or Article 5.

(Added by Ord. No. 3390, effective 8-20-09)

ARTICLE 8. REVISION OF AMBULANCE SERVICE PROVIDER LICENSES

6-07-8000 AMBULANCE SERVICE PROVIDER LICENSES: MODIFICATIONS:

(a)    An ambulance service provider licensee shall file an application with the Health Director if the licensee desires to have the ambulance service provider license amended to allow the licensee to do any of the following:

(1)    Change the number of ambulances or make any exchange thereof, or change the required staffing thereof.

(2)    Change the location where ambulances, operating equipment, and supplies are located.

(3)    Make any change in ownership of the business not affecting control of the ambulance company.

(4)    Modify or delete any of the conditions or terms of the ambulance service provider license.

(b)    The Health Director shall investigate any proposed change as specified in subdivision (a)(1) or (a)(2) of this section and shall either approve or disapprove any such change. Within ten (10) days of receiving notice of the Health Director’s decision, an ambulance service provider licensee may file with the Health Director a notice of appeal to the Board of Supervisors. If the ambulance service provider licensee desires a hearing before the Board of Supervisors, the licensee shall request such a hearing in writing at the time of filing the appeal. The Health Director shall then file a report and recommendation, including the Health Director’s original decision and the ambulance service provider licensee’s notice of appeal, with the Board of Supervisors regarding such proposal. The Board shall thereafter hold a public hearing on such appeal if a hearing is requested by the ambulance service provider licensee or, if no hearing is requested, the Board may act on such appeal without holding a public hearing.

(c)    The Health Director shall investigate any proposed change as specified in subdivision (a)(4) of this section and shall file a report and recommendation with the Board regarding such proposal. The Board shall thereafter hold a hearing on such change as provided in this Chapter.

(Added by Ord. No. 3390, effective 8-20-09; amended by Ord. No. 3490, effective 2-25-16)

6-07-8010 SAME: EMERGENCY MODIFICATIONS:

When conditions or circumstances occur which would authorize the issuance of a temporary license under Article 5, the Health Director or, in his or her absence, the Health Officer may temporarily modify any ambulance service provider license. Such emergency modification shall be effective for a period not to exceed thirty (30) days.

(Added by Ord. No. 3390, effective 8-20-09)

6-07-8020 ADDITIONAL RESTRICTIONS:

The issuance of an ambulance service provider license shall not prevent the Board from amending this Chapter to impose additional restrictions or requirements on an ambulance service provider license. The Board shall also have the power to impose additional restrictions, requirements and conditions on an existing ambulance service provider license. The Board shall give an ambulance service provider license licensee at least ten (10) days’ written notice and an opportunity for a hearing before the Board before imposing such additional restrictions, requirements or conditions.

(Added by Ord. No. 3390, effective 8-20-09)

ARTICLE 9. SUSPENSION AND REVOCATION OF AMBULANCE SERVICE PROVIDER LICENSES

6-07-9000 CAUSES:

Any ambulance service provider license issued under the provisions of this Chapter may be suspended or revoked if the ambulance service provider licensee or any of the licensee’s employees or agents have:

(a)    Violated any of the provisions of this Chapter.

(b)    Violated any provisions of this Ordinance Code or other laws of the County, the State or Federal government pertaining to the operation of an ambulance, failed to comply with the EMS Agency Policies and Procedures Manual, or breached any written Agreement with the County.

(c)    Misrepresented a material statement of fact in the application for an ambulance service provider license or renewal thereof.

(d)    Violated any of the terms or conditions of the 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 Health Director.

(Added by Ord. No. 3390, effective 8-20-09)

6-07-9010 SAME: INVESTIGATION AND CORRECTION:

The Health Director shall, upon reasonable cause, investigate to determine whether an ambulance service provider licensee appears to have committed any act or failed to perform any duty specified in this Article. If the Health Director determines that there is sufficient evidence of such a violation, the Health Director may privately reprimand, publicly reprimand, require corrective measures, and/or notify the license collector in writing of the alleged violation and recommended action.

(Added by Ord. No. 3390, effective 8-20-09)

6-07-9020 REVIEW BY LICENSE COLLECTOR:

Upon receipt of the Health Director’s notice pursuant to section 6-07-9010, the license collector shall proceed as provided in Chapter 1 of this Part. If, at the conclusion of the proceedings, the applicable official finds that the ambulance service provider licensee has violated any of the provisions of this Chapter, the applicable official may revoke, suspend or modify the ambulance service provider license or take any other action which the official deems necessary for the best interests of the residents of the County. If the matter is appealed to the County Hearing Officer, the decision of the County Hearing Officer shall be final, and appeal therefrom may be made as provided in Chapter 1 of this Part.

(Added by Ord. No. 3390, effective 8-20-09; amended by Ord. No. 3559, effective 6-20-19)

6-07-9030 EMERGENCIES: SUMMARY SUSPENSION:

The Health Director shall have the power to summarily suspend any ambulance service provider license if it appears to the Health Director, in the exercise of his or her reasonable judgment, that the failure to suspend the ambulance service provider license presents an immediate threat or danger to the public health, safety, and welfare. The Health Director shall immediately give notice to the County Hearing Officer of the suspension and the reasons for the suspension in accordance with this Article and the County Hearing Officer shall thereafter hold a hearing on revocation of the ambulance service provider license pursuant to this Article.

(Added by Ord. No. 3390, effective 8-20-09; amended by Ord. No. 3559, effective 6-20-19)

ARTICLE 10. COMPLAINT PROCEDURE

6-07-9500 COMPLAINTS:

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 such service, or compliance with this Chapter, may file a written complaint with the Health Director setting forth in detail the reasons for said complaint. The Health Director shall notify the local office of the California Highway Patrol of any such complaint if appropriate, investigate the allegations contained in the complaint and, if there is substantial evidence to verify said allegations, the Health Director shall notify the licensee of his or her findings and the measures to be taken pursuant to Article 9, if any.

(Added by Ord. No. 3390, effective 8-20-09)

ARTICLE 11. VIOLATIONS

6-07-9700 VIOLATIONS:

Any person who violates any of the prohibitions of this Chapter which are declared to be unlawful shall be guilty of a misdemeanor and shall be punishable as provided in section 125 of this Ordinance Code.

(Added by Ord. No. 3390, effective 8-20-09)