Chapter 8.24 AMBULANCE SERVICE

The city is an optional municipal code city, organized under RCW Title 35A, with all powers possible for a city or town to have under the Constitution and laws of the state.

The city has been required over its history to provide a complete range of municipal services to city residents, as well as providing services to its neighboring community. The services long provided by the city include fire, emergency medical services, and other emergency responses. As part of its services to the community, the city has, pursuant to RCW 35.21.766 and other authority, established and maintained a system of basic life support services. The provision of emergency medical services is a basic governmental program, necessary to meet the objective of providing for the public health and safety.

The city is not adequately served by existing private ambulance service(s), and has not been for many years. During the past year, significant concerns have arisen regarding the delivery of emergency medical services in Skagit County, and more particularly in Burlington. To maintain quality service to the community, it is necessary to establish the city’s ambulance service, as a governmental function of the city, which shall be operated as a utility of the city. In order to achieve the economy of scale to justify a standing force of trained emergency medical personnel, it is further necessary to establish the city ambulance service as the emergency medical service provider to provide service for all emergencies occurring within the city. Further, it is necessary to establish regulatory standards for the provision of ALS and BLS ambulance service.

The city has, in the past, supported county-wide efforts for EMS funding. Current EMS funding for ambulance service is derived from fees and charges, as well as contracts for receipt of proceeds of an EMS levy paid by city and county residents. The source of EMS funding may vary from year to year, and a stable and secure financial structure is necessary for ambulance services to be maintained. Following recent actions of the county, it appears that, for the near term, funding will be stable. However, the provision of emergency medical services cannot be continued without adequate funding. Moreover, there are no assurances regarding funding sources and the city may in the future increase rates, provide for fees (including taxes), and take other means to support the ambulance service. (Ord. 1713 § 1, 2010).

8.24.020 Definition of terms.

The words and phrases set forth herein shall have the respective meanings ascribed to such words and phrases in the findings hereto and in this chapter, unless the context clearly requires otherwise:

A. “Advanced life support” or “ALS” means invasive emergency medical services.

B. “Ambulance” means a ground, air, or water vehicle designed and used to transport patients and to provide personnel, facilities, and equipment to treat patients before and during transportation.

C. “Basic life support” or “BLS” means noninvasive emergency medical services requiring basic medical treatment skills as defined in chapter 18.73 RCW.

D. “City” means the city of Burlington, Washington.

E. “City ambulance service” means the BLS, ILS, and/or ALS ambulance transport service operated by, or under contract with, the city of Burlington.

F. “County” means Skagit County, Washington.

G. “Emergency” means a situation or patient condition (1) in which either of the following procedures is performed: administration of a drug (except oxygen) or initiation of an intravenous line; (2) which a person requesting ambulance assistance indicates requires immediate response by medically trained personnel; or (3) which an EMT would assess, in the interest of good patient care, as requiring the assistance of at least a paramedic certified pursuant to chapter 18.71 RCW and regulations promulgated thereunder.

H. “Emergency medical service” or “EMS” means medical treatment and care that may be rendered at the scene of any medical emergency or while transporting any patient in an ambulance to an appropriate medical facility, including ambulance transportation between medical facilities.

I. “Emergency medical technician” or “EMT” means a person who is certified as such by the Secretary of the Department of Health, pursuant to chapter 18.73 RCW and regulations promulgated thereunder.

J. “Finance director” means the city finance director or his/her duly authorized designee.

K. “Fire chief” means the city fire chief or his/her duly authorized designee.

L. “Fire department” means the fire department of the city of Burlington, Washington.

M. “ILS” means intermediate life support as identified in WAC 246-976-010.

N. “Medical program director” means the person who is the approved medical program director for Skagit County, as defined by RCW 18.71.205.

O. “Mutual aid” refers to situations in which a licensed basic, intermediate, or advanced life support ambulance service is required, as determined by the fire department, to make ambulances, personnel, and equipment under the city’s direction available for basic or advanced life support response to other jurisdictions.

P. “Patient” means a person who is ill, injured, or otherwise incapacitated or helpless, and in need of, or receiving, medical treatment, including trauma care.

Q. “Person” means any individual, corporation, political subdivision of the state of Washington, municipal corporation, quasi-municipal corporation, company, firm, joint stock company, co-partnership, joint venture, trust, business trust, club, association, society, or any group of individuals acting as a unit, whether mutual, cooperative, fraternal, nonprofit, or otherwise, or any receiver, administrator, executor, assignee, or trustee in bankruptcy.

R. “Police chief” means the city police chief or his/her duly authorized designee.

S. “Secretary” means the Secretary of the Department of Health of the State of Washington.

T. “Skagit emergency communications” means the Skagit 911 center. (Ord. 1713 § 1, 2010).

8.24.030 Title – Gender.

A. All references to the finance director, medical program director, Secretary, police chief, and/or fire chief shall include their respective designees.

B. Any reference to or use of the terms “he,” “she,” “him,” “her,” or other gender based classification, if applicable as shown by the context thereof, shall also apply to the opposite gender. (Ord. 1713 § 1, 2010).

8.24.040 Purpose.

A. The city council declares it to be in the public interest and for the protection of the health, safety, and welfare of the residents of the city and its locality to provide for the highest level of emergency medical services reasonably practicable. The city council finds it to be in the public interest to provide for the inspection, regulation, and control of emergency medical services to achieve high standards and thereby to eliminate inadequate, improper, and harmful practices that may endanger the health and safety of the people.

B. The city council hereby finds and declares that the city of Burlington is not adequately served by existing private ambulance service. Accordingly, pursuant to RCW 35.21.766, the city hereby establishes the city ambulance service for the use and for the health, safety, and welfare of all city residents and visitors to be operated as a public utility of the city.

C. It is expressly the purpose of this chapter to provide for and promote the health, safety, and welfare of the general public and not to create or otherwise establish or designate any particular class or group of persons who will or should be especially protected or benefited by the terms of this chapter.

D. It is the specific intent of this chapter that no provision nor any term used in this chapter is intended to impose any duty whatsoever upon the city or any of its officers, employees, agents, or volunteers, for whom the implementation and enforcement of this chapter shall be discretionary and not mandatory.

E. Nothing contained in this chapter is intended nor shall be construed to create or form the basis of any liability on the part of the city, or its officers, employees, volunteers, or agents, for any injury or damage resulting from any action or inaction on the part of the city related in any manner to the enforcement of this chapter by its officers, employees, volunteers or agents. (Ord. 1713 § 1, 2010).

Article I. Authority and Administration

8.24.050 Authority.

The provisions of this chapter constitute an exercise of the city’s police power to promote the public health, safety and welfare of all city residents and visitors, and its provisions shall be liberally construed for the accomplishment of that purpose. (Ord. 1713 § 1, 2010).

8.24.060 Operation and administration.

A. The city council shall be the governing body of the city ambulance service utility.

B. The city ambulance service shall be operated and administered by the mayor, through the fire chief, as set forth herein to ensure care is provided in the best interest of the patient. The city ambulance service shall be operated and administered in accordance with (1) state law, regulations of the State Department of Health, and procedures adopted thereunder, including, but not limited to, chapters 18.71, 18.73 and 70.168 RCW and chapter 246-976 WAC; and (2) federal law. (Ord. 1713 § 1, 2010).

8.24.070 Medical program director.

The medical program director shall be responsible for the provisions of patient care quality and treatment protocols. (Ord. 1713 § 1, 2010).

8.24.080 Fire chief – Duties.

A. The fire chief, through the fire department, shall oversee and superintend the operation and administration of the city ambulance service.

B. The fire chief shall be vested with the authority to promulgate, revise, or rescind such reasonable rules and regulations as may be necessary or appropriate to administer the provisions of this chapter, as well as the operation and administration of the city ambulance service.

C. The fire chief shall make such regular inspections as the fire chief deems necessary, and shall make such reports relative to conditions existing at such times and in such manner as the mayor may direct. (Ord. 1713 § 1, 2010).

8.24.090 Finance director – Duties.

The finance director shall keep a system of accounts of revenues and disbursements of the city ambulance service as prescribed by the State Auditor, all as required by law. (Ord. 1713 § 1, 2010).

Article II. Operation and Funding

8.24.100 Additions, betterments, purchases – Compliance with capital facilities plan.

Additions, betterments, and purchases to and for the city ambulance service shall be made in accordance with the city’s capital facilities plan as the same now exists or as it may hereafter be amended. (Ord. 1713 § 1, 2010).

8.24.110 Additions, betterments, purchases – Financing.

The cost of making additions, betterments or purchases to and for the city ambulance service shall be paid from such sources and by such means as the city from time to time may direct, in accordance with RCW 35A.80.010 and other laws of the state as the same now exist or as they may hereafter be amended. (Ord. 1713 § 1, 2010).

8.24.120 Ambulance service fund.

A. There shall be created and established in the office of the finance director a special fund, to be known and designated as the “ambulance service fund.” There shall be deposited in the ambulance service fund: (1) all revenues collected pursuant to the ambulance service fees set forth in BMC 8.24.130; (2) all revenues collected pursuant to any contract and/or agreement to provide all or a portion of the ambulance service; (3) appropriations from the city, the county, state and federal government; and (4) such other funds as may be received for the use of the ambulance service. The ambulance service fund shall be administered in accordance with the laws of the state.

B. Assistance of a form other than funds shall be accounted for in accordance with state law, applicable regulations of the State Auditor, and in accordance with RCW 36.32.470. (Ord. 1713 § 1, 2010).

8.24.130 Ambulance service fees.

Fees for users of the city ambulance service (“ambulance service fees”) shall be fixed from time to time by resolution of the city council. (Ord. 1713 § 1, 2010).

8.24.140 Use of ambulance service fees.

All proceeds derived from the ambulance service fees in BMC 8.24.130 shall be used solely for the operation, maintenance, and capital needs of the city ambulance service. (Ord. 1713 § 1, 2010).

8.24.150 Billing of ambulance service fees.

Each patient who utilizes the city ambulance service shall be billed by the city in accordance with the ambulance service fees immediately after the provision of the ambulance service. The finance director shall establish a procedure to bill and collect city ambulance service fees for the ambulance services rendered. Under the procedure, the city may elect to bill the patient directly or bill the patient’s insurance company, and if the patient’s insurance does not cover all of the cost of the ambulance service, bill the remaining balance to the patient directly. The city may contract with a public or private entity to bill and collect the city ambulance service fees. (Ord. 1713 § 1, 2010).

8.24.160 Civil enforcement.

The city ambulance service fees imposed by this chapter may be collected by appropriate civil action instituted by the city attorney for that purpose. (Ord. 1713 § 1, 2010).

8.24.170 Fee determination criteria.

Ambulance service fees shall be set at a level to cover the actual costs incurred by the city in operating the city ambulance service. It is the intent of the city that ambulance service fees shall be charged in exchange for targeted ambulance service that alleviates the burden placed on such service by its users. In classifying customers served, or ALS, ILS or BLS ambulance service, the city may, in its discretion, consider any or all of the following factors: the difference in cost of service to various customers; the location of the various customers within the city; the difference of cost of maintenance, operation, repair and replacement of the various parts of the city ambulance service; the different character of service furnished various customers; and any other criteria or matters which constitute a reasonable ground for distinction. (Ord. 1713 § 1, 2010).

8.24.180 Amendment of ambulance service fees.

The city ambulance service fees provided in BMC 8.24.130 may be amended from time to time in the discretion of the city council as financial requirements for the city ambulance service may dictate, and such amended fees shall apply to and be binding upon users of the city ambulance service; provided, that such fees shall be uniform for the same class of users of the city ambulance service. (Ord. 1713 § 1, 2010).

8.24.190 Compliance with Medicare and Medicaid requirements.

This chapter and the city ambulance service fees hereunder shall be construed and implemented in a manner consistent with applicable Medicare and Medicaid requirements. If any part of this chapter is found to conflict with Medicare and Medicaid requirements, the conflicting part of this chapter shall be inoperative to the extent of the conflict and such finding or determination shall not affect the operation of the remainder of this chapter. (Ord. 1713 § 1, 2010).

8.24.200 Additional funding.

To the extent permitted under the Washington Constitution and the laws of the state of Washington (including, but not limited to, RCW 35.21.768 and 84.52.069, as may be amended), the city may adopt ordinances for the levy and collection of taxes or other charges and/or fees for the sole purpose of paying the costs for the operation, maintenance and capital needs of the ambulance service. (Ord. 1713 § 1, 2010).

8.24.210 Countywide ambulance service.

The city may contract with the county and/or a public corporation formed pursuant to RCW 35.21.730 et seq., for the provision of all or a portion of ALS, ILS and/or BLS ambulance service within the city’s jurisdictional limits on such terms and conditions agreed upon by the city and the county and/or public corporation. (Ord. 1713 § 1, 2010).

Article III. Licensing

8.24.220 Applicability.

All ALS, ILS, and BLS ambulance service involving the provision of emergency medical services to emergencies occurring within the city shall be provided within the city limits by the fire department in accordance with the provisions of this chapter; provided, that this provision shall not be applicable to medical services provided by any public hospital district for interfacility patient transport. (Ord. 1713 § 1, 2010).

8.24.230 License required – Application – Fee.

A. It shall be unlawful for any person (other than the fire department) to:

1. Operate or cause to be operated within the city limits an ambulance service without first being issued a license by the city for that purpose.

2. Operate or cause to be operated an ambulance service within the city limits, except as provided in BMC 8.24.310.

B. In the event the city elects to enter into a contract with an ambulance service, an ambulance service license may be obtained by applying at the finance department on forms provided. The finance director, subject to a review and approval from the fire chief, is responsible for issuing, denying, revoking, renewing, suspending, and canceling ambulance licenses to operate an ambulance service within the city.

C. The fee schedule for such license shall be adopted by city council, and it shall be renewable annually. The fee shall be payable in January of each year for the ensuing year, and there shall be no proration for new applications during the year. Each ambulance service license issued by the finance director shall be valid for the period of one year. The license year shall be from January 1st to December 31st of each year.

D. The finance director shall not issue such license unless the applicant has fulfilled all requirements of this chapter.

E. No person shall operate an ambulance service within the city unless there is on file with the finance director proof that the required license/licenses have been obtained from the Secretary as required by state law, including, but not limited to, chapter 18.73 RCW and chapter 246- 976 WAC, as now or hereafter amended.

F. To the extent not inconsistent with other provisions of this chapter, the provisions of BMC Title 5, regarding the general issuance of city licenses, shall also be applicable to ambulance service providers. (Ord. 1713 § 1, 2010).

8.24.240 Standards for license.

A. All applicants for an ambulance service license shall be appropriately certified by the Secretary, and be in good standing pursuant to chapter 18.73 RCW and regulations promulgated thereunder. Upon receiving an application and fee, the finance director shall forward the application to the fire chief for review and recommendation for approval or denial. No license shall be issued unless the fire chief is satisfied, pursuant to policies duly adopted, that (1) the applicant is properly certified by the state; (2) the applicant’s facilities, ambulances, and equipment meet state standards; (3) employees of the applicant are certified and in good standing; (4) a record check of the applicant and its employees by the police chief shows no criminal convictions for offenses having a direct adverse relationship to custody of incapacitated persons, custody of narcotic or controlled substances, or safe driving of emergency vehicles; and (5) the applicant is otherwise in good standing and capable of performing ambulance service.

B. Upon written recommendation of approval of the application by the fire chief, the finance director is authorized to issue an ambulance service license. All equipment proposed for use shall be subjected to random inspection by the fire chief or his/her designee, who shall determine whether said records and equipment conform to all requirements of this chapter. It shall be the responsibility of the licensee to immediately notify the finance director in writing of any change in any of the information required on the application.

C. The applicant shall obtain and at all times maintain in full force the following insurance in amounts determined by the office of the city attorney:

1. Comprehensive general liability;

2. Automobile liability for all vehicles; and

3. Professional liability.

The applicant shall provide an insurance certificate to this effect, naming the city as an additional insured as to subsections (C)(1) and (2) of this section. Such policies shall also provide for prompt advance notice to the city of intended cancellation of coverage. The applicant shall also agree to indemnify, defend, and hold the city harmless from any causes of action arising from the operation of the ambulance service. No person shall operate an ambulance service within the city unless there is on file with the finance director satisfactory proof that the required insurance is in effect as required herein. An ambulance service operated by a political subdivision of the state, or by a municipal corporation, or quasi-municipal corporation, may elect to be a self-insurer; provided, that the office of the city attorney is satisfied with the adequacy of the self-insurance. (Ord. 1713 § 1, 2010).

8.24.250 License not transferable.

No ambulance service license issued under the provisions of this chapter shall be transferable or assignable. (Ord. 1713 § 1, 2010).

8.24.260 Ambulance personnel.

No ambulance shall be operated as such without at least two persons. Such personnel shall not have been convicted of offenses having a direct relationship to custody of incapacitated persons, custody of narcotic or controlled substances, or safe driving of emergency vehicles and shall hold a valid Washington State driver’s license. An ALS ambulance shall be staffed by at least one paramedic and one EMT-B (or higher level certification). An ILS ambulance shall be staffed by at least one ILS-certified EMT (or higher level certification), and one EMT-B (or higher level certification). A BLS ambulance shall be staffed by at least two EMTs (or higher level certification). (Ord. 1713 § 1, 2010).

8.24.270 Ambulances and equipment.

A. Ambulances shall be maintained and inspected pursuant to requirements from time to time adopted by the Secretary. All licensees shall provide the fire department with copies of reports of inspection submitted to the Secretary pursuant to RCW 18.73.145.

B. All ambulances and equipment storage and cleaning areas are subject to inspection by the fire department, at reasonable times, to ensure that they are maintained in a clean and functional state. Disinfection or chemical sterilization of reusable equipment must meet guidelines established by the National Centers for Disease Control.

C. Licensees shall take immediate action to eliminate any unsanitary condition when becoming aware of it and shall immediately correct any situation about which the fire chief or the Secretary has delivered written notice. Failure to immediately correct any such situation may result in license suspension or revocation.

D. Ambulances shall not be used without the minimum equipment prescribed by the Secretary and fire department. In the event any variance from requirements is granted by the state, a licensee must apply for and obtain a similar such variance from the fire department. (Ord. 1713 § 1, 2010).

8.24.280 Performance standards – Compliance – Records.

A. All operations of and services provided by a licensee and representatives thereof shall, as a minimum, fully comply at all times with all applicable provisions of (1) city and county ordinances and procedures adopted thereunder; (2) state law, regulations of the State Department of Health, and procedures adopted thereunder, including, but not limited to, chapters 18.71, 18.73 and 70.168 RCW and chapter 246-976 WAC; and (3) federal law.

B. All services performed hereunder shall be in accordance with the standards and principles of the course of instruction given EMTs or paramedics, as the case may be, by the state, and pursuant to medical protocols established from time to time by the Skagit County medical program director.

C. The fire department shall be informed by the licensee of rates charged and changes in rates which may occur from time to time.

D. Records shall be logged by ambulance crews and shall include date and time of service and response times. Copies of such records shall be mailed or otherwise delivered to the fire department on a weekly basis, or more often if requested for good cause. Subject to the requirements of the state Public Disclosure Act, and subject further to the provisions of the federal Health Insurance Portability and Accountability Act of 1996, such records are confidential and shall be released only to proper officials of the city. (Ord. 1713 § 1, 2010).

8.24.290 Emergency notification.

In the event a call for emergency ambulance service is received by licensee or a representative thereof, the caller shall be directed to call Skagit emergency communications for response by the Burlington fire department. (Ord. 1713 § 1, 2010).

8.24.300 Response to calls.

It is unlawful for a licensee in responding to any call to use emergency lighting or siren, unless (A) responding to emergencies or transporting a patient in accordance with the mutual aid provisions herein, or (B) directed to do so by the Burlington fire department. (Ord. 1713 § 1, 2010).

8.24.310 Mutual aid.

A. A licensee is required to cooperate with any request by the fire department for mutual aid. At such times, the city will have operational control of all equipment and personnel for all purposes and may dispatch ambulances to any point within the city. However, in the event of any suit or claim arising out of activities under this section, the city and licensee shall each be responsible for, and to the extent of, their own respective liability.

B. A licensee shall equip vehicles with city fire department frequencies, which, however, shall only be used by licensees in the event of a mutual aid situation described herein. (Ord. 1713 § 1, 2010).

8.24.320 Ambulance service agreement.

In the event the city determines it to be in the best interests of the public to enter into an agreement with a public ambulance service to provide ambulance services, the city may, as authorized by the city council, enter into an interlocal agreement with such public ambulance service. (Ord. 1713 § 1, 2010).

8.24.330 Denial, revocation, or suspension of license.

A. Grounds. The finance director, upon recommendation of the fire chief, may deny a license application or license renewal, or revoke, suspend or restrict a license if the finance director has reasonable cause to believe that the applicant for or holder of the license has violated any provision or failed to meet any provision, term or standard established in this chapter.

B. Notice. If the finance director denies a license application or license renewal, or revokes, suspends or restricts a license, the applicant for or holder thereof shall be given a written notice stating: (1) the facts and conclusions upon which the decision is based; and (2) that the finance director’s decision shall be final and conclusive and that the applicant or holder shall be deemed to have waived all rights to an administrative hearing unless the applicant or holder files with the finance director a written notice of appeal pursuant to subsection (C) of this section.

Notice of a license revocation, suspension or restriction shall be given prior to the effective date of such action; provided, that the finance director may revoke, suspend or restrict a license, without prior notice, but subject to a timely appeal, if the finance director finds that immediate action is necessary in order to protect the health, welfare or safety of the public.

C. Appeal. The notice of appeal shall be filed with the office of the finance director within 10 business days following notice of the finance director’s decision and shall state the grounds for the appeal. Upon the filing of an appeal, the finance director shall cause to have scheduled a hearing thereon before the city council within 30 days and provide at least 10 days’ notice of the hearing to the applicant or holder.

The decision of the finance director shall be upheld unless the city council finds that the decision was arbitrary, capricious, or contrary to law. The decision of the city council shall be final and conclusive unless review is sought in a court of competent jurisdiction within 10 days of the written decision of the city council. The proceeding before the city council shall be considered proceedings under RCW 42.30.140(1) and (2). (Ord. 1713 § 1, 2010).

8.24.340 Penalty for violation.

A. In the event of a violation of any provision of this chapter, the fire department shall promptly notify the licensee thereof and, if the situation warrants it, give the licensee a reasonable opportunity to take corrective action.

B. Any licensee or employee of a licensee who violates any provision of this chapter shall subject the licensee to suspension or revocation of license pursuant to BMC 8.24.330. Any person violating a provision of this chapter shall be guilty of a gross misdemeanor and upon conviction shall be punished by a fine not exceeding $5,000 and up to 365 days in jail. (Ord. 1713 § 1, 2010).

8.24.350 Severability.

If any of the provisions of this chapter or its application to any person or circumstances is held invalid, the remainder of this chapter or the application of the provision to other persons or circumstances is not affected, and to this end, the provisions of this chapter are declared to be severable. (Ord. 1713 § 1, 2010).

8.24.360 Effective date.

This chapter shall take effect May 15, 2010. (Ord. 1713 § 1, 2010).