ORD-06-86 URGENCY MEASURE TO ESTABLISH NEW REQUIREMENTS FOR THE OPERATION OF AMBULANCES WITHIN THE CITYORDINANCE NO. 6-
86 AN INTERIM ORDINANCE OF THE CITY
COUNCIL OF THE CITY OF ORANGE ADOPTED AS AN
URGENCY MEASURE AMENDING CHAPTER 5.35 OF THE
ORANGE MUNICIPAL CODE TO REVISE AND RENUMBER
THE SECTIONS THEREIN AND TO ESTABLISH
NEW REQUIREMENTS FOR THE OPERATION OF
AMBULANCES WITHIN THE
CITY.WHEREAS, in 1978, the Board of Supervisors adopted
a comprehensive ambulance ordinance which set forth
basic rules for the operation of ambulance and convalscent
transpor-tation vehicles in the unincorporated areas of the
County and in those cities adopting substantially the same
ordinance;
and WHEREAS, Orange was one of the cities adopting
the County's ordinance;
and WHEREAS, the County has extensively revised the
ambulance ordinance because of recent antitrust court actions;
and WHEREAS, the new County ordinance significantly
amends the previous ordinance and provides for the
following:1. Deregulation of non-emergency
ambulance services.2. Setting a maximum rate for
emergency
transportation services.3. An Objective competitive mechanism
whereby contracts for emergency response areas may
be awarded.WHEREAS, when the City adopts substantially
the same ordinance as that of the County, the City would
have total and complete authority over all emergency
responders operating within the City through the Request for Proposal
process and subsequent contracts; the County of Orange
will license emergency ambulance services and establish
standards for personnel employed by such
firms; and WHEREAS, the City's ordinance, based on
the ordinance of the County of Orange, when adopted,
would establish operating procedures and standards for
medical transportation services within the City, to provide a fair
and impartial means of allowing private operators to provide
such services in the public interest and to provide a means for
the designa-tion of emergency response
areas;
WHEREAS, the City Council has determined that this
Ordinance should be adopted as an urgency measure for the
preservation of the public health because it is vital that
the City's ordinance be consistent with the County's ordinance
to assure that citizens of the community receive the most
appropriate level of care in the least amount of time.
THE CITY COUNCIL OF THE CITY OF ORANGE ORDAINS AS
FOLLOWS:
Section I:
Chapter 5.35 of the Orange Municipal Code is hereby
amended to read in its entirety as follows:
5.35.010 Intent and Purpose. It is the intent of this
Chapter to establish general operating procedures and standards
for medical transportation services operating within the
City in both emergency and other situations, to provide a
fair and impartial means of allowing responsible private
operators to provide such services in the public interest
and to provide a means for the designation of emergency
response areas.
5.35.020 Definitions. For purposes of this Chapter,
the following terms are defined:
A. Advanced life support service and basic life
support service mean the same as defined in the California
Health and Safety Code.
B. Ambulance means a motor vehicle, helicopter, or
similar vehicle, specifically constructed, modified, equipped
or arranged and operated for the purpose of transporting
patients requiring immediate or ongoing medical services
excluding the transportation of such persons to or from
locations not providing services as defined in this Chapter.
C. Ambulance service means the activity, business or
service, for hire, profit or otherwise, of transporting one
or more persons by ambulance; provided, however, ambulance
service shall not include the transportation by ambulance by
an employer of his or her own employees in an ambulance
owned and operated by the employer solely for this purpose.
D. Ambulance service operator means any person who
operates or owns an ambulance service.
ORD 6-86 2 -1
E. Attendant means a trained, qualified individual
who, regardless of whether he or she also services as driver,
is responsible for the care of patients.
F. County means the County of Orange, State of California.
City means the City of Orange, County of Orange, State of
California.
G. Department means the Emergency Medical Services
Agency of the County of Orange or the Health Care Agency of
the County of Orange, or as otherwise designated by the
Board of Supervisors.
H. Dispatcher means an individual employed by an
ambulance service operator responsible for sending an ambulance
to provide ambulance service to a patient.
I. Driver means an attendant who drives or pilots an
ambulance.
J. Emergency means a sudden, unforeseen event giving
rise to a need for ambulance service with basic or advanced
life support services.
K. Emergency response area means a geographical
location specified by the Fire Chief within which emergency
service may be provided under a license.
L. Emergency service means ambulance service performed
in response to an emergency.
M. Fire Chief means the Director of Fire Services for
the City of Orange.
N. Health Officer means the Orange County Health
Officer or other official designated by the Board of Supervisors
of Orange County to perform the Health Officer's function
under this Chapter.
O. Licensee means an ambulance service operator which
has been granted a license under this Chapter to provide
ambulance service.
P. Medical services means services provided by health
care professionals licensed pursuant to the California
Business and Professions Code or as specified by regulations
adopted pursuant to this Chapter.
3 -ORD 6-86
Q. Paramedic means the same as defined in the California
Health and Safety Code.
R. Patient means a wounded, injured, sick, invalid,
or otherwise incapacitated person.
S. Person means an individual, firm, corporation,
partnership, association or other group or combination as a
unit.
T. Physician means a medical doctor or osteopath
holding the appropriate license or certificate to practice
as such with the State of California pursuant to the Business
and Professions Code.
u. Public safety agency means any public law enforcement
agency, fire protection agency, or forest ranger operating
in the County.
5.35.030 License Required. A. It shall be unlawful
for any person to be an ambulance service operator, or to
act in such a capacity either directly or indirectly, without
possession of a license issued pursuant to this Chapter.
A license may specify the specific geographical area
within the City in which it is valid; provided, however,
with respect to emergency response areas, reference to the
emergency response area by a specific number or similar
identification shall be sufficient description of geographic
limitation. A license shall be valid for not more than one
1) calendar year or the expiration of the calendar year in
which it was issued, whichever is shorter.
B. The provisions of this Chapter shall not apply to:
1. Ambulances operated at the request of a
public safety agency during any "state of war emergency,"
state of emergency" or "local emergency," as defined in the
Government Code.
2. Ambulance service transporting a patient from
a location outside of Orange County regardless of destination.
3. Ambulance service transporting a patient by a
fixed-wing
airplane.5.35.040 Transfer and Term of License. No
license issued pursuant to this Chapter can be transferred by
operation of law or otherwise. The following shall be
considered transfers for purposes of this
Section:ORD 6-86 4 -
T
A. Any change in the business structure of a licensee,
including, but not limited to, changes from or to:
1. A sole proprietorship.
2. A partnership, including any change in the
partners.
3. A corporation, including any change in the
shareholders, whether by operation of law or otherwise.
B. Bankruptcy, an assignment for the benefit of
creditors, or the appointment or a receiver.
C. A sale or transfer of over ten (10) percent of the
assets of a licensee.
A licensee may apply to the Health Officer for an
amendment to the terms of the license, which request shall
be processed in the same manner as an original application.
Notwithstanding anything in this Section to the contrary,
licenses may be suspended, revoked or terminated prior to
the expiration date, pursuant to the provisions of this
Chapter.
5.35.050 Applications. A. Each application for a
license shall be accompanied by an application fee, it any,
set by the Board of Supervisors, and be made upon forms
prescribed by the Health Officer.
B. Each applicant shall submit the following:
1. The names and addresses of the applicant(s)
and the owner(s) of the ambulance(s) and the business and
any interest therein.
2. The applicant's training and experience in
the transportation and care of patients.
3. The names under which the applicant has
engaged, does, or proposes to engage in ambulance service.
4. A description of each ambulance including the
make, model, year of manufacture, vehicle identification
number, current state license number, the length of time the
vehicle has been in sue, and the color scheme, insignia,
name, monogram, and other distinguishing characteristics of
the vehicle, a description of the company's program for
maintenance of the vehicle, and a description of the vehicle's
radio(s).
5 -ORD 6-86
5. Proof that the applicant has obtained all
licenses and permits required by State of local law or
regulation for the type of ambulance service proposed,
excluding only a license to provide the service for which
application is made.
6. The names and qualifications of each attendant,
driver or dispatcher employed, or to be employed, in providing
ambulance service.
7. Proof that the applicant possesses and maintains
currently valid California Highway Patrol inspection reports
for each vehicle listed in the application.
8. A description of the company's training and
orientation programs for attendants, drivers and dispatchers.
9. Evidence of such financial responsibility and
insurance coverage as may be required by the Health Officer
pursuant to regulations adopted in accordance with this
Chapter.
10. Identification of the geographical area to be
served by the applicant, if required by the department.
11. As to new applications or transfers as specified
in Section 5.35.040, a fingerprint receipt for each principal
of the applicant, issued by the Orange County Sheriff-
Coroner indicating each principal of the applicant has undergone
a complete criminal history check, followed by a report
from the Orange County Sheriff-Coroner showing no
conviction of crimes which would be violations of the provisions
of Section 5.
35.070.12. A list of all substations or
offices where equipment and personnel are, or will be
based, including hours
of operation.13. A description of whether the
service proposed by the applicant will include basic life support
services or advanced life support service, and,
if so:a. The number of basic life supp~
rt service or advanced life support serv~
ce units to be deployed on
each shift.b.The emergency response area(s)
to receive basic life support service
or advanced life
support service.ORD 6-86
c. The provisions, if any, for continuing
education of attendants.
14. Such other information as the Health Officer
may require in regulations adopted pursuant to this Chapter.
C.
same form
tions.
Renewal applications shall be submitted in the
and require the same materials as original applica-
5.35.060 Investigations. Upon receipt of a completed
application and the required fee, if any, the Health Officer
shall make, or cause to be made, such investigation as the
Health Officer deems necessary to determine if:
A. The applicant is a responsible and proper person
to conduct, operate or engage in the ~ovision of ambulance
services.
B. The applicant meets the requirements of this
Chapter and of other applicable laws, ordinances or regulations.
5.35.070 Issuance or Denial of License. A. The
Health Officer shall issue a license to an applicant if the
Health Officer, after completing any investigation required
pursuant to this Chapter, determines all requirements of
this Chapter have been met and the license fee, if any, set
by the Board of Supervisors, has been paid.
B. In the event of denial, the applicant shall be
informed in writing of the reasons therefor.
C. The licensee shall obtain and keep in force during
the term of a license, comprehensive automobile liability
insurance and professional liability insurance issued by a
company authorized to do business in the State of California,
acceptable to the Health Officer, insuring the owner against
loss by reason of injury or damage that may result to persons
or property from negligent operation or defective construction
of such ambulance, or from violation of this Chapter or any
other law of the State of California, or the united States.
Said comprehensive automobile liability policy shall be in
the sum of not less that Five Hundred Thousand ($500,000)
Dollars for combined single limit, bodily injury and property
damage. Said professional liability insurance shall be in
the sum of not less than One Million ($1,000,000) Dollars
per person and One Million ($1,000,000) Dollars annual
aggregate. Workers' Compensation Insurance shall be carried
7 -ORD 6-86
covering all employees of the license holder. Before the
Health Officer shall issue a license, copies of the policies
or certificates evidencing such policies, shall be filed
with the Health Officer. All policies shall contain a
provision requiring a thirty (30) day notice to be given to
the Department prior to a cancellation, modification or
reduction in limits. The amount of comprehensive automobile
liability insurance shall be subject to review and adjustment
by the Health Officer pursuant to regulations adopted under
this Chapter. In the use of helicopters the equivalent
insurance requirements shall apply.
D. Grounds for denial of a license application shall
be:
1. Failure to meet the requirements of any
provisions of this Chapter.
2. Violation by any principal of an applicant of
Penal Code Section 290.
3. Habitual or excessive use of narcotics or
dangerous drugs.
4. Conviction during the preceding seven (7)
years of any crime relating to the use, sale, possession or
transportation of narcotics, addictives or dangerous drugs.
5.
beverages.
Habitual or excessive use of intoxicating
6.
years of any
California.
Conviction during the preceding seven (7)
crime punishable as a felony in the State of
7. Conviction of any crime involving moral
turpitude, including fraud or intentional dishonesty for
personal gain.
E. In determining the effect of any criminal acts on
the issuance or denial of a license, the Health Officer
shall consider whether the criminal acts are related to the
activities of an ambulance service and shall evaluate the
rehabilitation of the persons involved. The Health Officer
shall not consider crimes of which the applicant is, or was,
accused but not convicted.
ORD 6-86 8 -
L._~__~__~____--"-- _~______.~___._~5.35.
080 License Suspension or Revocation. A. The Health Officer
may suspend or revoke license for failure by the licensee
to comply, and maintain compliance with or for violation of
any applicable provisions, standards or requirements of State
law or regulation of this Chapter or of any regulations promulgated hereunder.
Suspension of a license is not a condition precedent
to revocation of a license.B. Before
suspension or revocation,shall give
written notice to the licensee.shall:the
Health
Officer Said notice
l.to
be
taken.Specify the
reasons for which the action is 2. Set
a hearing for not more than fifteen (15)days nore
less than seven (7) days after the date of the notice.3.
Specify
the date, time and place of the hearing.4.
Be
served on the licensee either by delivery to its
principal place of business or to its designated agent for
service of such notices, if any.c. If
the licensee, subsequent to service of a suspension or
revocation notice under this Section, remedies some or
all of the conditions to which the notice refers,the Health
Officer may rescind a suspension or revocation at any time.
D. At
the hearing, the Health Officer has the burden of proof
and may present evidence as to why such action should be
taken and to answer the evidence presented by the licensee.E.
The
Health Officer may reduce the period of time for hearing
under a suspension or revocation notice to no less than
twenty-four (24) hours when the Health Officer makes
written preliminary findings that such action is necessary
to protect the public health, safety and welfare.When,
as a result of such an emergency proceeding, a license is
suspended or revoked, the licensee may request an addi-tional
hearing at which the licensee will have the burden of establishing
renewed compliance justifying reinstatement of the
license. Such additional hearing will be commenced within
five (5) days of the licensee's request. The request for,
and the scheduling of, an additional hearing shall not stay
operation of the suspension or revocation order.9 -
ORD 6-86
F. Hearings conducted pursuant to this Section shall
be conducted before a hearing officer designated by the
Department. At the conclusion of said hearing, the hearing
officer shall expeditiously prepare a written summary of the
evidence and proposed findings and conclusions for considera-
tion by the Health Care Agency Director.
G. The Health Care Agency Director shall issue a
written decision within thirty (30) days after conclusion of
the hearing.
5.35.090 Appeal to Board of Supervisors. In the event
of denial, suspension or revocation of a license, the
applicant or licensee shall have the right to request a
hearing before the Board of Supervisors, which hearing shall
be requested and conducted in the manner specified in Section
5-2-19 of the Codified Ordinances of
Orange County.5.35.100 Notification. The licensee shall
notify the Health Officer within twenty-four (24)
hours after any change in ownership or management of the
licensee, or any interruption of service of more than
twenty-four (24) hours duration, or any substantial change
in staffing or equipment.For purposes of this Section,
the term "substantial change"shall be as defined by regulation
adopted
pursuant to this Chapter.5.35.110 Personnel Standards.
A. A licensee shall only employ personnel performing
tasks described in this Chapter who comply with the
requirements of this Section.B. Attendants shall be at
least eighteen (18) years of age and trained and competent in the
proper use of all equipment, and shall hold current "
EMT lA" certification in compliance with all State
laws, rules and regulations.Additionally, each attendant shall hold
a license from the Health Officer indicating
compliance with this Section.Applications for such licenses shall be
in a form required by the Health Officer and shall be
accompanied by the fee,if any, established therefor.
All applicants for licenses as an attendant shall be subject to
the same criminal history review as required for
principals of ambulance companies pursuant to this Chapter no less than
once every four (4)years. Certificates may be denied,
suspended, or revoked in the same form and fashion as
that specified for ambulance service licensees in this Chapter.
Licenses shall be. valid for two (2) years from the date
of issuance or certification as an Emergency Medical
Technician-lA, whichever is less.Renewal of a license shall be in
the same fashion as
issuance of a new license.
C. Each licensee shall have at least one dispatcher.
Emergency ambulance service licensees shall have a dispatcher
of a twenty-four (24) hour-per-day basis
and shall adequately train the dispatcher to radio operation and
protocols and to the emergency responses area(s) served
before said dispatcher begins dispatching emergency calls. For
purposes of this Section, "adequate" training of a dispatcher
shall be that which meets State standards, if any,
or County requirements.D. Ambulance drivers shall, in addition
to the require-ments of this Chapter for attendants,
maintain an appropriate license issued by the California Department
of Motor Vehicles and, if applicable, the
Federal Aviation Administration.5.
35.120 Rates.
those rates
approved ambulance services.No licensee shall
charge more than by the Board of
Supervisors for emergency 5.35.130 Usage of Ambulance
Service Licensees. A.The C~ty shall contract with licensees
on a competitive basis for provisions of ambulance service
in response to emergencies in each emergency response
area. Said contracts shall provide for one primary
contractor per emergency response area, with such other back-
up service by other emergency ambulance service providers
as deemed necessary by the City. In awarding these
contracts, the City shall consider the comparative value of
competing proposals in the same fashion as would be the case
were the City evaluating proposals from prospective service
providers for other City
activities, including consideration of:1. The quality of
service to be provided.2. The level of
service to be provided.3. The rates charged for
services to be provided.4. The cost, if
any, to the City.B. The Fire Chief shall
administer the contracts for ambulance service awarded by the
City Council under this Section. The Fire Chief shall also
prepare and keep current emergency response area
lists specifying contract providers for each area. The Fire Chief shall include
on the list for each emergency response area the
provider which has entered into an ambulance service agreement with
the City as the primary contractor as well as
the emergency ambulance service provider(s) who will provide
back-up
ambulance service for that area.
C. In the event no proposals acceptable to the City
under the provisions of this Section are received for one or
more emergency response areas, the City shall designate one
or more licensees in that emergency response area to provide
emergency ambulance services. From the date of such designa-
tion until a regular emergency ambulance service agreement
is signed for the affected area(s), provision of emergency
service shall be an express condition of the license and
unreasonable or unjustified refusal of such calls shall be a
violation of this Chapter.
D. No person shall provide ambulance service in
response to, or as a result of, an emergency, unless that
person is a licensee specified in each instance by a physician
or public safety agency. A licensee thus specified by a
physician need not be a contractor selected pursuant to this
Section. Any ambulance service operator receiving a request
for emergency ambulance service from other than a public
safety agency shall immediately, by telephone, notify a
public safety agency designated by regulation of the request.
No licensee responding to an emergency shall transport
a patient unless:
1. A paramedic is present at the location of the
patient.
2. A physician is present at the location of the
patient and directs transportation in the absence of a
paramedic.
3. A safety qualified employee of the Orange
County Fire Department, or an appropriate employee of a
public safety agency designated by regulation directs transpor-
tation in the absence of a paramedic.
5.35.140 Rules and Regulations. A. As to all Sections
of th~s Chapter except Section 5.35.130, the Health Officer
shall make such rules and regulations and as may be necessary
to implement this Chapter. Prior to adoption, proposed
rules and regulations shall be submitted to the Orange
County Emergency Medical Care Committee for comment.
B. As to Section 5.35.130, the Fire Chief shall make
such rules and regulations and as may be necessary to implement
this Chapter. Prior to adoption, the Fire Chief's rules and
regulations shall be submitted to the Orange County Emergency
Medical Care Committee for comment.
ORD 6-86 12 -T~ -
C. The Health Officer or the Fire Chief or their
designee(s) may inspect the records, facilities, transpor-
tation units, equipment and method of operations of each
licensee whenever necessary and, by the Health Officer, at
least annually.
5.35.150 Complaints. The City, the Department, any
user, subscriber, publlc safety agency or consumer who
believes, or has reason to believe, that he or another party
has been required to pay an eXGessive charge for services,
received inadequate services or services provided were not
in compliance with the provision of this Chapter, may file a
written Gomplaint with the Department setting forth such
allegations. The Department shall notify the ambulance
service operator of such complaint. The ambulance service
operator shall file a written response within fifteen (15)
calendar days after receipt of notification.
5.35.160 Variance. As to all but Section 5.35.130,
the Health Officer may grant variances from the terms of
this Chapter if he finds such action is necessary to protect
the public health, safety or welfare. As to Section 5.35.130,
the Fire Chief may grant variances from the terms of this
Chapter if he finds such action is necessary to protect the
public health, safety or welfare. As to the Health Officer,
such varianGes may include the issuance of a temporary
license. No variance shall exceed one hundred and eighty
180) days in duration.
5.35.170 Violation. Violation of any provision of
this Chapter by an ambulance serviGe operator shall be a
misdemeanor.
Section II:
The reasons for this urgency are as follows:
The City CounGil has determined that it is vital to the
public health that this Ordinance be adopted immediately to
assure that citizens of the community receive the most
appropriate level of care in the least amount of time. The
existing ordinance and contract with the County of Orange
may be vulnerable to antitrust legal aGtion. Without this
Ordinance and the contract with the County, it would be
incumbent upon the City to assure ambulance service compliance
to state and local regulations. This would be very expensive
and would take many months to develop. An ordinance enacted
pursuant to the regularly established procedure would require
at least six weeks from the date it is introduced to become
13 -ORD 6-86
effective. Pursuant to Section 36937 of the California
Government Code, the City Council hereby enacts this Ordinance
as an urgency measure to become effective immediately in
order to protect the public health, safety and welfare until
the time that the permanent ordinance becomes effective.
Section III:
This Urgency Ordinance shall become effective immediately
and shall remain in effect until Ordinance No. 7-86
becomes effective. When Ordinance No. 7-86 becomes
effective, this Urgency Ordinance shall become null and void
without further action of the
City Council.ADOPTED this 18th day of
February,
1986.
ATTEST:J~ ~ty Cle~of thetlC~ty
of Orange STATE
OF CALIFORNIA )COUNTY OF
ORANGE ) ss CITY
OF ORANGE )I, MARILYN J. JENSEN, City Clerk of the City
of Orange,California, do hereby certify that the
foregoing Ordinance was introduced at the regular meeting of the
City Council held on the 18th day of February ,
19~, and thereafter at a regular meeting of said City
Council duly held on the 18th day of February , 1986
was duly passed and adopted by the following vote,
to wit:AYES:COUNCILMEN: SMITH, MAYOR BEAM,
PEREZ, BEYER NOES:
COUNCILMEN: NONE ABSENT:
COUNCILMEN: BARRERAflw/l/L- J --Ie
O::tuR4V'C~ty Cler~f e 0kY
of Orange ORD 6-86