ORD-07-86 REVISE AND RENUMBER THE SECTIONS TO ESTABLISH NEW REQUIREMENTS FOR THE OPERATION OF AMBULANCESORDINANCE NO. 7-
86 AN ORDINANCE OF THE CITY COUNCIL OF
THE CITY OF ORANGE 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, this ordinance, based on the ordinance
of the County of Orange, when adopted, will
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
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 specifically delete Sections 5.35.180 through
5.35.230 and to amend Chapter 5.35 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 def~ned in the Cal~fornia
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 7-86 2 -
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.
rise
life
J. Emergency means a sudden, unforeseen event giving
to a need for ambulance service with basic or advanced
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 7-86
Q. Paramedic means the same as defined in the California
Health and Safety Code.
R. Patient means a wounded, injured, sick, invalid,
or otherwise ~ncapacitated 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 -
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 of 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 if
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 use, 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 7-86
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.l3. 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 support
service or advanced life support service
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 7-86 6 -
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 provision 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 7-86
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.
be:
D. Grounds for denial of a license application shall
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 7-86 8 -
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 compliancewithorforviolationofanyapplicableprovisions, standards or
requirements of State law or regulation of thisChapterorofanyregulationspromulgatedhereunder. Suspension of a license isnotaconditionprecedenttorevocationofalicense.
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.hearing.3. Specify the date, time
and
place
of the 4. Be served on the licensee either
by delivery to its principal place of business ortoitsdesignatedagentforserviceofsuchnotices, ifany.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, anadditionalhearingshallnotstayoperationofthesuspensionor
revocation order.9 -ORD 7-86
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.ORD 7-86 10 -
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. No licensee shall
charge more than those rates approved by the Board of
Supervisors for
emergency ambulance services.5.35.130 Usage of Ambulance
Service Licensees. A.The City shall contract with licensees on
a compet~tive 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.
11 -ORD
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:
l. 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 this 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 7-86 12 -
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, public safety agency or consumer who
believes, or has reason to believe, that he or another party
haS been required to pay an excessive charge for services,
received inadequate services or services provided were not
in compliance with the provision of this Chapter, may file a
written complaint 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 variances 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 service operator shall be a
misdemeanor.
Section II:
A summary of this Ordinance shall be published and a
certified cOpy of the full text of this Ordinance shall be
posted in the Office of the City Clerk at least five (5)
days prior to the City Council meeting at which this Ordinance
is to be adopted. A summary of this Ordinance shall also be
published once within fifteen (15) days after this Ordinance's
passage in the Orange City News, a newspaper of general
circulation, published and circulated in the City of Orange.
The City Clerk shall post in the Office of the City Clerk a
certified copy of the full text of such adopted Ordinance
along with the names of those City Council members voting
13 -ORD 7-86
for and against the Ordinance in accordance with Government
Code Section 36933. This Ordinance shall take effect thirty
30) days from and after the date of final passage.
ADOPTED this 25th day of Februar 1986.
ATTEST:
Re ~C~~ of e C y 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 Februarv , 19 ji2, and
thereafter at a regular meeting of said City Council duly
held on the 25th day of Februarv , 19~ was duly
passed and adopted by the following vote, to wit:
AYES:COUNCILMEN: BARRERA, PEREZ, BEYER
COUNCILMEN: NONENOES:
ABSENT:COUNCILMEN: SMITH, MAYOR BEAM
wn~~C~ty Cler of e C y 0 Orange
ORD 7-86 14 -1