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Ordinance No. 4057
AN ORDINANCE OF THE COUNTY OF BUTTE
REPEALING SECTIONS 45-1 THROUGH 45-17 OF CHAPTER 95, EMERGENCY
MEDICAL RESPONSE OF THE BUTTE COUNTY CODE AND
REPLACING THEM WITH SECTIONS 45-1 THROUGH 45-81
CHAPTER 45. EMERGENCY MEDICAL RESPONSE
ARTICLE 1. GENERAL PROVISIONS
The Board of Supervisors of the County of Butte ordains a:
(follows:
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Section 1. Sections 95-1 through 95-17 of the Butte County Code
tare repealed and replaced with Sections 45-1 through 45-81 tc
read as follows:
'45-1. TITLE; PURPOSES; LIBERAL CONSTRUCTION.
(a) This Chapter shall be known as the Emergency Medical
Response Ordinance ("EMRO") of Butte County.
(b) 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
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attention or, in non-emergency situations, a need for basic or
advanced life support services as defined by the California
Health and Safety Code.
(c) This Chapter does not apply to wheelchair vans, gurney cars
or similar non-emergency vehicles or operations or to vehicles
not requiring an emergency vehicle permit from the California
Highway Patrol.
(d) Nothing in this Chapter shall be limited by an ambulance
service's base hospital agreement. Nothing in this Chapter shall
limit a base hospital from imposing standards higher than those
provided in the EMRO; however, the base hospital must apply
those standards uniformly to all Providers who have entered into
(Provider Agreements.
(e) The Butte County EMS system includes the designation o
Exclusive Operating Area(s)(~~EOAS") pertaining to the furnishin
of 911 emergency medical services. At periodic intervals, th
'county Local Emergency Medical Services Agency (LEMSA) may elec
to conduct a competitive procurement process for the 91
Provider Agreements within each EOA. A11 911 ambu
'Providers must have an Advanced Life Support Provider Agreemen
in place with the LEMSA at the conclusion of the competitiv
procurement process, prior to beginning ambulance services in a
EOA. Each non-911 ground ambulance Provider and each ai
ambulance Provider is also required to obtain an ALS Prov
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1 Agreement with the LEMSA prior to beginning ambulance service
2 in the county.
3 (f) This Chapter shall be liberally construed for the
4 accomplishment of these purposes.
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45-2. NOT EXCLUSIVE REGULATION.
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~ This Chapter shall supplement and be in addition to other
a regulating statues and ordinances heretofore or hereafter
9 enacted by the State, the County, or any other legal entity ox
1o agency having jurisdiction. This Chapter is not intended tc
11 supplant, overlap, or interfere with existing Emergency Medical
12 Services ("EMS") regulations established under the California
13 EMS Act and the operational standards established by the Local
14 EMS Agency, promulgated pursuant to Division 2.5 of the Health.
15 and Safety Code. However, in the case of a conflict and where
16 the EMRO calls for a higher level of service, the EMRO shall
1~ prevail.
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45-3. DEFINITIONS.
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The definitions set forth in Health and Safety Code sections
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1797.50, et se q, are incorporated herein, and the following
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definitions are intended to be consistent therewith. Except
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where the context otherwise requires, all these incorporated and
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specified definitions shall govern the construction of this
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Chapter.
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(a)"Advanced Life Support" or "ALS" shall mean those special
services defined by Health and Safety Code section
1797.52 and any amendments thereto and referred to in the
Emergency Medical Services System and the Prehospital
Medical Care Personnel Act, Health and Safety Code
section 1797, et seq., and any amendments thereto, or
regulations promulgated thereunder.
(b)"Air Ambulance" shall mean 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.
(c) "Ambulance" shall mean any vehicle, including an air
ambulance, that is specifically constructed, modified, equipped,
(designed and primarily used and operated for the provision of
emergency medical transportation services to sick, injured, or
otherwise incapacitated persons.
(d) "Ambulance Company" shall mean any person, entity,
corporation, partnership, association, trust or estate that
owns, leases or operates one or more ambulances for the purpose
of providing emergency ambulance services within the County.
(e) "Ambulance Services" shall mean any emergency ambulance
services as defined by this section provided through an
ambulance response to an emergency 911 call.
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(f) "Attendant" shall mean any EMT, certified by a LEMSA or
Paramedic licensed by the State of California and approved by
LEMSA who is responsible to provide prehospital medical care for
a sick, injured or otherwise incapacitated person in an
lambulance.
(g) "Basic Life Support" or "BLS" shall mean those services
defined by Health and Safety Code section 1797.60 and any
amendments thereto and referred to in the Emergency Medical
Services System and the Prehospital Medical Care Personnel Act,
Health and Safety Code section 1797, et seq., and any amendments
thereto, or regulation promulgated thereunder.
(h) "Board" shall mean the Board of Supervisors of the County
of Butte.
(i) "County" shall mean the County of Butte.
(j) "Days" shall mean calendar days.
(k) "Driver" shall mean a person who is authorized as an
ambulance driver and possesses a current ambulance driver's
license issued by the California Department of Motor Vehicles
and is certified and approved by the LEMSA as an EMT (at least).
(1) "Emergency Medical Dispatching" or "EMD" shall mean
dispatching by a person trained, qualified and certified to
prioritize 911 calls and give 'pre-arrival" first aid
instructions to 911 callers.
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(m) "Emergency Medical Advisory Group" or "EMAG" shall mean
(the Group established by Butte County to serve in an advisory
capacity to the LEMSA.
(n) `Emergency Medical Services" or "EMS" shall mean all
(services required to identify, respond to, stabilize and treat
fall medical and psychiatric emergencies.
(o) "EMS Agency Policies and Procedures Manual" shall mean the
(policies and procedures of the Emergency Medical Services System
that are approved by the Local EMS Agency in accordance with
Health and Safety Code section 1798, et seq.
(p) "Emergency call" shall mean a request for the dispatch of
Ian 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, or, in a medical emergency, as determined by
a physician, to transport blood, any therapeutic device,
accessory to such device, or tissue or organ for transplant.
(q) "Emergency Medical Services Authority" or "EMSA" shall
(mean the State of California regulatory agency as defined in
section 1997.54 of the California Health and Safety Code.
(r) "Emergency Medical Technician" or "EMT" shall mean 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, Chapter 2,
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sections 100005 et seq., and certified as such by the Local EMS
Agency.
(s) "Emergency service" shall mean any service performed in
response to an emergency call.
(t) "Exclusive Operating Area" or "EOA" shall mean any
geographic area designated by the LEMSA, pursuant to Health and
Safety Code section 1797.224, where the provision of ambulance
services in response to 911 calls is restricted to one ambulance
Provider.
(u) "Exclusive Operation Area Agreement" or "EOA Agreement"
shall mean an agreement between a ground and/or air ambulance
service provider and the Local EMS Agency for the provision of
ambulance services in response to 911 calls in an EOA.
(v) "Health Director" shall mean the Director of the
Department of Public Health of Butte County or his/her
authorized representative or designee.
(w) "Local EMS Agency" or "LEMSA" shall mean Sierra Sacramento
Valley (S-SV) EMS, or such other agency as designated by the
County under Health and Safety Code section 1797.200.
(x) "Paramedic" shall mean an individual defined in Health and
Safety Code section 1797.84 with a scope of service set forth in
Health and Safety Code section 1797.172, trained in accordance
with the California Code of Regulations, Title 22 Chapter 4,
section 100139 et seq., and certified as such by the Local EMS
Agency.
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(y) "Patient" shall mean an injured, sick, or otherwise
incapacitated person.
(z) "Person" shall mean any individual, corporation,
partnership, association, trust, estate, municipal corporation,
city or special district.
(aa) ~~Provider" shall mean an ambulance company operating
pursuant to a valid Provider Agreement.
(ab) ~~Provider Agreement" shall mean an agreement entered into
pursuant to this Chapter between an ambulance service Provider
and the LEMSA pertaining to providing ambulance services in the
county. Such Agreements are of three types:
(1) Agreements for ALS Air ambulance service.
(2) Agreements for ALS non-911 ground ambulance services;
and
(3) Agreements for ALS 911 ground ambulance services, whic
Agreements shall be subject to a competitive bidding procurement
process and shall pertain to services within designated
Exclusive Operating Areas.
45-4. ADMINISTRATION AND ENFORCEMENT.
Except as otherwise specifically provided in this Chapter,
the LEMSA shall be responsible for the administration and
enforcement of this Chapter.
45-5. AUTHORITY TO SUSPEND.
The Health Officer shall have the authority to suspend all
or part of the EMRO in the case of a local emergency or
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catastrophe.
practicable.
The suspension shall be withdrawn as soon as is
ARTICLE 2. PROVIDER AGREEMENTS AND CERTIFICATES REQUIRED
X45-20. PROHIBITION.
(a) 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 entered into a Provider
Agreement with the LEMSA and obtained the current applicable
licenses or certificates as hereinafter provided.
(b) EOA Ambulance Service Provider Agreements. Every ambulance
company providing 911 ground ambulance services in an Exclusive
Operating Area (EOA) established in the county pursuant to
section 45-30 shall, in addition to entering into a Provider
Agreement with the LEMSA, enter into an EOA Agreement with the
LEMSA in accordance with the provisions of Article 3 of this
Chapter, unless otherwise provided.
(c) Air Ambulance Service Provider Agreements. Every Air
ambulance company located in the County and/or operating and
providing air ambulance services in the county shall enter into
an air ambulance service Provider Agreement in accordance with
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the provisions of Article 4 of this Chapter, unless otherwise
provided.
(d) Ambulance Certificates. Every ambulance or air ambulance
shall have a current inspection certificate issued by the
California Highway Patrol or applicable air carrier operating
certificate from the Federal Aviation Administration, unless a
public agency is exempted by law.
(e) Driver's License. Every Driver operating an ambulance shall
hold a currently valid California State Ambulance Driver's
License. Excepted from this requirement are 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.
(f) Attendant. Every person accompanying an ambulance patient
shall be an Attendant or, when determined by an attending
physician to be necessary in the case of an inter-facility
transfer, shall be a physician or registered nurse.
45-21. 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
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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 California 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 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.
ARTICLE 3. EXCLUSIVE OPERATING AREAS
X45-30. DESIGNATION OF EXCLUSIVE OPERATING AREAS.
The LEMSA shall, pursuant to Health and Safety Code sect
1797.224, divide the County into Exclusive Operating Area
("EOAs") for the purpose of designating areas within whi
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ground ambulance companies shall provide primary 911 emergent
service and the most timely and effective response in compliant
with the LEMSA policy and procedures for emergency dispatch. T
EOAs shall be shown on a map of the County kept on file with t
Health Director and filed with the Local EMS Agency EMS Plan.
45-31. EOA AGREEMENTS.
A competitive procurement process shall be utilized by the
LEMSA at appropriate intervals to select one or more ambulance
companies to provide exclusive 911 ambulance services in any
Exclusive Operating Area created pursuant to Health and Safety
Code section 1797.224.
45-32. EMERGENCY MODIFICATION OF EXCLUSIVE OPERATING AREAS.
The LEMSA 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.
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(d) Suspension, revocation or termination of an ambulance
service Provider Agreement under this Chapter. Upon request of
the LEMSA or Health Director under this section, an ambulance
service Provider shall cooperate fully and assume on a temporary
basis service responsibility in its expanded areas. Such service'
shall not be a violation of this Article or the Provider
Agreement for the EOA.
45-33. EXCLUSIVE OPERATING AREAS; PROHIBITIONS.
It shall be unlawful for any ground ambulance service
provider to provide any non-911 ambulance services within any
Exclusive Operating Area unless the Provider has entered into and
ALS Provider Agreement with the LEMSA.
45-34. EXCLUSIVE OPERATING AREAS; EXCEPTIONS.
An ambulance service Provider having a valid Provider
Agreement may provide emergency ambulance services in an
Exclusive Operating Area, not authorized by his/her Provider
Agreement under any of the following circumstances:
(a) Upon request by the LEMSA, a public safety agency or
another authorized ambulance service Provider when an ambulance
authorized 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's authorized and designated
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Exclusive Operating Area when the patient was picked up within
the authorized and designated Exclusive Operating Area.
(c) Upon request of the LEMSA, a Public Safety Answering Point
or authorized dispatch center request 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 MHOAC, the LEMSA, another ambulance
service Provider or a public safety agency to supplement
services during a multiple victim incident, or as otherwise
provided under EMS Policies and Procedures.
45-35. COMPETITIVE PROCESS.
As required, the LEMSA shall conduct a competitive
procurement process for selecting authorized Providers to
operate in Exclusive Operating Areas, which process shall
conform to "Guidelines for Creating Exclusive Emergency Medical
Services Operating Service Areas" issued by the California
Medical Services Authority in July 1985, or as subsequently
amended or supplemented. Where a competitive process is
required, the LEMSA may enter into a Provider Agreement with an
ambulance company for services within an Exclusive Operating
Area 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.
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(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) The compliance of the company with all applicable federal,
state, and county codes and regulations, and LEMSA policies and
procedures.
(h) 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.
45-36. APPLICATION FOR 911 EOA PROVIDER AGREEMENT.
Any person desiring to enter into a Provider Agreement to
provide 911 ground ambulance services in an EOA shall respond to
the applicable request for proposals issued by the LEMSA
pursuant to its competitive procurement process. Such response
shall comply with the requirements specified in said process,
include all the information and submittals required by Article 4
of this Chapter, and shall be processed in accordance with the
requirements of the competitive procurement process and Article
9.
ARTICLE 4. ISSUANCE OF AMBULANCE SERVICE PROVIDER AGREEMENTS
I45-40. APPLICATION FOR AMBULANCE SERVICE PROVIDER AGREEMENT;
INITIAL AND RENEWAL.
(a) Any person desiring a new or renewal ambulance service
Provider Agreement shall file an application with the LEMSA.
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Each application shall be accompanied by a reasonable
application fee covering any administrative costs related to
(processing, inspection and investigation.
(b) Any person holding a valid ambulance service Provider
(Agreement issued pursuant to this Chapter, other than a
temporary ambulance service Provider Agreement, may renew said
ambulance service Provider Agreement by filing an application
with the LEMSA 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 Agreement.
If a renewal application is not timely filed, the ambulance
service Provider Agreement shall automatically terminate on the
expiration date of the existing Provider Agreement, and the
former ambulance service Provider must thereafter file for a new
ambulance service Provider Agreement if he/she desires to do so.
(c) The LEMSA shall immediately forward to the Health Director
Ia copy of each new and renewal Provider Agreement application.
(d) Applications shall be made on such forms as may be
(prescribed by the LEMSA, must conform to all Provider
requirements set forth in the LEMSA's Provider policies, and
shall meet the requirements in the LEMSA ambulance application
packet.
45-41. LEMSA INVESTIGATION AND RECOMMENDATION.
The LEMSA shall review all applications for Provider
Agreements and make such investigation of the applicant and the
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vehicles, equipment and employees to be used by the applicant,
as it deems necessary and appropriate. The LEMSA shall process
the application in a manner consistent with the applicable
competitive procurement procedure. Upon the basis of the
application, evidence submitted and results of any
investigations and audits, the LEMSA 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, and shall consider
whether the findings required by Section 45-41.1 can be made. On
the basis of its findings, the LEMSA shall determine whether to
approve air ambulance and non-911 ground ambulance Provider
Agreements, and, as to 911 ambulance Providers which will
provide service in an EOA. The LEMSA Board shall, on the basis
of the findings and recommendations of the LEMSA Executive
Director, and its own findings pursuant to this Section, Section
45-41.1, and the requirements of the competitive procurement
process, determine whether or not to issue any EOA Agreement.
45-41.1. REQUIRED FINDINGS.
The LEMSA shall not approve air ambulance and non-911
ground ambulance Provider Agreements, and shall not recommend
911 ambulance Provider Agreements, unless all of the following
findings are made:
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(a) That the LEMSA has considered the impact the service will
have on the existing system in regards to emergency medical
care, cost of services, and any other issues relative to the
integrity of the existing system.
fi(b) That the applicant or its responsible managing employee is
adequately trained and experienced in the field of ambulance
services.
(c) That each ambulance will be staffed by at least two (2)
persons, one of whom is an Attendant and the other a Driver.
(d) That neither the applicant nor any co-partner or managing
employee thereof is registered as a sex offender under the
provisions of Penal Code Section 290.
(e) That the applicant or any co-partner or managing employee
thereof affirms that he neither habitually nor excessively uses,
used, nor is addicted to the use of narcotics or dangerous drugs
nor has been convicted of any offense relating to the use, sale,
possession or transportation of narcotics, mood or mind altering
or habit forming drugs.
(f) That the applicant or any co-partner or managing employee
thereof affirms that he is not a habitual user of intoxicating
beverages to excess.
(g) The applicant or any co-partner or managing employee thereof
within the three-year period immediately preceding the
application has not been under suspension, revocation, or
probation by the Department of Motor Vehicles for cause
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involving the safe operation of a motor vehicle and has not been
convicted of any of the following offenses:
(1) Failure to stop and render aid in an accident involving
injury or death;
(2) Driving while intoxicated;
~(3) Reckless driving.
(h) That the applicant or any co-partner or managing employee
thereof has not been convicted of any offense punishable as a
felony in the State of California and has not been convicted of
the crime of theft of either degree within the ten-year period
immediately preceding the application.
(i) The applicant or any co-partner or managing employee thereof
does not have any undisclosed financial interest in more than
one ambulance company operating within Butte County.
(j) That each ambulance owned or operated by the applicant has
been certified by the California Highway Patrol as in compliance
with the regulations pertaining to ambulances and complies with
the provisions of the EMRO.
(k) That the Local EMS Agency has certified the applicant's
compliance with all applicable regulations, standards, and
requirements.
(1) That the applicant has signed the statement of intended
compliance with the regulations set forth in Article 5.
45-41.2. ISSUANCE OF LICENSES PROHIBITED.
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No approval by any local governmental entity may be given
to any application for a business license or any other license
or permit to operate an ambulance or medical transport service
unless a Provider Agreement as required by the EMRO has been
approved by the LEMSA.
X45-41.3. RENEWAL APPLICATIONS.
An application for renewal of any Provider Agreement shall
be processed by the LEMSA in the same manner as an original
application for a Provider Agreement and denial shall be subject
to the same procedures as denial of an original application.
45-41.4. APPEALS.
In the event of a denial of a non-911 Provider Agreement
application by the LEMSA, the appeal procedure set forth by
LEMSA policy and procedure shall be followed and utilized.
45-42. INSURANCE; LIMITS; TERMINATION.
Each ambulance service provider shall obtain and keep in
(force, at its own expense, during the term of its Provider
Agreement and EOA Agreement, if applicable, insurance coverage,
in amounts not less than those set forth in LEMSA application
requirements or in the case of an EOA, the contract negotiated
between LEMSA and the provider.
(a) The Provider Agreement and/or EOA Agreement shall be deemed
automatically suspended during any period when such insurance is
not in full force and effect.
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(b) Said insurance shall contain coverage expressly recognizing
the indemnification obligations assumed by the ambulance
services or applicant in accordance with the EMRO, but shall not
be construed to limit in any manner the amount of an ambulance
service provider's liability thereunder.
(c) Said insurance coverages described above shall expressly
name the County of Butte, its Board of Supervisors, agents,
officers and employees as additional insureds.
(d) Said insurance shall not be subject to cancellation,
reduction or material alteration without sixty (60) days prior
written notice to the LEMSA. Any reduction or material
alterations in insurance coverage or change in carriers will be
reported by the LEMSA to the Health Director.
(e) Each ambulance placed in operation by the service shall be
included within the scope of the required insurance coverage and
limits.
(f) Upon receipt of any notice of cancellation or nonrenewal of
an insurance policy, the LEMSA may immediately order the
ambulance service Provider to cease service in Butte County and
to surrender and terminate any Provider Agreement or EOA
Agreement issued pursuant to the EMRO. Nothing contained herein
prohibits the Provider from appealing the action of the LEMSA
Executive Director in the manner specified in section 45-52 (b).
45-42.1. PROVIDER AGREEMENT REQUIREMENTS.
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(a) Each non-EOA Provider Agreement shall expire two (2) years
from its effective date and must be renewed prior to expiration.
(b) EOA Agreements shall be issued for each Exclusive Operating
Area for 911 ground ambulance service therein. Each Provider
shall be required to adhere to each EOA(s) requirements as
outlined in the applicable EOA Agreement and Provider Agreement.
(c) Any EOA Agreement and any Provider Agreement issued pursuant
to the EMRO shall be available for review in the principal place
of business of the Provider and shall not be altered or defaced
in any way. If any official entry on any such Agreement is
defaced, removed, obliterated, or altered in any way, the
Agreement may be subject to suspension under Article 5 of this
Chapter.
45-43. TEMPORARY PROVIDER AGREEMENTS.
Notwithstanding any provisions in this Chapter to the
contrary, if the LEMSA finds that the need for service to an EOA
or portion thereof, or to specific customers, justifies action
before a complete investigation and final determination can be
made pursuant to this Chapter, the LEMSA may issue a temporary
Provider Agreement, which shall be valid only for a stated
period, not to exceed six (6) months, on such conditions as the
LEMSA deems appropriate.
i145-44
EMERGENCY ISSUANCE OF TEMPORARY PROVIDER AGREEMENTS.
If ambulance service is disrupted or ended for any of the
reasons set out in section 95-32 or additional ambulance service
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is needed to prevent endangerment to the public health and
safety, the LEMSA may issue a temporary Provider Agreement so
that service is provided in any EOA or other service area or
service is increased to two or more ambulance service Providers
lin any EOA or other service area on a joint or rotating basis.
Such emergency issuance of a temporary Provider Agreement shall
be effective for a period not to exceed thirty (30) days
X45-45. AGREEMENTS; TRANSFERABILITY.
(a) No ambulance service Provider Agreement shall be
(transferred by sale, assignment, change of ownership, corporate
reorganization, merger, or otherwise, without the consent of the
LEMSA. Applicants for such transfers shall first file an
application with the LEMSA including such information and
documentation required by the LEMSA.
(b) The LEMSA shall investigate the proposed transfer and shall
file a report and recommendation with the LEMSA 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.
ARTICLE 5. RESPONSIBILITIES AND DUTIES OF AMBULANCE SERVICE
PROVIDER.
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~45-50. COMPLIANCE WITA LAWS, REGULATIONS, POLICIES AND
~ AGREEMENTS .
(a) Each Ambulance Service Provider shall comply with: the
provisions of the Emergency Medical Service System and the
Prehospital Emergency Medical Care Act, Health and Safety Code
sections 1797 et seq.; the California Code of Regulations, Title
22, sections 100000 et seq.; the LEMSA Policies and Procedures
Manual; and any applicable Provider Agreement or other written
agreement with the LEMSA and/or the County.
(b) In addition to the other requirements and obligations set
(forth in this Chapter, each ambulance service Provider shall:
(1) Render services required under this Chapter on a
twenty-four (29) hour a day basis throughout the entire
applicable EOA or other service area specified by the Provider
Agreement in accordance with the LEMSA Policies and Procedures
Manual. Such service shall commence on the date specified in the
Provider Agreement unless the LEMSA agrees to delay the
commencement date upon a showing of good cause by the ambulance
Provider.
(2) Notify the LEMSA 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. Copies of all related
state inspection and reporting forms used to evaluate the
Provider will be provided to the LEMSA.
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(3) Notify the LEMSA Medical Director and the State of
(California Emergency Medical Services Authority (EMSA) in
(writing as specified in Chapter 7 sections 1798.200 through
1798.211 of the California Health and Safety Code of any
(disciplinary action taken against any EMT or Paramedic employed
by the Provider which could result in suspension or revocation
of a certificate/license pursuant to California Code of
Regulations, Title 22, Division 9, Chapter 6.
(9) Notify the LEMSA 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.
(5) Immediately notify the LEMSA, the Health Director and
other affected public safety agencies beforehand of any
foreseeable interruptions, suspensions or delays in services
which may endanger the health, safety and welfare of the
residents of the EOA or other service area, or portion thereof,
covered by license.
(6) Immediately notify the LEMSA, the Health Director and
(other affected public safety agencies of any unforeseeable
interruptions, suspensions, or delays in service that occur and
result in the Provider being unable to put the required number
of ambulances in the field in accordance with its ambulance
Provider Agreement(s), and/or other contract(s) with the county
and/or the LEMSA, and/or the LEMSA Policies and Procedures
Manual.
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(7) Staff each ambulance with at least two (2) persons at
all times, one of whom is an Attendant and the other a Driver.
(8) Participate in the 9-1-1 telephone system of the County
45-51. AUTOMATIC SUSPENSION OF PROVIDER AGREEMENT.
Failure of any authorized ambulance service Provider to
comply with the notification requirements of section 45-50
(b)(5) or 45-50 (b)(6) shall result in the automatic suspension
of its ambulance service Provider Agreement effective
immediately upon interruption of service. If notification under
section 45-50 (b)(5) or 45-50 (b)(6) does not occur in time for
the LEMSA Board action before an interruption of service occurs
the LEMSA Executive Director may act under section 45-32 and/or
section 45-44.
Section 45-52. AMENDMENT OF AMBULANCE SERVICE PROVIDER
AGREEMENTS .
(a) An ambulance service Provider shall file an application
with the LEMSA if it desires to have its ambulance service
Provider Agreement amended to allow it to do any of the
following:
(1) Change the number of required 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) Modify or delete any of the conditions or terms of the
ambulance service Provider Agreement.
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(b) The LEMSA shall investigate any proposed change as
specified in subsection (a)(1) or (a)(2) and shall either
approve or disapprove any such change. Within ten (10) days of
receiving notice of the LEMSA's decision, an ambulance service
Provider may file with the LEMSA Executive Director a notice of
appeal to the LEMSA Board. Appeals to the LEMSA shall follow
the procedure(s) outlined in the LEMSA policy and procedure
manual. If the authorized ambulance service Provider desires a
hearing before the LEMSA Board, the authorized Provider shall
request such a hearing in writing at the time of filing his
appeal. The LEMSA Executive Director shall then file a report
and recommendation, including the LEMSA Director's original
decision and the ambulance service Provider's notice of appeal,
with the LEMSA Board regarding such proposal. The LEMSA Board
shall thereafter hold a public hearing on such appeal if a
hearing is requested by the ambulance service Provider or, if no
hearing is requested, the LEMSA Board may act on such appeal
without holding a public hearing.
(c) The LEMSA Executive Director shall investigate any
proposed change as specified in subsection (a)(3) and shall file
a report and recommendation with the LEMSA Board regarding such
proposal. The LEMSA Board shall thereafter hold a hearing on
such change as provided in this Chapter.
45-53. TERMINATION OF AMBULANCE SERVICE PROVIDER AGREEMENTS FOR
CAUSE.
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Any ambulance service Provider Agreement issued under the
provisions of this Chapter may be suspended or terminated if the
authorized ambulance service Provider or any of its employees or
agents has:
(a) Violated any of the provisions of this Chapter.
(b) Violated any provisions of this Code or other laws of
the County, the State or Federal government pertaining to the
operation of an ambulance, failed to comply with the LEMSA
Policies and Procedures Manual, or breached any written
Agreement with the County or LEMSA.
(c) Misrepresented a material statement of fact in the
application for an ambulance service Provider Agreement or
renewal thereof.
(d) Violated any of the terms or conditions of its Provider
Agreement or EOA Agreement.
(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.
45-54. SAME; INVESTIGATION AND CORRECTION OF MATERIAL BREACH.
The LEMSA shall, upon reasonable cause, investigate to
determine whether an ambulance service Provider appears to have
committed any act or failed to perform any duty specified in
violation of this Article. If the LEMSA determines that there is
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sufficient evidence of such a violation by a non-911 Provider,
the LEMSA may privately reprimand, publicly reprimand, require
corrective measures, or terminate the Provider Agreement, and
shall notify the Provider and the Public Health Director in
writing of its determination and action.
In all such cases except those in which the LEMSA
terminates the Provider Agreement, the ambulance Provider shall
meet with the LEMSA and the Public Health Director within 7 days
of receiving notification of the determination and action and
shall provide a corrective action plan with timetables and
deadlines for correction. If the LEMSA determines that there is
sufficient evidence of such a violation by a 911 EOA Provider,
the LEMSA shall notify the Provider and the Public Health
Director in writing of its determination and the action it
recommends
45-55. REVIEW BY THE LEMSA BOARD.
Upon receipt of the LEMSA's notice pursuant to section 45-54
pertaining to a violation of this Article by a 911 ambulance
service Provider, the LEMSA Executive Director shall set a date a
time for a hearing before the LEMSA Board and shall send a notice
thereof to the Provider. In the event the LEMSA Board determines
at the conclusion of the hearing that there has been a violation
this Article which constitutes an immediate threat to public heal
and safety, the LEMSA Board may determine that there has been a
material breach of the EOA Agreement and may terminate said
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Agreement immediately. As to all other violations, the LEMSA Board
shall mail the Provider written notice, return receipt requested,
setting forth with reasonable specificity the nature of the
violation(s). The Provider shall have the right to cure such
violations within seven (7) calendar days of receipt of such
notice. Within twenty-four (24) hours of receipt of such notice,
the Provider shall deliver to LEMSA, in writing, a plan of action
to cure such material breach. If the Provider fails to cure such
violation(s) within the period allowed for cure (with such failure
to be determined in the sole and absolute discretion of the LEMSA)
or the Provider fails to timely deliver the cure plan to the LEMSA
Board, the LEMSA Board may terminate the EOA Agreement. In the
event of termination of the EOA Agreement, the Provider shall
cooperate completely and immediately with the LEMSA and County to
effect a prompt and orderly transfer of all responsibilities to a
new Provider.
The Provider shall not be prohibited from disputing any such
finding of violation and any action by the LEMSA Board with respect
thereto through litigation; provided, however, that such litigation
shall not have the effect of delaying, in any way, the transfer of
911 ground ambulance service in the EOA to a new Provider.
45-56. EMERGENCIES; SUMMARY SUSPENSION.
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The LEMSA shall have the power to summarily suspend any
ambulance service Provider Agreement if it appears to the LEMSA,
in the exercise of its reasonable judgment, that the failure to
suspend the ambulance service Provider Agreement presents an
immediate threat or danger to the public health, safety and
welfare. The LEMSA shall immediately give notice to the Public
Health Director and the LEMSA Board of the suspension and the
reasons for the suspension in accordance with section 45-59 of
this Article and the LEMSA Board shall thereafter hold a hearing
on revocation of the ambulance service Provider Agreement
pursuant to section 45-55 of this Article.
45-57 INSPECTIONS.
(a) The LEMSA shall inspect, or cause to be inspected, every
ambulance before it is placed into use and annually thereafter.
The LEMSA may assign such inspection to a designee(s). The LEMSA
shall direct such inspection and review the report, consult with
the designee(s) and may order further inspection. Such
inspections do not duplicate, and shall not be in lieu of,
inspections performed or required by the California Highway
Patrol.
(b) After inspection, a written report shall be prepared
indicating every violation or omission of any requirement,
standard, or provision contained in the EMRO with respect to the
ambulance inspected. The report shall set a time period for
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correction of each violation or omission. A copy of the report
(shall be given to the Provider of the service concerned.
(c) In addition to the routine inspections required in
subsection (a), the LEMSA and/or designee may, at any time and
in his/their sole discretion, make non-routine inspections of
any unit, station or substation regulated hereunder for the
purposes of determining whether or not any aspect of the service
subject to the EMRO is, or is not, in compliance with the EMRO.
A written report shall be prepared pursuant to subsection (b).
45-58 AMBULANCE REQUIREMENTS.
(a) Operations, standards and procedures, equipment and
response times.
(1) In order to be placed into service, each ambulance must
be currently approved by the California Highway Patrol and the
LEMSA, pursuant to the EMRO.
(2) Each ambulance must be maintained in a safe operating
condition, including all engine parts, body parts, and all other
operating parts, and equipment used in and on the unit.
(3) Each ambulance must have affixed on each side and the
rear thereof the unit designation assigned by the operator and
name of the service. The lettering for such identification shall
be at least four (4) inches in height. The assigned unit
designation shall also be affixed to the ambulance top and shall
be at least twenty-four (29) inches in height.
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(4) Every ambulance operated in Butte County shall be in a
clean and sanitary condition subject to the sanitary standards
~as are prescribed by the LEMSA.
(b) Communication equipment. Each ambulance shall be equipped
with at least the following communication equipment:
(1) Standardized UHF/Mobile radio providing at least ten
(10) channels with fixed unit located in the patient compartment
Hof the vehicle.
(2) VHF 16 Channel (minimum) radio with Butte County
recommended frequencies.
(3) At least one (1) portable UHF radio.
Additional communications equipment requirements may be
established by the LEMSA.
(4) All radio communication equipment shall be narrow band
capable as required by the FCC.
(c) Required personnel.
(1) The service must maintain sufficient staff to ensure
twenty-four-hour dispatch capability.
(2) No service will allow either ambulance Attendants or
Drivers to work more than forty-eight (48) hours consecutively.
If a service allows its Attendants or Drivers to work forty-
eight (48) hours consecutively it is prohibited by this Chapter
to do so more than one (1) time per consecutive fourteen day
period. During any shift longer than twenty-four (24) hours,
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Drivers and Attendants shall perform only pre-hospital care and
shall have no other duties.
(3) In addition to any other requirements contained herein,
no service may utilize a Driver to operate a unit unless:
a. He or she is familiar with the EOA or other geographic
area of the Provider's service area;
b. He or she has adequate knowledge of all the hospitals
within the EOA or other geographic area of the Provider's
service area;
c. He or she can operate a two-way radio; and
d. He or she can drive an ambulance under emergency
conditions.
(4) Each service must provide written notice to the LEMSA
any change in personnel or ambulances, within ten (10) days
after such change, unless an alternate plan has been approved by
the LEMSA.
(5) Services may utilize only those Drivers and Attendants
who are appropriately licensed, certified and accredited.
(6) When in operation every ambulance must be staffed, at a
minimum, by two (2) persons, one of whom is an Attendant and the
other a Driver.
(7) Services must ensure to the best of their ability that
their attendants are free of physical defects or diseases which
may either endanger their patients or impair their ability to
attend to patients.
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(d) Insurance requirements.
(1) Each ambulance service Provider shall obtain and keep it
force during the term of its Provider Agreement insurance
coverage issued by a company authorized to do business in the
State of California and of the type and coverage amount
specified in Section 45-42.
(2) Each ambulance placed into operation by the Provider
shall be included within the scope of the required insurance
coverage and limits.
(e) Vehicle Equipment
(1) All ambulances must have equipment as specified in the
LEMSA policy referencing Vehicle Equipment List.
(2) A11 medical equipment and supplies on ambulances must
be stored pursuant to LEMSA approved medical control policies.
(f) Requirements for interior configuration, design and
dimension of ambulances. Each ambulance must:
(1) Contain at least three hundred (300) cubic feet of
space.
(2) Have additional shelf and other storage space
sufficient for controlled substances including locked storage in
accordance with Section 45-59.1.
(3) Have proper storage of other medical equipment and
supplies to prevent patient injury in transit and to meet
approved procedures for management of patients.
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(4) Have systems which will control temperature adequately
to maintain the integrity of the medical supplies and drugs as
well as the health and safety of the patients and Attendants.
(g) Maintenance program. Each ambulance, at a minimum, shall
~be maintained in accordance with a maintenance and replacement
(plan approved by the LEMSA.
(h) Required equipment reserve. Each Provider is to maintain a
minimum backup reserve to adequately meet response time
standards. These ambulances must normally be based in Butte
County and readily available for immediate use. The ambulances
would be used for high volume periods, standbys, and backup for
transfers and maintenance.
(i) Response time criteria. Each ambulance service Provider
shall meet or exceed the response time criteria established for
all areas as determined by LEMSA policy.
(j) Dispatching. Each 911 ambulance service Provider in Butte
County shall be required to adhere to the following dispatching
requirements:
(1) Any requirement set forth by the LEMSA in any
(competitive procurement process documents for the provision of
ambulance services which includes ambulance dispatch.
(2) Twenty-four-hour EMD.
(3) Have radio equipment sufficient to permit
(communication:
a. With all ambulances operated by the service; and
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b. Permitting communication with the service's local and
county public service answering points.
(4) Phone system with multi outside line capability.
(5) Back-up power system with an automatic start or
immediate access to an alternative dispatching source.
(6) Complying with all CHP guidelines.
(k) Call service. Non-911 ground ambulance service Provider
are not required to provide dispatching services as set forth in
sub-section j above. However, such Providers shall be required
to provide a call-answering service twenty-four hours per day,
seven days per week.
(1) Station requirements. Every station and substation used by
an ambulance service must meet the following requirements:
(1) Compliance with applicable building, fire, zoning and
land use codes and regulations;
(2) Adequate sanitary storage space for equipment and
materials to be used in the operation of the service;
(3) Communication capability with a central dispatch
facility having both a primary and secondary communication
system;
(4) Properly located to permit any ambulance operating
therefrom rapid and safe egress to a main thoroughfare;
(5) Adequate off-street parking space for all units
operating therefrom;
(6) Attended by EMD personnel on a twenty-four-hour basis,
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unless the service participates in a central dispatch facility
approved by the LEMSA and provides EMD and pre-arrival
instructions;
(7) At least one (1) additional clean uniform for each on
duty staff member;
(8) Maintained in a clean and sanitary condition and have
suitable sleeping quarters, and an on-site restroom facility;
(9) Maintain clean, sanitary and safe food preparation and
storage facilities.
(m) Every station and substation shall be inspected prior to
the issuance of any Provider Agreement and, thereafter, shall be
inspected at least once yearly by the LEMSA or its designee(s)
for the purpose of determining whether or not the station or
substation is in compliance with the EMRO and any other health
department regulations.
45-59.1 DRUGS, DANGEROUS DRUGS AND CONTROLLED SUBSTANCES.
All administration, supply, re-supply, documentation,
storage and security measures and destruction of drugs,
dangerous drugs, controlled substances and hypodermic devices
must be in compliance with all laws and regulations of the state
and federal government and the local EMS agency. As used in this
section, drugs, dangerous drugs and controlled substances have
the meaning ascribed to them in the State Board of Pharmacy
regulations.
45-59.2 AMBULANCE SERVICE; REQUIRED REPORTS AND RECORDS.
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(a) A report of each ambulance call shall be maintained by the
Provider and kept per CHP and LEMSA requirements. One (1) copy
of the report shall accompany patient's records and delivered to
the receiving medical facility in accordance with the LEMSA
documentation policy, and one (1) copy shall be filed with the
ambulance Provider.
(b) The provisions of subsection (a) of this section shall apply
with equal force where patients die before being so transported
therein or at anytime prior to the acceptance of the patient
into the responsibility of the hospital or medical or other
authority if the patient is still under the care or
responsibility of the ambulance.
(c) Records kept by any Provider pursuant to state regulations
shall, during regular business hours, be open to inspection by
the LEMSA or its designated representative upon request.
45-59.3. RULES AND REGULATIONS.
The LEMSA is hereby authorized and directed to propose
(rules and regulations prescribing and defining the duties and
procedures to be observed and complied with by an ambulance
Provider and by Drivers and Attendants, which rules and
regulations and any amendments thereof shall be subject to
approval by the LEMSA Board. Such rules and regulations shall
include, but not be limited to:
(1) Ambulance Vehicle Equipment List;
(2) Ambulance Maintenance Program; and
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(3) Ambulance Operation Standards.
Such rules and regulations and amendments thereto, when approved''
by the LEMSA Board through its Medical Control Committee shall
constitute enforceable provisions of the EMRO. Copies of said
rules and regulations and any amendments thereof shall be
delivered to each ambulance service Provider at the time the
Provider Agreement is issued.
45-59.4. SUPPLEMENTAL REGULATIONS.
The provisions of the EMRO shall be deemed as supplemental
to the provisions of any other pertinent laws or ordinances of
the county.
ARTICLE 6. ISSUANCE OF EMT and PARAMEDIC CERTIFICATES; DUTIES
AND RESPONSIBILITIES
45-60. EMT CERTIFICATE.
Any person desiring to act as or be employed as an EMT or
provide EMT services for an Ambulance Service Provider within
the County shall apply for and obtain an EMT certificate from
any LEMSA within the State in accordance with Health & Safety
Code sections 1797.210 and 1797.212 and in accordance with LEMSA
Policies and Procedures Manual.
45-61. (PARAMEDIC)LICENSE.
Any person desiring to act as or be employed as an EMT-P or
provide EMT-P services for an Ambulance Service Provider within
the County shall apply for and obtain an EMT-P license in
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accordance with Health & Safety Code sections 1797.172 and in
accordance with the State Emergency Medical Services Authority
(EMSA) and be accredited by the LEMSA.
45-62. RESPONSIBILITIES AND DUTIES OF EMTs AND PARAMEDICS.
In addition to the other requirements and obligations set forth
in this Chapter, each EMT, Paramedic 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.; the California Code of Regulations, Title
22, section 100000 et seq.; and the LEMSA 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 LEMSA Policies and Procedures
Manual.
ARTICLE 7. COMPLAINT PROCEDURE
45-70 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 LEMSA setting forth in detail the reasons for said
complaint. The LEMSA shall notify the local orrice oz the
California Highway Patrol of any such complaint if appropriate,
investigate the allegations contained in the complaint and, if
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there is substantial evidence to verify said allegations, the
LEMSA shall notify the Health Director and the ambulance
Provider of his findings, and the measures to be taken pursuant
to sections 45-63, 45-51, or 95-54, if any.
ARTICLE 8. LEMSA BOARD DECISIONS AND JUDICIAL REVIEW
~45-80. LEMSA BOARD DECISIONS FINAL; NEW APPLICATIONS.
The determination of the LEMSA Board after the conclusion of
any hearing pursuant to this Chapter shall be final. An
applicant or authorized ambulance service Provider may not
submit a new application for a Provider Agreement to serve the
same or a portion of the same EOA or other service area
determined adversely to it, of for which its Agreement has been
terminated for cause, for a period of six (6) months after said
determination has been made by the LEMSA Board, unless the LEMSA
Board finds that the public interest requires a reconsideration
of the matter within a shorter period of time.
45-81. JUDICIAL REVIEW OF DECISION.
Judicial review of a decision of the LEMSA Board made after a
hearing pursuant to this Chapter, if the decision terminates an
ambulance service Provider Agreement, shall be made pursuant to
section 1094.6 of the Code of Civil Procedure of the State of
California. The method of judicial review, the time limits for
judicial review, and all of the other provisions of said section
1094.6 shall govern such judicial review. When giving written
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(notice to the applicant that the ambulance service Provider
(Agreement application has been denied or an ambulance service
Provider Agreement revoked, the LEMSA Board shall notify the
applicant or an ambulance service Provider that the time within
which judicial review must be sought is governed by said section
11094.6.
Section 2. Severability. If any provision of this Ordinance orb
(the application thereof to any person or circumstances is for
any reason held to be invalid by a court of competent
jurisdiction, such provision shall be deemed severable, and the
invalidity thereof shall not affect the remaining provisions or
other applications of the Ordinance which can be given effect
without the invalid provision or application thereof.
Section 3. Effective Date and Publication. This Ordinance
shall take effect thirty (30) days after the date of its
passage. The Clerk of the Board of Supervisors is authorized
and directed to publish this ordinance before the expiration of
fifteen (15) days after its passage. This Ordinance shall be
published once, with the names of the members of the Board of
Supervisors voting for and against it, in the Chico Enterprise
Record, a newspaper of general circulation published in the
County of Butte, State of California.
PASSED AND ADOPTED by the Board of Supervisors of the County of
Butte, State of California, on the 21st day of May, 2013, by the
following vote:
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AYES: Supervisors Wahl, Kirk, Lambert, Teeter and Chair Connelly
NOES: None
ABSENT: None
NOT VOTING: None
`~~
Bill Connelly, Chair of the
Butte County Board of Supervisors
(ATTEST:
Paul Hahn, Chief Administrative Officer
an
IBy
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