§ 28-5. Permits and permittees.

(a)

Permits. It shall be unlawful for any person, either an owner, agent or otherwise, to operate, conduct, advertise, or otherwise engage in or profess to be engaged in, the business or service of the transportation of emergency medical patients in the county of Sonoma without possessing a valid permit to do so from the county. A permit shall not be required for:

(1)

Fire district or fire department owned and operated ambulances;

(2)

Vehicles operated as ambulances at the request of local authorities during any "state of war emergency," duly proclaimed "state of emergency," or "local emergency" as defined in the California Emergency Services Act (Chapter 7 of Division 1 of Title 2 of the Government Code) as amended.

(b)

Temporary Permit. A temporary operating permit may be authorized by the EMS agency for ambulance services based outside the county and properly licensed by the California Highway Patrol or Federal Aviation Administration for up to thirty (30) days for special activities. Such temporary operating permit shall conform to the requirements of Section 28-5(e) and shall contain such additional conditions and restrictions as the EMS agency medical director deems appropriate for the operation. Temporary permit fees shall be as determined by the board of supervisors.

(c)

Nontransferable. Permits issued in conformance to this section are nontransferable.

(d)

Duration. Permits are valid for one (1) fiscal year (July 1st—June 30th).

(e)

Permit Fees. Permit fees shall be those set by resolution of the board of supervisors, county of Sonoma. All permits shall be issued for a fiscal year from date of issuance. Upon demonstration of financial hardship, permit fees may be waived for public agencies.

(f)

Application for a Permit or Renewal of a Permit. Prerequisites for the issuance of a permit or renewal of a permit for an applicant shall include filing an application in writing on approved forms which shall provide the following minimum information:

(1)

Name and description of the applicant;

(2)

Business address and residence address of record of the applicant;

(3)

Trade or firm name, or DBA as registered with the county clerk;

(4)

If a corporation, a joint venture or a partnership or limited partnership, the names of all partners, or the names of corporate officers and owners, their permanent addresses and their percentage of participation in the business;

(5)

A statement of facts showing the experience of the operator and the operations of an ambulance service and that the applicant is qualified to render efficient twenty-four (24) hour ambulance service. For ground ambulances, a photocopy of the license issued by the commissioner of the California Highway Patrol to privately owned ambulances in accordance with Section 2501, California Vehicle Code, and Title 13, California Code of Regulations, shall be appended to the application. For air ambulances, a photocopy of the air carrier operating certificate issued by the Federal Aviation Administration shall be appended to the application;

(6)

The approximate geographical area proposed to be served by the permittee;

(7)

A statement of facts that the applicant owns or has under his control, in good mechanical condition, required equipment to adequately conduct an ambulance service in a territorial service area for which he is applying which meets the requirements established by the California Vehicle Code, applicable California Code of Regulations, and this chapter, and that the applicant owns or has access to suitable and safe facilities for maintaining his ambulance in a clean and sanitary condition;

(8)

A declaration provided under penalty of perjury, amended as required during the year, for any changed, substituted, loaned or leased vehicles, giving a complete description of each ambulance vehicle operated by the applicant, including the patient capacity thereof, and a copy of the most recent ambulance inspection report issued by the California Highway Patrol for each vehicle;

(9)

A declaration under penalty of perjury, that each permitted ambulance and its appurtenances conform to all applicable provisions of this chapter, the California Vehicle Code, and the California Code of Regulations, and any other state or county applicable directive shall be provided to the department prior to the start or renewal date of ambulance operations;

(10)

A covenant that the applicant employs sufficient certified personnel adequately trained to deliver emergency medical services of good quality at all times at the applicant's proposed level of service;

(11)

A covenant amended as required during the permit year for any personnel changes for renewal applications, giving a description of the level of training and record of completed required annual training for each ambulance employee, and a copy of each certificate or license issued by the state and county establishing qualifications of such personnel in ambulance operations shall be provided to the EMS agency medical director prior to the start or renewal of ambulance operations;

(12)

A schedule of rates, including any special rates, to be charged by the permittee for ambulance services provided under this chapter;

(13)

A covenant signed by the applicant that as a condition of the county issuing a permit, applicant agrees to appear and defend all actions against the county arising out of the exercise of said permit, and shall indemnify and save the county, its officers, employees and agents harmless from all claims, demands, actions or causes of actions of every kind and description resulting directly or indirectly, arising out of, or in any way connected with, the exercise of this permit;

(14)

Such other facts or information as the EMS agency medical director may require.

(g)

Investigation by Local EMS Agency. Upon the receipt of a completed application, the local EMS agency may conduct an investigation to determine if the applicant meets all the requirements of this chapter. Upon completion of this investigation, the director of public health/EMS agency medical director shall recommend to the board of supervisors that a permit be granted, denied or conditioned for the requested ambulance service area, as set forth below.

(h)

Issuance or Denial of Permit.

(1)

The board of supervisors may order the issuance of a permit to conduct an ambulance service in a specified area upon finding that the applicant meets all requirements of this chapter.

(2)

The board of supervisors may order the denial of a permit if the applicant or any partner, officer or director thereof:

(i)

Was previously the holder of a permit issued under this chapter which permit has been revoked or not reissued and the terms or conditions of the suspension have not been fulfilled or corrected;

(ii)

Is committing any act which if committed by a permittee would be ground for the suspension or revocation of a permit issued pursuant to this chapter;

(iii)

Has acted in the capacity of a permitted person or firm under this chapter without having a permit therefor;

(iv)

Has entered a plea of guilty to, or been found guilty of, or been convicted of a felony or a crime involving moral turpitude, and the time for appeal has lapsed or the judgment of conviction has been affirmed on appeal, irrespective of an order granting probation following such conviction suspending the imposition of sentence or of a subsequent order under the provisions of Section 1203.4 of the Penal Code allowing such person to withdraw his plea of guilty and to enter a plea of not guilty or setting aside the plea or verdict of guilty, or dismissing the accusation or information.

(i)

Corrective Action. The provision of ALS and emergency medical services is critical to the public health and safety. The purpose of corrective action under this chapter is to correct violations which may affect public health and safety; it is not punitive. This provision shall be construed so as to maximize the safety and welfare of patients.

(j)

Permit Denial, Revocation or Suspension Grounds. A permit may be revoked or suspended if the applicant permittee or its employees, partners, officers or directors commits or has committed any of the actions listed in Health and Safety Code Section 1798.200 (a) through (k). In addition, a permit may be revoked or suspended for the following:

(1)

A person knowingly makes any false statement or fails to disclose or suppresses another from disclosing material facts in an application, report or other document furnished to the local EMS agency;

(2)

In the case of an applicant or permittee, said applicant or permittee is not the real party in interest in the business;

(3)

Is required to register as a sex offender under the provisions of Section 290 of the California Penal Code;

(4)

Habitually or excessively uses or is addicted to the use of narcotics or dangerous drugs;

(5)

Habitually or excessively uses intoxicating beverages;

(6)

In the case of a driver has been culpably involved during the preceding year in any motor vehicle accident causing death or bodily injuring or in three (3) or more motor vehicle accidents;

(7)

Has been convicted during the preceding seven (7) years of any offense involving moral turpitude, including fraud or intentional dishonesty for personal gain;

(8)

Has been convicted during the preceding seven (7) years of theft or any felony involving force, violence, threat, or intimidation;

(9)

Aids or abets an unlicensed person to evade compliance with provisions of this chapter;

(10)

Permits operation of ambulance service in violation of any provision of this chapter or any other law, regulation, or policy of the county, state or federal government pertaining to the operation of an ambulance;

(11)

Knew or should have known of falsified data supplied to the county EMS agency during the course of operations, including, but not limited to, dispatch data, patient report data, response time data, financial data, or falsification of any other data permittee is required to submit to the Sonoma County EMS agency;

(12)

Failure to maintain equipment in accordance with safe industry standards;

(13)

Failure of permittee's employees to conduct themselves in a professional and courteous manner, where reasonable remedial action has not been taken by permittee;

(14)

Failure to comply with any applicable service response time standards. "Failure" is defined as failure to meet or exceed such standards according to the terms outlined in the agreement for service;

(15)

Any other wilful acts or negligent omissions of permittee which endanger the public's health and safety;

(16)

When the EMS agency medical director determines that grounds for corrective action may exist, he shall conduct an investigation. He shall notify the applicant or permittee in writing that he believes grounds may exist for corrective action and shall specify the nature of the grounds. He shall notify the permittee that he is investigating whether corrective action is necessary to preserve public health and safety, and shall afford the permittee a reasonable opportunity to be interviewed during the course of the investigation;

(17)

At the conclusion of the investigation the permittee shall be notified as to whether or not a violation exists and, if so, shall specify the nature of the violation(s). If the violation is curable in the determination of the EMS agency medical director, a reasonable period to correct the violation shall be authorized;

(18)

If the EMS agency medical director concludes that revocation, suspension or imposition of conditions is warranted, he shall so notify the permittee specifying the grounds for said action. The permittee shall have twenty (20) days from the mailing of said notice to request a hearing before an investigative review panel (hereinafter "IRP"). Said IRP shall be comprised of a base hospital physician, a mobile intensive care nurse, and an Emergency Medical Technician-P. The IRP shall be aided by a nonvoting presiding officer, an attorney, who shall consider the admissibility of evidence as well as preliminary questions regarding the conduct of the hearing including, but not limited to, good cause for postponements and extensions of time beyond the times permitted in the California Code of Regulations for IRPs or those set forth in this chapter. Procedures related to this hearing shall be, to the extent applicable, identical to those set forth for similar investigative review panels in the California Code of Regulations, except that the findings and conclusions of the IRP shall be or are subject to judicial review pursuant to Section 1094.5 et seq. of the Code of Civil Procedure;

(19)

Permit Summary Action. Other corrective action notwithstanding, the EMS agency medical director shall have the power to take summary action against any permit, if it appears in the exercise of reasonable judgment by the EMS agency medical director that the failure to take action against the permit presents an immediate threat or danger to the public health, safety or welfare. The EMS agency medical director shall immediately give notice to the board of the action and the reasons for it. At any time during the effective period of the summary action, but not more than once during any single summary action effective period, the permittee may request a hearing by submitting a written request to the EMS agency medical director. Upon receipt of such a request, the EMS agency medical director shall schedule a hearing before the board of supervisors to be conducted at a regular or special meeting. At the hearing, the board shall consider whether the summary action shall remain in effect pending full investigation and an IRP, as specified above. The hearing shall be scheduled as soon as possible following the EMS agency medical director's receipt of a written request, but not later than thirty (30) days following the receipt of request. Appeal procedures for emergency actions of the EMS agency medical director are the same as those delineated in Section 28-26 of this chapter.

(k)

Renewal of Permits.

(1)

Permits shall be renewed annually by the EMS agency upon application of the permittee if it is determined that the permit holder has during the period of the expiring permit operated in conformity with the provisions of this chapter and adopted rules and regulations thereto and that the permittee is capable of continuing operation in conformity.

(2)

Annually, or more often if requested by the EMS agency medical director, each permittee shall submit compiled patient and ambulance operation information pursuant to Section 28-7(a).

(l)

Amendment of Permits.

(1)

Upon request by the permittee, the EMS agency may amend the conditions specified in the permit when such changes are in substantial compliance with the provisions of this chapter.

(2)

Such amendments shall not affect the expiration date of the existing permit.

(3)

Such amendments shall not authorize a change in ownership from that specified in the original permit.

(4)

Change in level of service shall not be allowed unless in compliance with the Sonoma County EMS plan.

(5)

A permittee must conform with the requirements of the permit unless revision is approved by the board of supervisors or EMS agency medical director as may be applicable.

(m)

Conditional Operation and Temporary Variance.

(1)

In the event of a change in ownership of any kind or nature, any interruption of service of more than twenty-four (24) hours duration, or any substantial change in staffing or equipment of the ambulance service which causes the ambulance service to be carried out differently than specified in the current operating permit, the permittee shall notify the EMS agency medical director immediately in writing, stating the facts of such change.

(2)

Upon request by the permittee, the EMS agency medical director may grant a temporary waiver from the condition so specified in the original permit if he finds that such change is in substantial compliance with the provision of this chapter and is not a threat to public health and safety. If the EMS agency medical director finds that such change is not in compliance with this chapter, he may suspend or revoke the permit. In all cases when a change of ownership occurs in an ambulance service, an application for a new permit shall be filed with the department within thirty (30) days. In no case shall any temporary variance be valid for more than sixty (60) days without written approval of the board of supervisors.

(n)

Responsibilities and Duties of Permittees. In addition to the other requirements and obligations set forth in this chapter, permittees shall:

(1)

Render services required under this chapter on a twenty-four (24) hour a day basis. Such service shall commence five (5) days after the issuance of a permit unless time extension is granted by the EMS agency medical director or board of supervisors;

(2)

Not discontinue any services to the service area or any portion thereof without first giving written notice to the EMS agency at least ninety (90) days prior to the proposed discontinuance;

(3)

Notify the EMS agency 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;

(4)

Notify the EMS agency in writing within five (5) days after being informed of any disciplinary action being taken by the state against any ambulance driver or attendant employed by the permittee;

(5)

Notify the EMS agency medical director in writing within thirty (30) days of any other changes in the information set forth in any application, certification document required by this chapter;

(6)

Notify the EMS agency and other affected public safety agencies beforehand of any known or foreseeable interruptions, suspensions or delays in services which may endanger the health, safety and welfare of the residents of the service area or portion thereof, served by the permittee.

(o)

Bonding of Applicant. Before any permit is issued under the provisions of this chapter, the board shall require the applicant, as a condition to the issuance of the permit, to post with the clerk of the board a cash bond in the sum of one hundred thousand dollars ($100,000.00) or a surety bond in the same amount furnished by a corporation authorized to do business in the state of California, payable to the county of Sonoma. The bond shall be conditioned upon the full and faithful performance by the permittee of his obligations under the applicable provisions of this chapter and shall be kept in full force and effect by the permittee throughout the life of the permit and all renewals thereof. The board of supervisors may by resolution establish additional or lower bond requirements. The bond requirement shall be waived by resolution of the board of supervisors if public need and necessity require it or the applicant has demonstrated his ability to meet the obligations of this chapter by three (3) or more years of providing emergency medical services in Sonoma County. The bonding requirement may be instituted for cause. The bonding requirement shall be waived for municipal ambulance providers. The bonding requirement shall be waived for fire district or fire department ambulance services.

(p)

Liability Insurance.

(1)

General Liability for Vehicle Operation. The permittee shall obtain, and keep in force during the term of said permit, public liability and bodily injury insurance, issued by a company approved by the county of Sonoma and authorized to do business in the State of California, insuring the owner and also naming the county as an additional insured of such ambulance 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 of any other law of the state of California, or the United States. Said policy shall be in the sum of not less than one million dollars ($1,000,000.00) combined single limit for personal injury and property damage for each vehicle in any one accident. Workers' compensation insurance shall be carried covering all employees of the permit holder. Copies of the policies, or certificates evidencing such policies, shall be filed with the EMS agency medical director before a permit is issued. All policies shall contain a provision requiring a minimum of fifteen (15) calendar days' notice to be given to the county prior to cancellation, modification or reduction in limits. The amounts of public liability insurance for bodily injury or property damage shall be subject to review and adjustment by the board annually at the board's option. Municipal fire department and fire district ambulance services may submit their self-insurance programs for review and approval by the county.

(2)

Medical Liability. The permittee shall defend, indemnify and hold harmless the county, its agents and employees, from and against any and all claims and actions for damages or losses to persons or property arising out of or in connection with the activities of the permittee, his/her agencies or employees, in which the claim or action against the county is in any way derived from or vicariously based upon the activities of the permittee, his/her agencies or employees. Said defense and indemnification shall include, but not be limited to, any and all costs, expenses, attorneys' fees and liability incurred in defense of such claims or actions whether same proceeds to judgment or not. Permittee shall maintain comprehensive medical liability insurance in the amount of one million dollars ($1,000,000.00) and shall furnish the EMS agency medical director with a certificate of insurance prior to issuance or renewal of an operational permit. Said policy shall name the county as co-insured and shall require a minimum of fifteen (15) calendar days notice to be given to the county prior to cancellation, modification or reduction in limits. The amount of liability coverage shall be subject to review and adjustment by the board annually at the board's option. Fire department and fire district ambulance services may submit self-insurance programs for approval by Sonoma County.

(Ord. No. 4435 § 2, 1991; Ord. No. 4386 § 1, 1991.)