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ORDINANCE NO 756.1

AN ORDINANCE OF THE COUNTY OF RIVERSIDE AMENDING ORDINANCE NO. 756 ESTABLISHING REGULATIONS FOR ALS AMBULANCE, AIR AMBULANCE, BLS AMBULANCE, AND CRITICAL CARE TRANSPORT PROVIDERS

The Board of Supervisors of the County of Riverside Ordains as Follows:

Section 1. Ordinance No. 756 is amended in its entirety to read as follows:

“AN ORDINANCE OF THE COUNTY OF RIVERSIDE ESTABLISHING REGULATIONS FOR ALS AMBULANCE, AIR AMBULANCE, BLS AMBULANCE, CRITICAL CARE TRANSPORT AND SPECIALIZED SERVICES TRANSPORT PROVIDERS

Section 1. PURPOSE AND INTENT.

The County, through its EMS Agency and as identified in its Emergency Medical Service Plan, has determined the need to enact local regulations consistent with, and which enhance the County's responsibilities under, the "Emergency Medical Services System and the Prehospital Emergency Medical Act" (Health & Safety Code Sections 1797 et seq.) and which further serve and protect the health and safety of patients in the County while being transported.

Section 2. DEFINITIONS. As used in this ordinance, unless otherwise stated, words and terms shall be defined as follows:

Section 3. PROHIBITIONS. It is prohibited and shall be unlawful for any person or entity to operate, or advertise the operation of an ALS Ambulance, an Air Ambulance, a BLS Ambulance, Critical Care Transport Provider, or a Specialized Services Transport Provider service in the County without having obtained a Provider Permit to do so, or as otherwise may be authorized by this ordinance, or if having a Provider Permit, to operate or advertise in violation of the terms, conditions, or restrictions of said Provider Permit.

Section 4. NON-APPLICABILITY.

1. A non-permitted ALS Ambulance or Air Ambulance service provider based and operated under the regulatory authority of a governmental entity other than the County may operate in the County for a limited purpose of transporting patients to or through the County if the transportation of the patient was initiated outside the County.
2. A non-permitted BLS Ambulance or CCT/SST service provider based and operated under the regulatory authority of a governmental entity other than the County may operate in the County for limited purpose of transporting Patients to or through the County if the transportation of the patient was initiated outside the County.
3. In the event of a local disaster, as proclaimed by the Riverside County Board of Supervisors, the requirements of this ordinance may be suspended in whole or part by the Director of the Emergency Management Department until such time as the disaster proclamation is rescinded.

Section 5. PROVIDER PERMITS.

A. Initial Issuance. Pursuant to the procedures and conditions established, or as may be established, by this ordinance and REMSA policies, the Permit Officer shall issue Provider Permits and Provider Unit Permits to:

1. ALS 911 Emergency Ambulance Provider(s) as approved pursuant to the EMS Plan.
2. ALS Inter-facility Ambulance Provider(s) for operation in the County.
3. Air Ambulance Provider(s) for operation in the County.
4. BLS Ambulance and CCT Service Provider(s) for operation in the County.
5. Specialized Services Transport (SST) Providers for operation in the County (Hospital based PICU/NICU Team Transport only).

B. Renewal. An application for renewal of a Provider Permit shall be submitted to the Enforcement Officer at least sixty (60) days prior to the expiration of the Provider Permit to be renewed. A Permit Holder shall have its permit renewed upon expiration if the Permit Holder does not seek a substantial change in the permit and there do not exist grounds for denial for renewal of the permit as specified in Section 5 subsection M of this ordinance. For the purpose of this subsection, a "substantial change in the permit" shall mean a change in the level, scope or manner of service permitted under the Permit Holder's current or previous Provider Permit or such condition as may be determined by the Permit Officer.

1. Late Renewal Application Penalty. If a Permit Holder makes application for the renewal of a Provider Permit less than sixty (60) days prior to the expiration of the Permit Holder's Provider Permit for which renewal application is made, the Permit Holder shall pay an additional twenty percent (20%) of the fee due.

C. Expiration. Except as provided herein below for the issuance of temporary Provider Permits, all Provider Permits shall expire on the date of June 30 of each year.

D. Application. Application for a Provider Permit shall be made to the Enforcement Officer on form(s) as may be prescribed by the Permit Officer. At the time the application is made, the applicant shall provide, the information as required in REMSA Ambulance Permit Policy.

E. Application Review. Upon the submittal of an application, the EMS Agency shall review the application to ensure its conformity with Section 5 subsection D. of this ordinance within ninety (90) days of receipt, unless the Enforcement Officer investigates pursuant to Section 5 subsection F. Where the Enforcement Officer conducts such an investigation, the review of an application shall be completed within one hundred twenty (120) days of receipt. Upon the completion of the application review, and further investigation if required, the applicant shall immediately be notified in writing of the granting or denial of the application by the Enforcement Officer.

F. Application Investigation. Upon receipt of an initial or renewal application, the Enforcement Officer may conduct, or cause to be conducted, an investigation into the applicant's proposed provision of service, if deemed necessary.

G. Denial of Permit Upon Initial Application. An Initial Application for a Provider may be denied by the Enforcement Officer. For the purpose of this subsection, an "Initial Application" shall mean an application submitted by an applicant that is not a Permit Holder at the time application is made or, if a Permit Holder, makes application for a Provider Permit other than which it presently holds and would therefore not qualify for renewal of a Provider Permit as provided in Section 5 subsection C of this ordinance. The grounds for denial of an initial application shall be provided in REMSA Ambulance Permit policy.

1. Notification. The Enforcement Officer shall provide the applicant with written notification that its application has been denied and stating the grounds upon which the denial is based as provided hereinabove and a brief statement of the facts and circumstances upon which Enforcement Officer has made his/her determination that the grounds for the denial of the application exists. Said notification shall also advise the applicant of its right to have the decision to deny the application reviewed by the Permit Officer pursuant to procedures prescribed herein below.
2. Procedure for Review.

a. Within fifteen (15) days of receipt of written notification that its initial application has been denied, the applicant may file a written request for review of the Enforcement Officer’s decision to deny the application. The applicant’s request for review shall briefly state the reasons that the Enforcement Officer’s decision to deny the initial application should be reversed. The applicant may accompany the request for review with documentation relevant to its basis for requesting the review.

b. The Permit Officer, upon timely receipt of a request for review of denial of an initial application, shall, within thirty (30) days, conduct such further investigation as may be warranted after due consideration of the applicant's request. Thereupon the Permit Officer may vacate the Enforcement Officer’s decision to deny the application for initial permit and grant said application.

c. If, upon further consideration of the request for review, the Permit Officer does not reverse the Enforcement Officer’s decision to deny the application, the Permit Officer shall so notify the applicant in writing and further advise the applicant that the Permit Officer will personally hear the request, if requested by the applicant, to ensure that the request and all relevant information is given due consideration by the Permit Officer.

d. In no event shall the Permit Officer's review of the request exceed a period of sixty (60) days after the applicant's written request is received, unless the applicant and Permit Officer so stipulate to an extension of this time period for review of the request.

e. The decision of Permit Officer to deny an initial Provider Permit shall be final.

H. Condition of permit. The acceptance of a Provider Permit shall obligate the Permit Holder to meet otherwise fulfill each condition set forth in the REMSA policies and this ordinance.

I. Form and Content of Permits. Provider and Provider Unit permits shall be issued in a form as may be prescribed by the Permit Officer. The content of a Provider Permit shall include, but not be limited to, the Provider authorized under the permit, any special conditions or restrictions as authorized by this ordinance and, as to ALS Ambulance Provider, the Exclusive Operating Area(s) as prescribed by the EMS Plan within which such provider shall operate.

J. Permit Variance. Upon written request by a Permit Holder, the Permit Officer may grant a variance in writing from the conditions specified in a Permit Holder's permit if the Permit Officer finds that such change is in substantial compliance with the minimum provider operation requirements established by this ordinance and appropriate REMSA policies and that such action is necessary to protect the health, safety, or welfare of public or to better serve the public

K. Provider Permit Transfer Prohibition. The transfer of a Provider Permit from a Permit Holder to another person or entity shall be prohibited. The transfer of a Permit Holder's ownership interest in part or whole in a permitted Provider shall require the filing of an initial application for a Provider Permit by the person or entity to whom ownership will be transferred.

L. Provider Unit Permit Transfer Prohibition. The transfer of a Provider Unit Permit from one Provider Unit to another Provider Unit is prohibited. For any permitted Provider Unit that ceases to be operational, the Permit Holder shall give written notice of this fact to the Enforcement Officer. The Permit Holder shall file a written request for Provider Unit permit which the Permit Holder intends to operate under a Provider Permit, but which has not been previously issued a Provider Unit Permit. The Permit Holder shall pay the established Provider Unit fee at the time of such request.

M. Denial of Renewal, Suspension and Revocation of Provider Permit. The Enforcement Officer, after conducting an investigation or upon such facts or circumstances as may be known to him/her, may deny the renewal of, suspend or revoke a Provider Permit issued under the provision of this ordinance when it has been found that a Permit Holder has not met the provisions listed in REMSA ambulance permit policy and/or this ordinance. In addition to the foregoing grounds, those listed in REMSA policies, and/or others list in this ordinance, the Enforcement Officer may deny renewal, suspend or revoke a Provider Permit when the continued operation of the permitted provider causes, or threatens to cause, harm to the health and safety of the public as determined by the Permit Officer.

1. Notification.

a. Upon the Enforcement Officer's denial of renewal, suspension, or revocation of a Provider Permit, he/she shall give the Permit Holder written notice of such determination by mail via electronic and certified. The written notice shall advise the Permit Holder of the grounds upon which the action is being taken, a brief statement of the facts or circumstances in support of such grounds, and the effective date(s) of the adverse action.

b. The denial of renewal of a Provider Permit shall be made no more than thirty (30) days after the Permit Holder makes application for renewal of a Provider Permit.

c. The suspension or revocation of a Provider Permit shall be effective no less than fourteen (14) days after receipt of notification, unless the Enforcement Officer makes a determination that the protection of the public health and safety warrants the immediate suspension or revocation of a Provider Permit in which case the suspension or revocation will be effective upon the Permit Holder's receipt of the notification.

2. Administrative Review.

a. Within seven (7) days of receiving notification of denial of renewal, suspension or revocation of its Provider Permit, the Permit Holder may request that the Permit Officer review the adverse action. The administrative review request shall be in writing. The written request for administrative review must be accompanied by a deposit equal to the full amount of the administrative fine(s) specified in the notice of administrative fine, if applicable. Failure to deposit this amount concurrently with the request for administrative review shall constitute a waiver of the operator’s entitlement to the administrative review. The review request and fee deposit shall be deemed filed on the date received by the local EMS agency.

b. Absent a determination by the Permit Officer that the immediate imposition of an adverse action as provided in this subsection is warranted, the Permit Officer shall set a date, time and location for the requested review prior to the date(s) set for the proposed adverse action and shall give written notice of same to the Permit Holder. The date set for the administrative review shall not be continued beyond the date set for imposition of the adverse action unless such continuation is mutually agreed to by the Permit Officer and the Permit Holder.

c. In the review, the Permit Holder shall have the burden of presenting all arguments and/or information relevant to the Permit Officer's action or mitigation thereof. The failure of the Permit Holder to appear at the administrative review shall constitute an abandonment of the review request and a failure to exhaust administrative remedies to judicially the imposition of the administrative fine. If the administrative review is abandoned, the issuing department shall keep the funds deposited with the review request.

d. After the administrative review, the Permit Officer may affirm, modify, or set aside the original adverse action. The Permit Officer shall give written notice of such decision to the Permit Holder, as soon as possible. However, in no event shall such notice be given more than seven (7) days after the administrative review.

e. As may be appropriate, the Enforcement Officer shall notify all public safety agencies, permitted Providers and public safety communication centers, hospitals and other agencies and organizations of any adverse action taken against a permitted Provider pursuant to this subsection.

3. Appeal to the Board. If, after an administrative review as provided hereinabove, the Permit Officer imposes adverse action against a Permit Holder, the Permit Holder may appeal such action to the Board, and the Board shall consider the appeal pursuant to the following procedures. Such appeal shall not suspend the imposition of any adverse action taken by the Permit Officer.

a. Request for Appeal Hearing. The Permit Holder shall submit a request for a hearing in writing to the Clerk of the Board within twenty (20) days following the denial of renewal, suspension, or revocation of a Provider Permit. The Board shall hear the appeal directly, or at its sole discretion, may appoint a neutral hearing officer to hear the appeal and make findings of fact on behalf of, and recommendations thereupon, to the Board.

b. Hearing Appeal Procedures. The Board or its appointed hearing officer shall hear the matter within sixty (60) days of receipt of the Permit Holder's request for appeal pursuant to the following procedures:

• Witnesses shall swear or affirm to tell the truth.
• Each party may present oral testimony and documentary evidence or other exhibits.
• The appealing Permit Holder shall present its case first.
• Each party shall have the right to be presented by counsel and shall have the right of cross-examination of witnesses.
• After both sides have completed presenting evidence, each party may, by closing argument, comment on the evidence.

c. Appeal Decision. Upon completion of the appeal hearing, the Board shall make findings of fact or, where appropriate, adopt the findings of fact of the appointed Hearing Officer, and shall make such determination thereupon. The decision of the Board shall be final for purposes of Judicial Review under Code of Civil Procedure Section 1094.5 and Ordinance No. 628.

N. Permit Fees. Upon application made for a Provider Permit, the applicant shall pay a non-refundable permit fee in accordance with the schedule identified in REMSA Ambulance Policy and shall pay a fee for each Provider Unit that the applicant proposes to operate under the Provider Permit for which application is made in the amount identified in REMSA Ambulance policy.

1. Non-Payment of Fee, Grounds for Rejection of Application. Failure of the Applicant to submit an application with the appropriate Provider(s) Permit and Provider Unit(s) fees may serve as grounds for the Permit Officer to refuse the receipt of an initial or renewal Provider Permit application.

2. Late Fee Penalty. If, upon review of an accepted application, the Enforcement Officer determines that a Provider Permit or a Provider Unit fee due at the time the application is made was not paid in full, the applicant shall pay the additional amount due within thirty (30) days of written notice of same and shall pay a penalty in the amount of twenty percent (20%) of the fee(s) due.

3. Prorated Fee. Provider Permit fees may be prorated on a quarterly basis on such permits that are issued for a period of less than a year.

4. Publicly owned and operated provider. Publicly owned and operated entities are exempt from all fees specified by this ordinance.

5. Public Interest Fee Exemption. The Permit Officer may, upon investigation and determination that it is in the public interest, waive all or part of Provider and/or Provider Unit fees that would be due prior to the issuance of a Provider Permit.

O. Temporary Provider Permit. The Permit Officer may issue a Provider Permit as authorized by this ordinance on a temporary basis which shall not exceed a period of sixty (60) days in response to extraordinary conditions where the Permit Officer determines that the public health and safety necessitates the issuance of such a temporary permit and that the proposed temporary Permit Holder possesses the minimum standards as prescribed by the ordinance. Provider Permits issued under this subsection may be revoked on such grounds specified in Section 5 subsections A. and M. of this ordinance on twenty-four-hour notice to the Permit Holder. The decision of the Permit Officer to revoke a Provider Permit issued under this section shall be final without rights of administrative review to the Permit Officer or the Board.

Section 6. ORDINANCE ADMINISTRATION. The EMS Agency shall be responsible for the administration of this ordinance, including, but not limited to, promulgating such policies, protocols, and regulations as expressly required herein or as may be necessary to effectuate other provisions of the ordinance subject to the approval of the Permit Officer and, where appropriate, the Medical Director.

Section 7. ENFORCEMENT. This ordinance and policies, protocols, and regulations established pursuant to it shall be enforced by the Enforcement Officer.

Section 8. VIOLATION.

A. Administrative Fines.

1. Permitted Provider. A Permit Holder that violates, or causes the violation of, any provision of this ordinance shall pay a fine for each such violation in the amount of five hundred dollars ($500.00) for each violation to the County.
2. Penalty for Late Payment of Administrative Fine. The administrative fines established hereinabove shall be paid within thirty (30) days of written notification being mailed in the U.S. Postal Service, and shall be deemed delinquent thirty (30) days after they are due and payable and deemed to be a debt to the County. If any fine is not paid prior to becoming delinquent, there shall be a penalty added to such fee, and such penalty shall be equal to twenty percent (20%) of the fee normally due.

B. Public Nuisance. Any continued violation of any provision of this ordinance is deemed a public nuisance dangerous to the health and safety of the public and may be enjoined or summarily abated in the manner provided by law.

C. Criminal Penalties. Any person who violates provisions of this ordinance shall be guilty of an infraction, and upon conviction thereof shall be punished by: (1) a fine not to exceed one hundred dollars ($100.00) for the first violation of this ordinance; (2) a fine not to exceed two hundred dollars ($200.00) for a second violation of the ordinance within one (1) year; and (3) a fine not to exceed five hundred dollars ($500.00) for each additional violation of this ordinance after second violation within one (1) year. Notwithstanding the above, even a first offense may be charged and prosecuted as a misdemeanor. Payment of any penalty herein shall not relieve a person from the responsibility for correcting the violation.

D. Remedies.

1. An action may be commenced in the name of the County in any court of competent jurisdiction for payment of the amount of any delinquent administrative fee or fine and penalty thereon.
2. All remedies available to the County shall be cumulative, and the use of one or more remedies by the County shall not bar the use of any other remedy for the purpose of enforcing the provisions of this ordinance. Nor shall the payment of any administrative fee or fine prevent criminal prosecution for violation of the provisions of this ordinance.
3. The additional remedies, penalties, and procedures for violation of this ordinance and for recovery of costs related to enforcement provided for in Ordinance No. 725, as it may be amended from time to time, are incorporated herein by this reference.

Section 9. SEVERABILITY. If any section, subsection, sentence, clause, or phrase of this ordinance as herein enacted, or the application thereof to any person or circumstances is held invalid or unconstitutional by decision of any court of competent jurisdiction, such invalidity shall not affect the other provisions or applications of this ordinance, or any section or portion of section hereof, which can be given effect without the invalid provisions where application and to this in the provision so this ordinance are and are intended to be, severable. The Board of Supervisors hereby declares that it would have passed this ordinance and each section, subsection, clause, or phrase thereof irrespective of the fact that any one or more other sections, subsections, clauses, or phrases may be declared invalid or unconstitutional.

Section 10. EFFECTIVE DATE. This ordinance shall take effect thirty (30) days after its adoption. (10/20/2023)