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HomeMy WebLinkAboutORD-2010-024 EMS Second Reading: Amendments to the EMS Franchise Agreement6Av'.,1 O l.6 —a :?- AN ORDINANCE REGULATING AMBULANCE, EMERGENCY MEDICAL, FIRST REPSPONDER AND RESCUE SERVICE AND GRANTING OF FRANCHISE AND CONTRACTS TO THE OPERATOR IN THE COUNTY OF ORANGE An ordinance governing the granting of franchises for emergency services and other prehospital emergency medical services, the County of Orange Board of Commissioners do ordain the following: SECTION I. DEFINITIONS Unless the context otherwise requires, the following definitions shall apply to the interpretation and enforcement of this Ordinance: 1.1 Ambulance. The term "ambulance" means any privately or publicly owned motor vehicle, aircraft, or vessel that is specifically designed, constructed, or modified and equipped and is intended to be used for and is maintained or operated for the transportation on the streets or highways, waterways, or airways of this State of persons who are sick, injured, wounded, or otherwise incapacitated or helpless. 1.2 Ambulance Provider. The term "ambulance provider" means an individual, firm, corporation, or association who engages or professes to engage in the business or services of transporting patients in an ambulance. 1.3 Approved. The term "approved" shall mean approved by the North Carolina Medical Care Commission pursuant to the latter's rules and regulations promulgated under N.C.G.S. 143B -165. 1.4 Advisory Committee or Committee. The term "Advisory Committee" or "Committee" shall mean the Orange County Emergency Medical Services Committee which is the advisory committee designated by the Board of County Commissioners with respect to emergency medical services in Orange County. 1.5 Contract. The term "contract" shall mean the instrument by which both parties agree to the terms of operation of the service to be provided. 1.6 Convalescent Transportation Services. The term "convalescent transportation service" shall mean the operation of an ambulance for any purpose other than transporting emergency or emergent patients. 1.7 County. The term "County" shall mean Orange County and its Board of Commissioners or their designated representative(s). 1.8 Emergency. The term "emergency" or "emergency transportation services" shall mean the use of a service, its equipment and personnel to provide medical care, rescue, and /or transportation of a patient who is in need of immediate rescue or medical treatment in Page 1 of 2 W order to prevent loss of life or further aggravation of physiological or psychological illness or injury. 1.9 Emergency Management System or EMS. Emergency Management System or "EMS" shall mean a coordinated arrangement of local resources under the authority of the Emergency Services Director (including all agencies, personnel, equipment, and facilities) organized to respond to medical emergencies and integrated with other health care providers and networks including public health, community health monitoring activities, and special needs populations. 1.10 Emergency Medical Dispatcher or Telecommunicator. The term " emergency medical dispatcher" of "telecommunicator" shall mean an emergency telecommunicator who has completed educational requirements and been credentialed by the Department of Health and Human Services as an emergency medical dispatcher and who is available to receive requests for emergency services, to dispatch emergency services, and to advise local law enforcement agencies, fire departments, rescue squads, first or medical responder units and emergency medical services and facilities of any existing or threatened emergency. 1.11 Emergency Medical Services. "Emergency Medical Services" means services rendered by emergency medical services personnel in responding to improve the health and wellness of the community and to address the individual's need for emergency medical care within the scope of practice as defined by the North Carolina Medical Board, in accordance with G.S. 143 -514, and the Orange County Medical Director in order to prevent loss of life or further aggravation of physiological or psychological illness or injury. 1.12 Emergency Medical Services Instructor. "Emergency Medical Services Instructor" means an individual who has completed educational requirements approved by the Department of Health and Human Services and has been credentialed by that Department as an emergency medical services instructor. 1.13 Emergency Medical Services Peer Review Committee. Emergency Medical Service Peer Review Committee means a panel composed of EMS program representatives responsible for analyzing patient care data and outcome measures to evaluate the ongoing quality of patient care, system performance, and medical direction within the EMS system. The committee may include physicians, nurses, EMS personnel, medical facility personnel and county government staff as determined by the Emergency Services Director in consultation with the County Medical Director. 1.15 Emergency Medical Technician (EMT). The term "emergency medical technician" means an individual who has completed a training program in emergency medical care that has been approved for legal recognition by the North Carolina Department of Health and Human Services, in accordance with rules promulgated by the Medical Care Commission, has been certified as an EMT by the State of North Carolina Office of Emergency Medical Services, and approved by the County Medical Director to perform services as an EMT in the Orange County EMS system. Page 2 of 2 1.16. Emergency Medical Technician — Intermediate. The term "emergency medical technician - intermediate" means an individual who has completed a training program in emergency medical care at the intermediate level that has been approved for legal recognition by the North Carolina Department of Health and Human Services, in accordance with rules promulgated by the Medical Care Commission, has been certified as an EMT - Intermediate by the State of North Carolina Office of Emergency Medical Services, and approved by the County Medical Director to perform services at the EMT - Intermediate level in the Orange County EMS system. 1.17. Emergency Medical Technician — Paramedic. The term "emergency medical technician - paramedic" means an individual who has completed a training program in emergency medical care at the paramedic level that has been approved for legal recognition by the North Carolina Department of Health and Human Services, in accordance with rules promulgated by the Medical Care Commission, has been certified as an EMT - Paramedic by the State of North Carolina Office of Emergency Medical Services, and approved by the County Medical Director to perform services as an EMT - Paramedic in the Orange County EMS system.. 1.18. Emergency Services Director. The term shall mean the person designated by the Orange County Board of Commissioners to manage the overall Emergency Management System in Orange County. 1.19 First Responder. The term "first responder" shall mean an organization with personnel trained in emergency medical care that is dispatched to the scene of a medical emergency for the primary purpose of providing emergency medical assistance to a patient until the ambulance and additional medical aid arrives. 1.20 Franchise. The term "franchise" shall mean a permit issued by the County to a person for the operation of am ambulance service, rescue squad or first responder unit. 1.21 Franchisee. The term "franchisee" shall mean any person having been issued a franchise by the County for the operation of an ambulance service, rescue squad or first responder unit. 1.22. License. The term "license" shall mean any driver's license or permit to operate a motor vehicle issued under or granted by the laws of the State of North Carolina. 1.23. Medical Responder. "Medical Responder" shall mean an individual who has completed an educational program in emergency medical care and first aid approved and credentialed by the Department of Health and Human Services as a medical responder and the Orange County Medical Director to operate in Orange County EMS. 1.24. Medical Director. "Medical Director" shall mean the physician appointed, either directly or by written delegation, by the County and have the responsibilities as provide by 10A NCAC 13P .0403 and 10A NCAC 13P .0404. The County may, in addition, appoint an Page 3 of 3 assistant medical director. The medical director and the assistant medical director shall meet the criteria defined in the "North Carolina College of Emergency Physicians: Standards of Medical Oversight and Data Collection," which is incorporated by reference in accordance with G.S. 150B -21.6, including subsequent amendments and editions. 1.25. Non - Emergency Transportation Services. The term "non- emergency transportation service" shall mean the operation of an ambulance for any purpose other than transporting emergency or emergent patients. 1.26 Operation Protocols. "Operation Protocols" shall mean the administrative policies and procedures of EMS that provides guidance for the day -to -day operations of the system. 1.27 Operator. The term "operator" shall mean a person in actual physical control of an ambulance or rescue service vehicle which is in motion or which has the engine running. 1.28 Owner. The term "owner" shall man any person or entity who owns an ambulance or provides a service covered by this Ordinance. 1.29 Patient. The term "patient" shall mean an individual who is sick, injured, wounded, or otherwise incapacitated or helpless such that the need for some medical assistance might be anticipated while being transported to or from a medical facility. 1.30 Person. The term "person" shall mean any individual, firm, partnership, association, corporation, company, group of individuals acting together for a common purpose, or organization of any kind, including any governmental agency other than the United States. 1.31 Practical Examination. "Practical Examination means a test where an applicant for credentialing as an emergency medical technician, or medical responder, emergency medical technician — intermediate, or emergency medical technician — paramedic demonstrates the ability to perform specified emergency medical care skills. 1.32 Rescue. The term "rescue" shall mean the removal of individuals facing external, non- medical, and non - patient related peril to areas of relative safety. 1.33 Rescue Squad or Rescue Unit. The term "rescue squad" or "rescue unit" shall mean a group of individuals who are not necessarily trained in emergency medical services, fire fighting, or law enforcement, but who expose themselves to an external, non - medical, and non - patient related peril to effect the removal of individuals facing the same type of peril to areas of relative safety. 1.34 Secondary Ambulance Provider. The term "secondary ambulance provider" shall mean the system of personnel and equipment meeting the same criteria as a primary ambulance provider, but not normally dispatched on first call response. 1.35 Service. The term "service" shall mean the same as owner. Page 4 of 4 1.36 Treatment Protocols. "Treatment Protocols" shall mean a document approved by the medical director and the Office of Emergency Medical Service specifying the diagnostic procedures, treatment procedures, medication administration, and patient -care- related policies that shall be completed by emergency service personnel based upon the assessment of the patient. 1.37 Victim. The term "victim" shall mean any patient or potential patient that is entrapped, entangled pinned, fallen, suspended, or otherwise in need of rescue services. SECTION II. FRANCHISE REQUIRED 2.1 No person either as owner, agent or otherwise, shall furnish, operate, conduct, maintain, advertise, or otherwise be engaged in or profess to be engaged in the business or service of emergency medical service, emergency, emergent and/or non - emergency transportation of patients within the County of Orange unless the person holds a valid EMS Provider License and a valid permit for each ambulance used in such business or service issued by the North Carolina Department of Health and Human Services, Office of Emergency Medical Service, and has been granted a franchise for the operation of such business or services by the County pursuant to this Ordinance. 2.2 No person shall drive an ambulance, attend a patient in one, or permit one to be operated when transporting a patient within the County of Orange unless he or she holds a currently valid North Carolina Operator's License, a currently valid certificate as an EMT (Emergency Medical Technician), EMT -I (Emergency Medical Technician — Intermediate), EMT -P Emergency Medical Technician — Paramedic) or Medical Responder issued by the North Carolina Department of Health and Human Services, and has been approved by the Orange County Medical Director to provide such service in Orange County. 2.3 No person either as owner, agent or otherwise, shall furnish, operate, conduct, maintain, advertise, or otherwise be engaged in or profess to be engaged in the business or service of providing rescue services, medical responder services or first responder services unless they have been granted a franchise for the operation of such business or service by the County pursuant to this Ordinance. 2.4 No franchise shall be required for: a. Any entity operated from a location or headquarter outside of the County of Orange in order to transport patients who are picked up beyond the limits of the County of Orange, to facilities located within the County of Orange, or to pick up patients within the County of Orange for transporting to locations outside the County of Orange; but no such entity shall be used to pick up patients within the County of Orange for transporting to locations within the County of Orange or other locations unless it is rendering assistance to a franchised ambulance service in the case of a major catastrophe or mutual aid. Page 5 of 5 b. Ambulances owned and operated by an agency of the County, the State of North Carolina, or of the United States. C. A fire department in Orange County that by contract with the County provides rescue and emergency services as provided by this Ordinance. SECTION III. APPLICATION FOR AMBULANCE FRANCHISE 3.1 Application for a franchise to operate ambulances, emergency or convalescent, in the County of Orange shall be made by the ambulance provider upon such forms as may be prepared or prescribed by the County and shall include, but are not limited to, the following: a. The name and address of the ambulance provider and of the owner of the ambulance(s). b. The trade or other fictitious names, if any, under which the applicant does business, along with a certified copy of an assumed name certificate stating such name or articles of incorporation stating such name. C. A resume of the training and experience of the applicant in the transportation and care of patients. d. A full description of the type and level of service to be provided including the location of the place or places from which it is intended to operate, the manner in which the public will be able to obtain assistance and how the vehicle will be dispatched. A financial statement of the applicant as the same pertains to the operations in the County of Orange, said financial statements to be in such forms and in such detail as may be required by the County. e. A list of radio frequencies the applicant is authorized to operate on, and a copy of the FCC license(s) in the name of the person providing the service. £ A description of the applicant's capability to provide twenty -four hour coverage, seven days per week for the district covered by the franchise applied for, and an accurate estimate of the minimum and maximum times for a response to calls within such district. g. A copy of the written plan detailing how the applicant will furnish credentialed personnel and a current roster of all credentialed personnel with a list of their credentials. h. A copy of the applicant's written operational protocols for the management of equipment, supplies and medications. Page 6 of 6 i. Any information the County shall deem reasonably necessary for a fair determination of the capability of the applicant to provide ambulance services in the County of Orange in accordance with the requirements of state laws and the provisions of these regulations. SECTION IV. APPLICATION FOR MEDICAL OR FIRST RESPONDER 4.1 Application for a franchise to operate as medical or first responders in the County of Orange shall be made by the provider upon such forms as may be prepared or prescribed by the County and shall include, but not be limited to the following: a. The name and address of the provider and the owner of the service. b. The trade or other fictitious names, if any, under which the applicant does business, along with a certified copy of an assumed name certificate stating such name or articles of incorporation stating such name. C. A resume of the training and experience of the applicant in the treatment and care of patients. d. A full description of the type and level of service to be provided including the location of the place or places from which it is intended to operate, the manner in which the public will be able to obtain assistance and how the vehicle will be dispatched. A financial statement of the applicant as the same pertains to the operations in the County of Orange, said financial statements to be in such forms an in such detail as may be required by the County. A current financial statement provided by a fire department, volunteer or otherwise, operating within the County which has been provided to the County as part of the County budget process shall satisfy this financial statement requirement. e. A list of radio frequencies the applicant is authorized to operate on, and a copy of the FCC license(s) in the name of the person providing the service, unless included as part of a fire department radio system. f. A copy of the written plan detailing how the applicant will furnish credentialed personnel and a current roster of all credentialed personnel with a list of their credentials. g. A copy of the applicant's written operational protocols for the management of equipment, supplies and medications. h. A description of the applicant's capability to provide coverage for the district covered by the franchise applied for, and an accurate estimate of the minimum and maximum times for a response to calls within such district. Page 7 of 7 i. Any information the County shall deem reasonably necessary for a fair determination of the capability of the applicant to provide medical or first responder services in the County of Orange in accordance with the requirements of state laws and the provisions of these regulations. SECTION V. APPLICATION FOR RESCUE SERVICES 5.1 Application for a franchise to provide rescue services in the County of Orange Shall be made by the provider upon such forms as may be prepared or prescribed by the County and shall include, but are not be limited to the following: a. The name and address of the provider and of the owner of the service(s). b. The trade or other fictitious names, if any, under which the applicant does business, along with a certified copy of an assumed name certificate stating such name or articles of incorporation stating such name. C. A resume of the training and experience of the applicant in the rescue of victims. d. A full description of the type and level of service to be provided including the location of the place or places from which it is intended to operate, the manner in which the public will be able to obtain assistance and how the vehicle will be dispatched. A financial statement of the applicant as the same pertains to the operations in the County of Orange, said financial statements to be in such forms an in such detail as may be required by the County. e. A list of radio frequencies the applicant is authorized to operate on, and a copy of the FCC license(s) in the name of the person providing the service. f. A description of the applicant's capability to provide twenty -four hour coverage, seven days per week for the district covered by the franchise applied for, and an accurate estimate of the minimum and maximum times for a response to calls within such district. g. A copy of the written plan detailing how the applicant will furnish credentialed personnel and a current roster of all members of the rescue squad who are eligible for membership in the North Carolina Association of Rescue and Emergency Medical Services, Inc. ( "the Association "); number of hours they have attended training and meetings in the last calendar year; and a copy of the roster filed with the Secretary — Treasurer of the Association for the three years preceding the application for franchise. Page 8 of 8 h. A copy of the applicant's written operational protocols for the management of equipment, supplies and medications. i. A written statement showing that applicant meets the eligibility requirements established by the North Carolina Association of Rescue and Emergency Medical Services, Inc for the type of level of service being requested. j. Any information the County shall deem reasonably necessary for a fair determination of the capability of the applicant to provide rescue services in the County of Orange in accordance with the requirements of state laws and the provisions of these regulations. VI. GRANTING OF FRANCHISE 6.1 Prior to accepting application for the operation of any service, the Board of Commissioner may designate specific service areas as franchise districts. Said districts will be established using criteria that include geographic size, road access, the location of existing medical transportation services, population, and response time. The Commissioners shall have the authority to redistrict or rearrange existing districts ay any time at their discretion. 6.2 An applicant may apply for a franchise to operate an ambulance service, emergency or convalescent, rescue service, or Medical or First Responder Unit or any two or all three. If more than one (1) service is to be provided, an application must be filed for each service. 6.3 Upon receipt of an application for a franchise, the County shall schedule a time and place for hearing the applicant. Within 30 days after hearing, the County shall cause such investigation as it may deem necessary to be made of the applicant and his proposed operations. 6.4 A franchise may be granted if the County finds that: a. The applicant meets both county and state standards in addition to the standards outlined in the franchise ordinance; and. b. The proposed service will fit within the existing services so as not to adversely affect the level of service or operations of other franchisees to render service; and c. A need exists for the rendered services in order to improve the level of service available to the residents of the County helping to assure the provisions of adequate and continuing service which preserves, protects, and promotes the public health, safety and welfare and that granting the franchise is a cost effective and reasonable manner of meeting the need. Page 9 of 9 SECTION VII. TERM AND TERMINATION OF FRANCHISE 7.1 The County may issue a franchise hereunder to an ambulance provider, to be valid for up to a term of five (5) years. 7.2 The franchise holder can surrender the franchise with 60 days written notice to the County. 7.3 The County may revoke the franchise as provided in Section XIV I.E. After a notice of service termination is given, the provider may reapply for a franchise if continued service is desired. 7.3 Upon suspension, revocation, or termination of an EMS Provider's License, or an ambulance permit, or franchise granted hereunder, such franchised ambulance service, rescue squad or medical or first responder unit immediately shall cease operations and no care shall be rendered by the personnel associated with the ambulance service, rescue squad or medical or first responder unit. 7.4 Upon suspension, revocation, or termination by the State or Orange County of a driver's license or an attendant's credentials (i.e., first responder, rescue, emergency medical technician, EMT -I, EMT -P or medical responder credentials), such persons shall cease to drive an ambulance or provide medical care, medical or first responder services or attend an ambulance. 7.5 The franchise shall not permit an individual to drive an ambulance or provide medical care in conjunction with the ambulance service, provide rescue service, or medical or first responder service if the individual's credentials have been suspended, revoked or terminated by the State or Orange County. 7.3 Each franchised service shall comply at all times with the requirements of this Ordinance, the franchise granted hereunder, and all applicable state and local laws relating to health, sanitation, safety, equipment, ambulance design and all other laws and ordinances. 7.4 Prior approval of the County shall be required where ownership or control of more than 10 percent of the right of control of the franchise is acquired by a person or group of persons acting in convert, none of whom own or control 10 percent of more of such right of control, singularly or collectively, at the date of the franchise. By its acceptance of the franchise, the franchisee specifically agrees that any such acquisition occurring without prior approval of the county shall constitute a violation of the franchise by the franchisee and shall be cause for termination at the option of the County. Page 10 of 10 7.5 Any change of ownership of a franchised service without the approval of the County shall terminate the franchise and shall require a new application and a new franchise and conformance with all the requirements of this Ordinance as upon original franchising. 7.6 Any change in the level of service offered of a franchised ambulance service, rescue squad or first responder unit without the prior approval of the County shall terminate the franchise and shall require a new application and a new franchise and conformance with all the requirements of this Ordinance as upon original franchising. 7.7 No franchise may be sold, assigned, mortgaged, or otherwise transferred without the approval of the County; and a finding of conformance with all requirements of this Ordinance as upon original franchising. Each franchised ambulance, rescue, or medical or first responder service, its equipment and the premises designated in the application and all records relating to its maintenance and operation, as such, shall be open to inspection by the State, the County, or their designated representatives. 7.8 The franchise certificate shall be posted in a readily visible location at the base of operations for the franchised service. 7.9 A franchise certificate may not be defaced, removed, or obliterated. SECTION VIII. STANDARDS FOR PERSONNEL 8.1 Ambulance drivers and attendants shall comply with the standards for ambulance drivers and attendants as developed by the North Carolina Medical Care Commissions as requirements for certification of emergency medical technicians pursuant to Article 7, Chapter 131E -158, and Article 56, Chapter 143 of the General Statutes of North Carolina, and rules and regulations promulgated by the North Carolina Medical Care Commission and North Carolina Medical Board which are incorporated herein by reference. 8.2 All personnel of Emergency Medical Service providers shall be approved by the County Emergency Medical Services Director prior to providing medical care in Orange County. Each submission for approval shall be accompanied by the submission of a driver's license, criminal records history and letter outlining the applicant's credentials and training. The Department of Emergency Services may designate a form to be used by applicants. 8.3 Each franchise is required to notify the Emergency Services Director, or their designee, when personnel provided for subsection 8.1 leave the service of the franchise. Page 11 of 11 8.4 All emergency service personnel shall adhere to the standards set by state law, regulations and the Orange County Medical Services, Emergency Medical Practice Protocols and any amendments thereto. A practical examination may be given on the Orange County Practice Protocols before permission is granted by the Medical Director to practice in Orange County. 8.5 Emergency Medical Practice standards of care shall be reviewed by the Emergency Service Peer Review Committee. STANDARD IX. STANDARDS FOR AMBULANCES AND EQUIPMENT 9.1 Ambulances and equipment standards as developed by the North Carolina Medical Care Commission pursuant to Article 7, Chapter 131E -157, and Article 56, Chapter 143, of the General Statutes of North Carolina, shall be applied and the same are incorporated by reference. 9.2 All emergency ambulances and rescue squad vehicles franchised solely in Orange County shall contain the words "PROUDLY SERVING WITH ORANGE COUNTY EMERGENCY SERVICES" lettered on both sides and the rear of the vehicle body. SECTION X. STANDARDS FOR COMMUNICATIONS 10.1 Each ambulance vehicle shall be equipped with an operational two -way radio as provided by 10A NCAC 13P.0207 through 10A NCAC 13P.0213 This section shall not apply to privately owned vehicles of the members. 10.2 Each provider shall maintain current authorizations or Federal Communication Commission licenses for all frequencies and radio transmitters operated by that provider. Copies of all authorizations and licenses shall be provided to the Emergency Services Department and on display and available for inspection per Federal Communication Commission's Rules and Regulations. 10.3 Each base of operations must have at least one open telephone line. Telephone numbers must be registered with each law enforcement agency and the Emergency Services Communications Center in the County of Orange. 10.4 Each franchise shall be dispatched from the Emergency Service Communication Center or an acceptable and approved alternative as long as they are in compliance with the terms of this Ordinance and their franchise agreement as determined by the Emergency Services Director. SECTION XI. INSURANCE 11.1 No franchise shall be issued under this Ordinance, nor shall such franchise be valid after issuance, nor shall any service vehicles be operated in the county of Page 12 of 12 Orange unless the franchisee has at all times in force and effect either insurance coverage, issued by an insurance company licensed to do business in the State of North Carolina for every vehicle owned and /or operated by or for the service providing for the payment of damages: a. In the minimum sum of $1,000,000 for injury to or death of individuals in accidents resulting from an cause for which the owner of said vehicle would be liable on account of liability imposed on him by law, regardless of whether the vehicle was being driven by the owner of his agency; and b. In the minimum sum of $1,000,000 for the loss of or damage to the property of another, including personal property, under like circumstances, in sums as may be required by the State or as approved by the County of Orange. C. The insurance coverage minimum limits required in subsection (a) and (b) of this subsection shall be reviewed annually by the Orange County Department of Emergency Services, in Consultation with the County Attorney and Orange County Risk Manager. Such insurance coverage shall be revised as deemed appropriate and as directed by the Orange County Department of Emergency Services. In directing a change in insurance coverage, the Orange County Emergency Services Department shall consider the risk needs protected by this insurance coverage and the availability in the marketplace of the coverage amounts to be required. SECTION XII. RECORDS 12.1 Each franchise shall maintain the following records: a. Records of Dispatch — Shall show time call was received, time dispatched, time arrived on scene, time arrived at destination, time in service, and time returned to base. b. Trip Record — Shall state all information required in Section (a) In addition to information on a form approved by the County. The trip record shall be so designed as to provide the patient with a copy thereof containing all required information. c. Personnel Checklist and Inspection Report — Shall list contents and description of operation for each vehicle, signed by the individual verifying vehicle operations and equipment. d. Any other records required by state law, rules or regulations or deemed by the Department of Emergency Service as relevant to the effective and efficient operations of the Emergency Management System. Page 13 of 13 e. All of the records identified in subsection a through d above shall be maintained for a minimum three (3) year period unless a longer retention period is otherwise required by other retention periods. f. Confidentiality of Patient Records. Each franchise shall maintain confidentiality of patient records as provided by the Health Insurance Portability and Accountability Act of 1996 (HIPPA), Public Law 104 -191, N.C. Gen. Stat. 143 -518 and all other state and federal law. 12.2 Each franchise shall submit a written monthly report to the Emergency Services Director, or their designee, providing the number of calls and runs during the month. The report shall contain the number of emergency calls, the number of convalescent calls, the total number of calls and the total number of patients transported. SECTION XIII. RATES AND CHARGES 13.1 Each franchisee shall submit a schedule of rates to the County for approval and shall not charge more nor less than the approved by the County rates without specific approval. 13.2 No service shall attempt to collect rates on emergency calls until the patient has reached the point of destination, has received medical attention and is in a condition deemed by the physician fit to consult with the service, but such service may attempt to collect rates with family or guardian of the patient once patient is in the process of receiving medical attention. 13.3 On convalescent calls or calls where a person requires transportation to a non- emergency facility, attempts to collect payment may be made before the ambulance begins its trip. SECTION XIV. ENFORCEMENT 14.1 The Orange County Emergency Services Director shall be the enforcing authority for the regulations contained in this Ordinance. Such Director will: a. Receive all franchise applications from potential providers. b. Review each proposal for conformity to this Ordinance; conduct an investigation of the applicant's proposal under consideration by the County. C. Recommend to the Board of Commissioners the approval /disapproval of the franchise(s). Page 14 of 14 d. Inspect the premises, vehicles, equipment, and personnel of franchisees to assure compliance to this Ordinance and perform any other inspection that may be required. e. Recommend to the Board of Commissioners the temporary or permanent suspension of a franchise in the event of noncompliance with the franchise terms of this Ordinance. Recommend the imposition of misdemeanor or civil penalties as provided therein. f. Immediately stay the operations of a franchise that performs in a manner that is unsafe or detrimental to the health, safety and welfare of the residents of Orange County or the State of North Carolina, performs procedures outside the scope of practice for EMS credentialed personnel or is not in compliance with this Ordinance or their franchise agreement. In case of such stay, the franchise may appeal the suspension as provided in Section XVI. g. Insure by cooperative agreement with other services the continued service in a district where a service franchise has been suspended. h. Receive complaints from the public, other enforcing agencies, and services regarding franchise infractions. i. Recommend improvements to the County and implement procedures which will insure better rescue, medical care and ambulance transportation service. Maintain all records required by this Ordinance and other applicable State and County regulations. SECTION XV. INSPECTIONS 15.1 The County may upon reasonable notice inspect a franchisee's records, premises, and equipment at any time in order to insure compliance with this Ordinance and any franchise granted hereunder. SECTION XVI. ORANGE COUNTY EMERGENCY MEDICAL SERVICE ADVISORY COMMITTEE 16.1 The Orange County Emergency Medical Services Advisory Committee shall be a technical committee to provide guidance and make recommendations to the Board of County Commissioners and Emergency Services Director of Orange County on matters related to emergency medical services such as, but not limited to: Page 15 of 15 a. Review enforcement of this Ordinance and make recommendation to the Emergency Services Director on matters relating to the enforcement of this Ordinance. b. Provide information and advice to the Emergency Services Director regarding such standards of care, policies, procedures, and actions which will maintain and improve the quality of emergency medical services for the residents of Orange County, including pre - hospital care provided by volunteer rescue. /EMS Squads, county EMS services and privately owned ambulance services. c. Plan, develop and implement emergency medical care in coordination with the regional and statewide system.. 16.2 The goal of the Advisory Committee shall be to assure the provisions of a high level of quality care and service to persons in need of emergency medical services, non- emergency medical services and pre- hospital care in Orange County. 16.3 The County Emergency Medical Services Committee shall be comprised of the Emergency Services Director, Emergency Services Medical Director, the Assistant Medical Director, the Emergency Medical Services Operation Manager, a resident of Orange County who is a credentialed as an Emergency Medical Services Instructor and has a demonstrated to the Medical Director they have knowledge of Orange County Emergency Services practices, procedures and protocols and the County Health Director. 16.4 Representatives from the franchised providers may attend any meetings when the Committee considers matters relating to the granting of franchises and/or reviewing complaints from the public and investigations regarding franchise services. 16.5 The Emergency Medical Services Advisory Committee shall hear appeals of stay of franchises. In case of stay of a franchise as provided in Section XIV (f): a. The Emergency Service Director, or his designee, shall provide the franchise written notice of the stay and the reasons for the stay either concurrently with issuance of the stay or if oral suspension within 5 days of notice. Notice shall be provided either orally with a certified letter to follow or by certified mail. b. The Franchisee may appeal the decision to the Emergency Services Medical Advisory Committee within 10 days of receipt of written notice. If the appeal is not heard within 10 days the stay will be dissolved pending a hearing on the appeal. Page 16 of 16 c. An appeal shall be served on the County Attorney who will forward the appeal to Emergency Services Medical Committee. d. The franchisee may either appeal by letter or request a hearing before the Emergency Services Medical Committee. e. The Hearing shall be scheduled within 2 days of receipt of notice of appeal and shall be commenced within 10 days. The franchisee may present evidence and give oral testimony at the hearing. f. The Emergency Services Medical Committee shall provide a written response to the franchise within 10 days of the hearing. The Committee shall remove the stay, provide a recommendation for corrective action and set a time for completion or forward a recommendation to the Board of County Commissioners for suspension or termination of the franchise agreement. g. The Board of County Commissioners shall review the recommendation and make a decision based on the information contained in the recommendation from the County Emergency Medical Services Committee. SECTION XVII. EMERGENCY SERVICES PEER REVIEW COMMITTEE 17.1 In accordance with G.S. 131E -155, the Emergency Service Director shall provide an Emergency Medical Service Peer Review Committee composed of emergency medical service program representatives responsible for analyzing patient care data and outcome measures to evaluate the ongoing quality of patient care, system performance, and medical direction within the EMS system. 17.2 The committee shall include physicians, nurses, EMS personnel, medical facility personnel and county government staff as determined by the Emergency Services Director in consultation with the County Medical Director. 17.3 Review of medical records by the Emergency Service Peer Review Committee is confidential and protected under G.S. 143 -518. An Emergency Service Peer Review Committee, its members, proceedings, records and materials produced, and materials considered shall be afforded the same protection afforded the medical Review Committees, their members, proceedings, records, and materials under G. S. 131 E -95. SECTION XVIII. EFFECTIVE DATE; REPEALER; GRANDFATHER PROVISIONS 18.1 This Ordinance shall be amended as of the 16th day of February, 2010. Page 17 of 17 18.2 This Ordinance took effect on the 20th day of April, 1993. An Ordinance Regulation the Operation of Ambulance Services and the Administration of Emergency Medical Assistance in Orange County, North Carolina effective May 1, 1981, is hereby repealed effective, April 20, 1993. Any person, firm, or corporation providing ambulance service, rescue service or first responder service pursuant to a valid franchise issued by Orange County under the repealed March 1, 1981 Ordinance shall be entitled to continue that service as provided in the franchise and for the term of the franchise. Any such franchise may, however, be suspended, revoked, or terminated as provided in this Ordinance. The amendments to this Ordinance shall be effective on February 16, 2010 Bernadette Pelissier, Chair Orange County Board of Commissioners ATTEST: DATE: y �� Donna Baker, Clerk to the Orange County Board of Commissioners Page 18 of 18 Amendments to An Ordinance Regulating Ambulance and Emergency Medical, First Responder and Rescue Services and Granting of Franchise and Contracts to the Operators in the County of Orange THE ORANGE COUNTY BOARD OF COUNTY COMMISSIONERS ORDAINS: 1. ARTICLE H, FRANCHISE REQUIRED be amended to add Section 2.4 (c) to read as follows: 6 3. 2.4 No franchise shall be required for: a. Any entity operated from a location or headquarter outside of the County of Orange in order to transport patients who are picked up beyond the limits of the County of Orange, to facilities located within the County of Orange, or to pick up patients within the County of Orange for transporting to locations outside the County of Orange; but no such entity shall be used to pick up patients within the County of Orange for transporting to locations within the County of Orange or other locations unless it is rendering assistance to a franchised ambulance service in the case of a major catastrophe or mutual aid. b. Ambulances owned and operated by an agency of the County, the State of North Carolina, or of the United States. C. A fire department in Orange Coggg that by contract with the County provides rescue and emergency services as provided by this Ordinance. ARTICLE XV1, ORANGE COUNTY EMERGENCY MEDICAL SERVICES ADVISORY COMMITTEE be amended to Section 16.3 to read as follows: 16.3 The County Emergency Medical Services Committee shall be comprised of the Emergency Services Director, Emergency Services Medical Director, the Assistant Medical Director, the Emergency Medical Services Operation Manager, a resident of Orange County who is a credentialed as an Emergencv Medical Services Instructor and has a demonstrated to the Medical Director they have knowledge of Orange County Emergency Services practices, procedures and protocols and the County Health Director. ARTICLE XV1, ORANGE COUNTY EMERGENCY MEDICAL SERVICES ADvisoRY COMMITTEE be amended to Section 16.5 to read as follows: 16.5 The Emergency Medical Services Advisory Committee shall hear appeals of stay of franchises. In case of stay of a franchise as provided in Section XIV (f): a. The Emergency Service Director, or his designee, shall provide the franchise written notice of the stay and the reasons for the stay either concurrently with issuance of the stay or if oral suspension within 5 days of notice. Notice shall be provided either orally with a certified letter to follow or by certified mail. b. The Franchisee may appeal the decision to the Emergency Medical Services Advisory Committee within- 10 days of receipt of written notice. If the appeal is G a. not heard within 10 days the stay will be dissolved pending a hearing on the appeal. c. An appeal shall be served on the County Attorney who will forward the appeal to Emergency Medical Services Advisory Committee. d. The franchisee may either appeal by letter or request a hearing before the Emergency Medical Services Advisory Committee. e. The Hearing shall be scheduled within 2 days of receipt of notice of appeal and shall be commenced within 10 days. The franchisee may present evidence and give oral testimony at the hearing, f. The Emergency Medical Services Advisory Committee shall provide a written response to the franchise within 10 days of the hearing. The Committee shall remove the stay, provide a recommendation for corrective action and set a time for completion or forward a recommendation to the Board of County Commissioners for suspension or termination of the franchise agreement. g. The Board of County Commissioners shall review the recommendation and make a decision based on the information contained in the recommendation from the County Emergency Medical Services Advisory Committee. 4. All provisions of any county ordinance in conflict with these amendments are repealed. 5. These amendments to these Ordinances shall become effective upon adoption. This the _ day of February, 2010. Valerie P. Foushee, Chair Orange County Board of Commissioners Attest: Donna Baker, Clerk to the Orange County Board of Commissioners (Seal) alfuv ea d A motion was made by Commissioner Pelissier to say that the top three priorities are items 1, 2, and 3 and that these three items should be discussed: deer hunting with dogs, the Alamance /Orange County line and bio- solids disposal. THERE WAS NO SECOND. Commissioner Yuhasz said that items 8 (fire protection- additional state funding for state -owned buildings) and 17 ( wastewater system classifications for volunteer fire departments) both have to do with supporting local fire protection efforts. He thinks it is important to try and support this and get support from the legislators. Commissioner Yuhasz said that deleting the last sentence on item #1 would not be sufficient for him, so he would like to vote on all of the items except for #1. A motion was made by Commissioner Yuhasz, seconded by Commissioner Jacobs to say that the top priorities are items 2 and 3; that the Board of County Commissioners generally supports the resolution for bio- solids, action on the Alamance /Orange County line, and legislation to ban deer hunting with dogs; and it also supports items 8 (fire protection- additional state funding for state -owned buildings) and 17 (wastewater system classifications for volunteer fire departments). VOTE: UNANIMOUS A motion was made by Commissioner Pelissier, seconded by Commissioner Hemminger to support item #1 as one of the top three priorities, removing the last sentence. VOTE: Ayes, 6; No, 1(Commissioner Yuhasz) Commissioner Gordon made reference to the Alamance /Orange County line and said that as this is presented to the delegation, it should be offered as a draft because Orange County is waiting on input from Alamance County. She wants the legislators to know that Orange County is working with Alamance County on this. Commissioner Jacobs made reference to item #14 — Carolina North Transportation Funding — and suggested conveying this to UNC so that they know that it is of concern to Orange County. A motion was made by Commissioner Jacobs, seconded by Commissioner Pelissier to send a letter to the Chancellor of UNC - Chapel Hill, indicating that Carolina North Transportation is a high priority for Orange County. VOTE: UNANIMOUS 6. Regular Agenda a. Amendments to the EMS Franchise Agreement entitled "An Ordinance Regulating Emergency Medical First Responder and Rescue Service and Granting of Franchise and Contracts to the Operators In the County of Orange" The Board considered amendments to the EMS Franchise Ordinance entitled, "An Ordinance Regulating Ambulance and Emergency Medical, First Responder and Rescue Services and Granting of Franchise and Contracts to the Operators in the County of Orange ", and authorizing the Chair to sign. Staff Attorney Annette Moore said that when they were last here on February 2 "d, the Board passed amendments to this ordinance, but there were things that were of concern. There was a concern from the fire chiefs about the amendments and the ordinance, so now there is an amendment that specifically excludes the fire departments. The first amendment is to Section 2.4c, which would read: "A fire department in Orange County that by contract with the County provides rescue and emergency services as provided by this ordinance." This sets apart fire departments that the County contracts with from the EMS Franchise Ordinance. There was also a concern that members of the Medical Advisory Committee did not include a citizen. The second amendment is as follows for the citizen member of the Medical Advisory Committee: "A resident of Orange County who is credentialed as an Emergency Medical Service instructor and has demonstrated to the Medical Director they have knowledge of Orange County's Emergency Services practice, procedures, and protocols, as well as the Health Department Director." Another concern was regarding due process. Staff brought back some language that the public would know that there would be a public hearing. This is Section 16.5 and would be amended to read: "The hearing shall be scheduled within two days of receiving notice of appeal and shall be commenced within 10 days. The Franchisee may present evidence and give oral testimony at the hearing." Commissioner Yuhasz made reference to `c', and said that it should say "as defined by this ordinance" rather than "as provided." Commissioner Jacobs asked if anyone on a rescue squad would be able to serve on this Medical Advisory Committee. Annette Moore said that they would, but there is a potential for conflict because if a case is being heard about a specific rescue squad, then the citizen /rescue squad member would have to remove themselves. Commissioner Jacobs said that the pool of people that would be qualified is very small. A motion was made by Commissioner Yuhasz, seconded by Commissioner Hemminger to approve the amendments, with the change by Commissioner Yuhasz, to the EMS Franchise Ordinance entitled, "An Ordinance Regulating Ambulance and Emergency Medical, First Responder and Rescue Services and Granting of Franchise and Contracts to the Operators in the County of Orange and authorize the Chair to sign. VOTE: UNANIMOUS b. Reorganization of Human Rights and Relations Functions Into the Housing and Community Development Department The Board considered approving the County Manager's recommendation to integrate the Office of Human Rights and Relation functions into the Housing and Community Development Department. Frank Clifton said that the County is facing challenges on the organizational structure of County government, and they need to insure that all of the important functions have a sustainable future. The Human Rights and Relations Department has been a separate entity and last year it was placed under the direction of the County Manager. There are two functions — human rights and relations and women's rights. He said that he has tried to find similarities throughout the County in order to merge some departments and he found similarities in these two departments. He said that this department has had little or no oversight. This reorganization would put four Human Rights and Relations employees under Tara Fikes and one position focused on women's rights issues under the County Manager. He said that his preferred process is to make sure to take advantage of all of the talents, expand opportunities to provide partners, and make use of the resources to the best of the County's ability. Housing and Community Development Director Tara Fikes said that there would be no proposal to change any of the functions of the two departments. Frank Clifton reviewed the recommendations. He said that there are a couple of amendments to the by -laws of the advisory boards as it relates to personnel. PUBLIC COMMENT: Carolina Asurla is the current Vice -Chair for the Commission for Women (CfW) and she said that the Commission for Women did not have much information coming forth tonight. She Orange High School Renovations Orange County Schools Capital Project Ordinance QGwk -a?a .:0 .116 5 Be it ordained by the Orange County Board of County Commissioners that pursuant to Section 13.2 of Chapter 159 of the General Statutes of North Carolina, the following capital project is . hereby adopted. Section 1. The project authorized provides funds to renovate Orange High School. Planned renovations include improvements to the auditorium, science laboratories, tennis courts and athletic fields along with flooring replacement in the main gymnasium and construction of an athletic field house. Proceeds from a private placement loan finance the project. Section 2. The officers of the County are hereby directed to proceed with the project within the budget contained herein. Section 3. Section 4. The following revenue is anticipated to complete this project: The following amount is appropriated for this project: Through FY, . 04-05 FY 05-06 Through FY 05 -06 Sales Tax $240,000 $0 240,000 Bonds (2001) $0 $0 0 Impact Fees $0 $0 0 Private Placement $950,000 $0 950,000 Transfers from Completed Projects $0 - $0 0 Total Funding, $1,190,000 $0 1,190,000 The following amount is appropriated for this project: Section 5. This ordinance shall be in effect from the original date of adoption, March 24, 2003, until June 30, 2006. Adopted this 23rd day of June 2005. Through FY 04-05 FY 05-06 Through FY 05-06. Land/Building $50,000 $0 $50,000 Design $0 $0 $0 Construction $1,140,000 $0 $1,140,000 Other $0 $0 $0 Total Costs $1,190,000 $0 $1,190,000 Section 5. This ordinance shall be in effect from the original date of adoption, March 24, 2003, until June 30, 2006. Adopted this 23rd day of June 2005. 0,2 A- a4o5- ✓lam 9 bob Commissioner Jacobs said that the Homestead Road and Weaver Dairy Road Extension would be busy when Carolina North is built. He asked how this was incorporated in the design and the fact that there would be a lot of noise on the same side as the glass. Richard Gurlitz said that there will be a 30 -foot buffer and the insulated glass. Commissioner Jacobs said that the ERCD staff will work with Richard Gurlitz to assure that the trees are conserved. Richard Gurlitz said that the Town of Chapel Hill Manager and staff are requesting a crosswalk to Homestead Park that was requested by Active Seniors. The cost would be $60,000- $100,000 and the city will define it more in the SUP process. Others have said that this crosswalk should not be part of the site but the Town wants to keep it in as part of the approval process and it would have to be approved through DOT. Commissioner Jacobs suggested taking the money for this crosswalk out of the money to be used for Homestead Park. He suggested asking the Town to defer consideration of the crosswalk until there can be a conversation about it. The Chair should write a letter to the Town stating that the Board's position is that the crosswalk not be made a condition of approval until there is a discussion about it. A motion was made by Commissioner Halkiotis, seconded by Commissioner Jacobs to approve plans as submitted and to add language to the resolution that the crosswalk not be part of the condition of approval. VOTE: UNANIMOUS b. Approval of Fiscal Year 2005 -06 Budget Ordinance, Capital Project Ordinances, and Grant Project Ordinances The Board considered adopting the County's budget ordinance, capital project ordinances, and grant project ordinances for FY 2005 -06. John Link said that the Board made confirmed changes to the Manager's Recommended Budget, which are highlighted in the Resolution of Intent. Page 5 specifically captures the major changes to the budget. Section 1 states the major funds in the budget. Section 2 identifies the appropriation by major function. Section 3 is the revenue side. Section 4 is the tax rate levy for the fire districts. Section 5 states the approved per pupil amount for current expense, which is $2,796 per student. There are 10 sections. The yellow paper has the actual motions for the Board to consider. John Link said that because of actions the Board took during deliberations on capital, they will have to bring back the revised capital improvement plan for the two school systems and the County after the break. Commissioner Jacobs asked about the percentage of the budget used for education. Budget Director Donna Dean said that the education funding equals $72 million, which is 48% of the general fund. This includes current expense, recurring capital, long -range capital, debt service, and school nurses. Commissioner Halkiotis asked about non - departmental allocations and Donna Dean said that this is not included. She will bring this information back. Commissioner Halkiotis said that it is important to highlight that because if it were taken away, there would be significant impacts. Motion 1: A motion was made by Commissioner Gordon, seconded by Commissioner Halkiotis to adopt the 2005 -06 Orange County Budget Ordinance to include a Countywide tax rate of 84.3 cents and a Chapel Hill /Carrboro City Schools District Tax of 18.34 cents. VOTE: UNANIMOUS Motion 2: A motion was made by Commissioner Jacobs, seconded by Commissioner Halkiotis to authorize an employee compensation package that includes: - 4 percent in -range salary increases for proficient or higher work performance effective for fiscal year 2005 -06 - $5 increase in County 401 .(k) contribution for non -sworn law enforcement employees from $20 to $25 per pay period effective July 1, 2005 - Increase the County's Living Wage for employees from $9.11 per hour to $9.34 per hour effective July 1, 2005 - Elimination of Grade 7 in the Salary Schedule effective July 1, 2005 and moving employees and positions at Grade 7 to Grade 8 with salary administration as provided in the Personnel Ordinance VOTE: UNAIMOUS Motion 3: A motion was made by Commissioner Foushee, seconded by Commissioner Halkiotis to authorize the following position changes: Time Limited Positions to Be Extended One -Year from Current End Date: Recommended Increases in FTE: Department Position Title Position Position Current End Department Position Title Type Established Date Animal Services - Animal Care Animal Shelter Technician Full -time 6/1/2004 7/1/2005 Code Compliance Planninq Officer III Full -time 1/1/2004 1/5/2006 Code Compliance Planning Officer III Full -time 1/1/2004 6/21/2006 Income Maintenance Social Services Caseworker II Full -time 10/1/2004 12/6/2006 Income Maintenance Social Services Caseworker III Full -time 7/1/2004 9/27/2006 Recommended Increases in FTE: Department Position Title Current FTE Recommended FTE Health - Dental Dental Hygienist 0.5 20 hrs /wk 0.6 24 hrs /wk Health- Personal Health -Community Health Aide 0.5 20 hrs /wk 1 40 hrs /wk Recommended Change in funding source of FTE: Department Position Title Current Funding Recommended Funding Public Works Senior Public Health Educator 50/50 split 75/25 split Health- Promotion & (Healthy Carolinians County to County to Grant Education Coordinator ) rant fun din funding Aging - Wellness Program Senior Health Coordinator See note See note Public Works Wellness Pro ram Full -time 7/1/1993 (1) Historically, UNC Hospitals have contributed up to $50,000 to fund this position. For the most part, this amount has covered the total cost of the position. Beginning in FY 2005 -06, UNC plans to contribute $25,000 (a reduction of 50 %) to offset the cost of the position. The recommendation provides for the County to cover the remaining cost of the position, expected to be approximately $29,500. Time Limited Positions to Become Permanent: Department Position Title Position Type Position Established Public Works Convenience Center Operator Full -time 9/2/2003 Public Works Convenience Center Operator Full -time 7/1/1993 Public Works Convenience Center Operator Full -time 7/1/1993 Public Works Convenience Center Operator Full -time 7/1/1993 Public Works Convenience Center Operator Full -time 7/1/1993 Public Works Convenience Center Operator Full -time 7/1/1993 Public Works Convenience Center Operator Full -time 7/1/1993 Public Works Convenience Center Operator I Full -time 7/1/1994 VOTE: UNANIMOUS Motion 4: A motion was made by Commissioner Gordon, seconded by Commissioner Halkiotis to adopt the County Fee Schedule as presented during the budget work sessions. VOTE: UNANIMOUS Motion 5: A motion was made by Commissioner Halkiotis, seconded by Commissioner Foushee to approve the County and School Capital Project Ordinances for fiscal year 2005 -06 that require action before June 30, 2005. VOTE: UNANIMOUS