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Item K5BOARD OF COUNTY COMMISSIONERS AGENDA ITEM SUMMARY Meeting Date: _April 15, 2009 Division: BOCC Bulk Item: Yes No X Department: DIST 3 Staff Contact Person/Phone #: C.Schreck x 3430 AGENDA ITEM WORDING: The discussion and approval of resolution establishing an Emergency Medical Transportation Task Force for the purpose of identifying existing needs and gaps in services; procedures for improving communication regarding trauma emergencies, and the possible establishment of a coordinated medical transport system by private, public or combination of service providers. ITEM BACKGROUND: PREVIOUS RELEVANT BOCC ACTION: On 12/05/08 the BOCC adopted Ordinance No. 30-2008 creating a new article in the emergency and non -emergency medical services chapter of the county code providing for the establishment of two municipal service taxing units for the purposes of providing emergency air transport. Code 1979, sec 6.5-2 Ordinance No 1-1982 Ordinance No 20-1983 CONTRACT/AGREEMENT CHANGES: STAFF RECOMMENDATIONS: TOTAL COST: 0 COST TO COUNTY: INDIRECT COST: 0 BUDGETED: Yes No 0 SOURCE OF FUNDS: REVENUE PRODUCING: Yes No X AMOUNT PER MONTH Year APPROVED BY: County Atty X OMB/Purchasing Risk Management DOCUMENTATION: Included Not Required DISPOSITION: Revised 1/09 AGENDA ITEM # RESOLUTION NO. -2009 A RESOLUTION OF THE MONROE COUNTY BOARD OF COUNTY COMMISSIONERS PROVIDING FOR THE ESTABLISHMENT OF AN EMERGENCY MEDICAL TRANSPORTATION TASK FORCE FOR THE PURPOSE OF IDENTIFYING EXISTING NEEDS AND GAPS IN SERVICES; PROCEDURE FOR COMMUNICATING EMERGENCIES AND THE ESTABLISHMENT OF A COORDINATED MEDICAL TRANSPORT SYSTEM BY PRIVATE, PUBLIC OR COMBINATION OF SERVICE PROVIDERS. WHEREAS, Key Largo Fire Rescue and Emergency Services District, Monroe County has opted out of the Monroe County Sheriff's Office Emergency Air Transport service, TraumaStar and, WHEREAS, LifeNet, a privately owned and operated emergency air transport company serving the residents of Monroe County has increased its rates and, WHEREAS, communities north of Marathon, Monroe County did not support Resolution No. 222-2008 favoring legislation authorizing the levy of ad valorem taxes to fund Monroe County's Sheriff's Emergency Air Transport service, TraumaStar, and, WHEREAS, there is no guarantee that the residents of the Upper Keys will continue to receive no fee emergency air service by Miami -Dade, and, WHEREAS, some local medical professionals have asserted that there may be a need for additional Emergency Land and Air transportation service in Monroe County, and, WHEREAS, Monroe County has only one public Emergency Air Transportation Service, TraumaStar, and, WHEREAS, Monroe County and the Florida Keys are subject to hurricanes requiring mandated evacuations of visitors, residents, including hospital and nursing home care patients, and, WHEREAS, it is unlikely that a trauma center will ever be established in Monroe County due to its rural character and relatively small population, and, WHEREAS, the Florida Keys is a tourist destination with a varying number of visitors at any one time, and, WHEREAS, there currently is no comprehensive plan for coordinated emergency medical transport throughout Monroe County; now therefore BE IT RESOLVED BY THE BOARD OF COUNTY COMMISSIONERS FOR MONROE COUNTY, FLORIDA that: Section 1. An Emergency Medical Transportation Task Force shall be established to: 1. evaluate the County's needs for both inter -facility and on -site emergency trauma medical transport, 2. determine if those needs are currently adequately met through existing public and private services 3. determine if services are being provided for optimum cost -efficiencies to the taxpayers of Monroe County while meeting the medical trauma need 4. make recommendations to streamline existing services, improve communications, expand services or contract services, based on findings Section 2. The Task Force shall be comprised of: 1. One licensed medical professional appointed by each Commissioner who lives in that commissioner's district. 2. A representative from emergency staff at each hospital within the county limits, designated by hospital management (Lower Keys Medical Center, Fishermen's Hospital, and Mariners Hospital) 3. A representative from each emergency, fire and rescue service in the Keys, designated by service management (Monroe County Fire Rescue, Monroe County Emergency Services, Monroe County Sheriff s Department, Monroe County Emergency Management, Upper Keys Health Care Taxing District Advisory Board, LifeNet, and Key West Rescue and Ambulance Service) 4. One member of the public appointed by each Commissioner who lives in that commissioner's district 5. The Monroe County Health Administrator Section 3. The Emergency Medical Transportation Task Force will be chaired and coordinated by the Monroe County Health Department Administrator Section 4. The Task Force will provide an interim report to the BOCC within six months of its initial meeting. The Task Force will provide its final report and recommendations within 12 months of its first meeting. The Task Force will sunset upon completion of its final report. The members of the committee serve at the pleasure of the Board. PASSED AND ADOPTED, by the Board of County Commissioners of Monroe County, Florida at a regular meeting on said Board on the day of , A.D., 2009. Mayor George Neugent Mayor Pro Tern Sylvia Murphy Commissioner Heather Carruthers Commissioner Mario DiGennaro Commissioner Kim Wigington (SEAL) ATTEST: Danny L. Kolhage, CLERK L'In Deputy Clerk BOARD OF COUNTY COMMISSIONERS OF MONROE COUNTY, FLORIDA an Mayor George Neugent ORDINANCE NO.1 -1982 AN ORDINANCE REGULATING AMBULANCES, NON -EMERGENCY MEDICAL TRANSPORTATION VEHICLES, EMERGENCY AND NON -EMERGENCY MEDICAL TRANSPORTATION SERVICES IN MONROE COUNTY, FLORIDA; PROVIDING FOR PURPOSE; PROVIDING,FOR DEFINITIONS; PROVIDING FOR CERTI- FICATES OF PUBLIC C014VEIIIENCE AND NECESSITY; PROVIDING FOR CLASSIFICATION OF CERTIFICATES OF PUBLIC CONVENIENCE AND NECESSITY; PROVIDING FOR EXEMPTIONS AND EXCLUSIONS FROM CERTIFICATE REQUIREMENT; PROVIDING FOR ZONES OF OPERATION FOR EMERGENCY AND NON -EMERGENCY CALLS; PROVID- ING PROCEDURES FOR APPLYING FOR CERTIFICATES OF PUBLIC CONVENINECE AND NECESSITY; PROVIDING FOR REVIEW OF APPLICATION; PROVIDING FOR REQUIREMENT FOR BOARD APPROVAL IN GRANTING CERTIFICATE; PRO- VIDING FOR RIGHTS AND DUTIES GRANTED BY CERTIFI- CATE; PROVIDING FOR RENEWAL OF CERTIFICATE; PRO- VIDING FOR THE ESTABLISHMENT OF RULES AND REGULA- TIONS;, PROVIDING FOR PENALTIES; PROVIDING FOR REVOCATION, MODIFICATION AND SUSPENSION OF CERTI- FICATES; PROVIDING FOR INCLUSION IN CODE; PROVID- ING FOR THE EXCLUSION HEREFROM OF THE MONROE COUNTY TRANSPORTATION PROGRAM PROVIDED UNDER THE SOCIAL SERVICES DEPARTMENT; PROVIDING FOR APPLI- CABILITY; PROVIDING FOR REPEALING LAWS IN CON- FLICT; PROVIDING FOR SEVERABILITY AND PROVIDING FOR AN EFFECTIVE DATE. WHEREAS, the Board of County Commissioners of Monroe County, Florida has found and determined that it is necessary for the public health, safety and welfare of the residents of Monroe County to regulate emergency and non -emergency medical transportation services provided to the residents of the County; and WHEREAS, the Board of County Commissioners has found and deter- mined that it is in the public interest, convenience and necessity to regulate emergency and non -emergency medical transportation services to the residents of Monroe County; and WHEREAS, Section 401.25(8) and Section 401.39 of the Florida Statutes authorizes the Board of County Commissioners to adopt ordinances providing reasonable standards for the issuance of certi- ficates of public convenience and necessity for emergency and non - emergency medical transportation services; now, therefore, BE IT ORDAINED BY THE BOARD OF COUNTY COMMISSIONERS OF MONROE COUNTY, FLORIDA: SECTION 1. SHORT TITLE This ordinance shall be known and cited as the Monroe County Emergency and Non -Emergency Medical Transportation Services Ordi- nance of 1982. -2- SECTION 2. PURPOSE The purpose of this ordinance is to promote the health, safety and welfare of residents of Monroe County in need of emergency and non -emergency medical transportation services by establishing uni- form, county -wide standards for certification of emergency and non - emergency medical transportation service providers, by providing for the adoption of rules and regulations for the operation of all emergency and non -emergency medical transportation service providers and by providing for the enforcement of this ordinance and the rules and regulations by representatives of the Board of County Commis- sioners. SECTION 3. DEFINITIONS A. "Ambulance" means any private or publicly owned land, air or water vehicle that is designed, constructed, re -constructed, maintained, equipped or operated, and is used for, or intended to be used for air, land or water transportation of persons who are in need of emergency medical attention. B. "Emergency Medical Transportation Service" means any per- son, service, business entity, government agency, or volunteer organization that engages in, or holds itself out to the general public as engaging in, the business of regularly transporting in- dividuals pursuant to emergency medical calls. C. "Non -emergency Medical Transportation Vehicle" means any privately or publicly owned air, land or water vehicle that is designed, constructed, re -constructed, maintained, equipped or operated and is used for, or intended to be used for, air, land or water transportation of persons with non -emergency conditions re- quiring specialized transportation who will not need medical atten- tion at the scene or enroute. D. "Non -emergency Medical Transportation Service" means any person, firm, business entity or governmental agency that engages in, or holds itself out to the general public as engaging in, the business of responding to non -emergency calls. -3- E. "Emergency Medical Call" means a call indicating the need for transportation of a sick, injured or otherwise incapacitated person, by ambulance, upon the streets, highways or water ways of this County, that will require medical supervision at the scene or enroute. F. "Non -emergency Call" means a call requesting transporta- tion of sick, injured, handicapped or otherwise incapacitated individuals, requiring specialized transportation who will not need medical supervision or care at the scene or enroute. G. "Certificate" means a certificate of public convenience and necessity as authorized in Section 401-25(8), Florida Statutes, issued pursuant to this ordinance. H. "County" means the incorporated and unincorporated areas of Monroe County, Florida. I. "Board" means the Board of County Commissioners of Monroe County, Florida. J. "Administrator" means the Monroe County Administrator or his designee. K. "Dispatch Centers" means Board approved dispatch centers in Monroe County, Florida. L. "Patient" means any person who is in need of emergency medical treatment or medical transportation. M. "Passenger" means any person who is in need of non - emergency medical transportation. SECTION 4. CERTIFICATES REQUIRED A. It is unlawful and subject to the penalties as provided herein, for any person, business organization or public agency to represent herself, himself or itself as an emergency or non - emergency medical transportation service or engage in the business of conducting an emergency or non -emergency medical transportation service without first obtaining an appropriate certificate of public convenience and necessity from the Board as provided herein. JEAJI B. There shall be two categories of certificates of public convenience and necessity in Monroe County. 1. Certificates of public convenience and necessity for businesses and agencies that conduct an emergency medical trans- portation service, titled Class A, and 2. Certificates of public convenience and necessity for businesses and agencies that conduct a non -emergency medical transportation service, titled Class B. SECTION 5. PROCEDURE FOR OBTAINING CERTIFICATE A. Application for Class A certificate shall be made on forms provided by the Administrator. Such applications shall include: 1. the name, age, address and telephone number of each owner of the ambulance company or, if the company is a corporation, then the directors of the corporation and of each stockholder of the corporation; or if the provider is a volunteer organization, then the officers of the organization; 2. the date of incorporation or formation of the busi- ness association; 3, the zone(s) that the service desires to serve; 4. the applicant's present and proposed base station and all substations; 5. the names of all emergency medical technicians, paramedics and drivers to be utilized by the applicant; the roster will include the State of Florida certification number, date of certification expiration and any other relevant training of said personnel; 6. the year, model., type, Department of Health ambulance permit number, mileage and State of Florida vehicle license number of every ambulance vehicle used by this applicant; 7. a description of the applicant's communication systems including its assigned frequency, call numbers, mobiles, portables, other frequencies in use and a copy of all FCC licenses held by the applicant; 8. the names and addresses of three U.S. citizens who will act as reference for the applicant; -5- 9. a schedule of rates which the company will charge during the certificate year; 10. verification of adequate insurance coverage, during the certificate year; 11. an affidavit signed by the applicant or an authorized representative stating that all the information contained in the application is true; 12. such other pertinent information as the Administrator may request; 13. an initial nonrefundable application fee of $50.00; 14. an audit to be provided to the County Administrator by an independent certified public accountant selected by the County Administrator of the accounts and records of the company involved, said audit to be done annually to coincide with the end of the business year of the company. B. Application for Class B certificate shall be made on forms provided by the Administrator. Each application shall include: 1. the name, age, address and telephone number of each owner of the company, or if the company is a corporation, then the directors of the corporation and of each stockholder of the cor- poration; or if the provider is a volunteer organization, then the names of its officers; 2. the date of incorporation or formation of the busi- ness association; 3. the name under which the applicant will operate; 4. the year, model, type, Department of Health vehicle permit number, mileage, passenger capacity, State of Florida vehicle license number of every vehicle that will be used for patient trans- port; 5. the location of the place or places from which the applicant will operate and the geographic area or areas to be served by the applicant; 6. a description of the applicant's communication system, if any, including its assigned frequencies, mobiles and portables and a copy of each FCC license issued for those frequencies; 7. the names and addresses of three U.S. citizens who will act as reference for the applicant; 8. a schedule of rates which the applicant will charge during the certificate year; 9. verification of adequate insurance coverage during the certificate year; 10. an affidavit signed by the applicant stating that all information provided in the application is true; 11. a statement indicating the method of screening that will be used to assure that all calls responded to are non -emergency in nature; 12. such other information as may be reasonably requested by the Administrator; 13. an initial nonrefundable application fee of $50.00. 14. an audit to be provided to the County Administrator by an independent certified public accountant selected by the County Administrator of the accounts and records of the company in- volved, said audit to be done annually to coincide with the end of the business year of the company. C. Upon receipt of the application, the Administrator shall review the application and conduct an investigation of each appli- cant. The Administrator shall also make an investigation as to the public conveninece and necessity for an emergency or non -emergency medical transportation service within the zone or area requested. D. Requirement for Board approval in granting Class A or Class B certificate: 1. The Board shall schedule public hearings to consider all applications for certificates. The Administrator shall notify the applicant and all current holders of certificates by mail of the date, time and place of the public hearings at least one week in advance. 2. At the hearing, the Board may receive the report of the Administrator, testimony from the applicant or any other in- terested party and any other relevant information. The Board will consider the public's convenience and the necessity for the service -7- in the zone or area requested and whether the applicant has the ability to provide the necessary service. The Board shall then authorize the issuance of the certificate with such condition as are in the public's interest or deny the application setting forth the reasons for the denial. SECTION 6. RIGHTS AND DUTIES GRANTED BY CERTIFICATE A. Class A and Class B certificates granted by the Board shall be valid for one (1) calendar year and shall be personal to the applicant and not transferable. In the case of a corporation or business entity, a new certificate must be applied for if twenty-five per cent (25'/) of the outstanding share of the cor- poration or other incidents of ownership of the business association are transferred or undergo a change in ownership. B. Class A certificates permit the certificate holder to pro- vide emergency medical service transportation within his designated zone and non -emergency medical transportation service throughout the County irrespective of zones, providing the service complies with all applicable laws, ordinances and rules and regulations. C. Class B certificates permit the certificate holder to provide non -emergency medical transportation service throughout the County, providing the service complies with all applicable laws, ordinances and rules and regulations. D. Acceptance of a Class A certificate by the applicant shall obligate the applicant to: 1. provide complete emergency medical transportation service coverage to the entire zone or zones; 2. provide coverage to adjoining zones, when requested to do so by the dispatch center for emergency medical calls when the certificate holder for that zone is unable to respond; 3. to respond to all emergency medical calls issued to it, unless all vehicles are in service on other ambulance business; 4. abide by all requirements of this ordinance and rules and regulations adopted by the Board and all State and local laws; 5. provide access to the applicant's business for in- spection by the Administrator at reasonable times; 6. keep posted at his place of business a copy of the fee schedule required by this ordinance; 7. notify the Administrator of any changes in the fee schedule; 8. notify the Administrator at least thirty (30) days prior to termination or reduction of any service. E. The acceptance of a Class B certificate by the applicant obligates the applicant to: 1. operate in accordance with this ordinance and the rules and regulations adopted pursuant to this ordinance and all state and local laws; 2. provide access to its place of business for inspec- tion by the Administrator at reasonable times; 3. notify the Administrator at least thirty (30) days in advance of termination or reduction of service. 4. notify the Administrator of any changes in the fee schedule. SECTION 7. RENEWAL OF CERTIFICATE A. Applications for renewal of certificates of public con- venience and necessity shall be made on forms provided by the Administrator and filed no later than September 30th of each year. B. All requirements applicable to initial applications for a certificate shall be applicable to certificate holders seeking to renew them. C. Renewal certificates may be approved by the Board upon the recommendation of the Administrator without public hearings or notice to certificate holders. However, any actions to change zones, modify, suspend, revoke or otherwise change a certificate, shall be handled as a new certificate of public convenience and necessity. D. Each application for renewal of certificate shall be accom- panied by a $25.00 renewal fee. SECTION 8. RULES AND REGULATIONS The Administrator is hereby authorized to prepare such rules and regulations necessary to carry out the purpose of this ordinance and shall present these rules and regulations for the consideration by the Board of County Commissioners at a public hearing. The Board may adopt and subsequently amend rules and regula- tions adopted herein by motion, as its bi-weekly public meeting provided notice of the proposed change is given by publication not less than one week prior to consideration by the Board. SECTION 9. GENERAL PROHIBITION It shall be a violation of this ordinance, subject to the punishment as provided herein, for any person, business entity or governmental agency to: A. obstruct, bar or otherwise interfere with an inspection undertaken under the purview of this ordinance; B. knowingly make an omission of a material fact or a false statement, in any application or other document filed with the Administrator; C. violate or fail to observe any requirements of this ordi- nance, or any rule, regulation or order under the provisions of this ordinance. SECTION 10. DEFICIENCIES A. Whenever the Administrator finds, upon inspection or through information in their possession, that a certificate holder is not in compliance with a requirement established under this ordinance or the rules and regulations, the Administrator shall order the certificate holder to correct such deficiency. B. Every such correction order shall include a statement of the deficiencies found, the period prescribed within which the deficiency must be corrected and the provision of the law relied upon. The affected certificate holder may file a written request with the Administrator for reconsideration of the order or any portion thereof, within five (5) day of the receipt of such order. Failure of the Administrator to grant, deny or otherwise act upon a written request within seven (7) days of filing, shall be deemed a denial of such request. -10- SECTION 11. CERTIFICATION REVOCATION, MODIFICATION, SUS- PENSION Every certificate issued pursuant to this ordinance is subject to revocation, modification or suspension where it is found that any of the following has occurred: A. The certificate holder has failed or neglected to render services as required by the certificate, this ordinance or the rules and regulations promulgated by the Board, or Chapter 401 Florida Statutes; B. The application submitted to secure a license from the Board of County Commissioners contains false representations, omitted facts; C. The certificate holder or its agent has demanded money or other compensation in excess of that established in its schedule of fees filed with the Board pursuant to this ordinance; D. The certificate holder has failed to adequately serve the public's convenience and necessity; E. The certificate holder has failed to comply with a cor- rection order issued under Section 10 of this ordinance. SECTION 12 COMPLAINT PROCEDURES Complaints about the services of a certificate holder shall be referred by the Administrator to the Monroe County E.M.S. Council for investigation. The Council shall conduct an investigation and submit its findings to the Administrator. The Administrator shall review the complaints and the findings of the Council and present a recommendation to the Board of County Commissioners. If the Administrator finds that revocation, suspension or modification of a certificate is warranted, the Administrator shall notify the certificate holder by Certified Mail, and the Board of County Commissioners in writing, of such findings. This notice shall state the reasons for any finding and establish a hearing date. The hearing shall be held by the Board of County Commis- sioners for the purpose of considering the Administrator's recom- mendation. -11- SECTION 13. EMERGENCY POWERS If a situation exists which poses a serious or imminent threat to the health, safety or welfare and the public need and conven- ience, the Administrator shall have such temporary emergency powers as are necessary to remedy the situation. These temporary powers are intended to provide interim solutions until the Board meets to resolve the emergency situation. SECTION 14. EXCLUSION FROM CERTIFICATE REQUIREMENT Certificates shall not be required for: A. The transport of a patient pursuant to the Good Samaritan Act, 768.13, Florida Statutes; B. A vehicle rendering services as an ambulance in the event of a major catastrophe or emergency when ambulances with permits based in the locality of the catastrophe or emergency are incapaci- tated or insufficient in number to render the services needed. C. Ambulances based outside the County which pick up a patient in the County and transport said patient out of the County, or which pick up a patient outside the County and transport said patient into the County. D. Ambulances owned and operated by the State of Florida or Federal government. E. Vehicles operated by the Monroe County Transportation Program. SECTION 15. FALSIFICATION OF EMERGENCY MEDICAL CALLS Whoever, without reasonable cause, by telephone or otherwise, causes to be placed or places a false emergency medical call, shall be guilty of violation of this ordinance subject to punishment as provided herein. SECTION 16. PENALTIES A violation of any provision of this ordinance shall be deemed a misdemeanor and, upon conviction, the violator shall be subject to a fine not to.exceed Five Hundred ($500.00) Dollars and/or im- prisonment in the County Jail for not more than sixty (60) days, or both such fine and imprisonment. -12- A separate and distinct offense shall be deemed to have been committed each time a prohibited act occurs. SECTION 17. INCLUSION IN CODE It is the intention of the Board, and it is hereby ordained, that the provisions of this ordinanc shall become and be made a part of the Code of Laws and Ordinances of Monroe County, Florida; that the sections of this ordinance may be renumbered or relettered to accomplish such intentions; and that the word "ordinance" may be changed to "section", "article" or other appropriate words. SECTION 18. EXCLUSION OF MONROE COUNTY TRANSPORTATION PROGRA14 PROVIDED UNDER THE SOCIAL SERVICES DEPARTMENT The Monroe County Transportation Program provided under the Social Services Department of Monroe County, Florida, shall be excluded from any and all provisions of this ordinance. SECTION 19. APPLICABILITY It is hereby provided that this ordinance shall constitute a uniform law applicable in all the unincorporated and incorporated areas of Monroe County, Florida, to the extent permitted by the Florida Constitution, Article VIII, Section I. SECTION 20. REPEAL OF LAWS IN CONFLICT All local laws and ordinances applying to Monroe County in conflict with any provision of this ordinance are hereby repealed to the extent of such conflict. SECTION 21. SEVERABILITY If any section, paragraph, sentence, clause, phrase or word of this ordinance is, for any reason, held by any Court to be un- constitutional, inoperative or void, such holding shall not affect the remainder of this ordinance. SECTION 22. EFFECTIVE DATE The provisions of this ordinance shall become effective upon receipt of official acknowledgment by the Clerk of the Board of County Commissioners nance has been (Seal) -13- from the Department of State that this ordi- filed with the Department of State. BOrNNROE COUNTY COMMISSIONERS OF COUNTpRIDA B' r - ;x MayorIchairman : Attest:, Lrk � ADOPTED: January 26, 1982 FILED WITH SECRETARY OF STATE: EFFECTIVE DATE: February 17, 1982 APPIOVED AS TO FCRAi ,Attorn� Off'-� • ORDINANCE NO. 20 -1983 AN ORDINANCE AMENDING CHAPTER 6.5 OF THE CODE OF ORDINANCES OF MONROE COUNTY, FLORIDA. BE IT ORDAINED BY THE BOARD OF COUNTY COMMISSIONERS OF MONROE COUNTY, FLORIDA,: Section 1. That Section 6.5-1 of Chapter 6.5 of the Monroe County Code of Ordinances of Monroe County, Florida, shall be amended to read as follows: "Sec. 6.5-1. Short title. This ordinance may be cited as the Monroe County Emergency and Non -Emergency Medical Services Ordinance of 1982." Section 2. That Section 6.5-2 of Chapter 6.5 of the Monroe County Code of Ordinances of Monroe County, Florida, shall be amended to read as follows: "Sec. 6.5-2. Purpose. The purpose of this ordinance is to promote the health, safety and welfare of residents and visitors of Monroe County by establishing uniform, county -wide standards for certification of emergency medical services and non - emergency medical transportation services, by providing for the adoption of rules and regulations for the operation of all emergency medical services and non - emergency medical transportation services and by providing for the enforcement of this ordinance and the rules and regulations by representatives of the Board of County Commissioners." Section 3. That Section 6.5-3 of Chapter 6.5 of the Monroe County Code of Ordinances of Monroe County, Florida, shall be amended to read as follows: "Sec. 6.5-3. Definitions. A. "Administrator" means the Monroe County Administrator or his designee. B. "Advanced Life Support (ALS)" means treatment of life -threatening medical emergencies through the use of techniques such as endotracheal intubation, the administration of drugs, intravenous fluids, telemetry, cardiac monitoring, and cardiac defibrillation, by a qualified person, pursuant to Chapter 401 Florida Statutes and Chapter 1OD-66 Florida Administrative Code. C. "Advanced Life Support Service" means any emergency medical transport or nontransport service which used advanced life support techniques as defined in this ordinance. D. "Advanced Life Support Service/Fire Rescue" means any fire department which provides advanced life support services, but which does not routinely transport those persons receiving such services. E. "Ambulance" or "Emergency Medical Services Vehicle" means any privately or publicly owned land, air or water vehicle that is designed, constructed, re -constructed, maintained, equipped or operated for, and is used for, or intended to be used for air, land or water transportation of sick or injured persons who are in need of emergency medical attention during transport and who must be transported on a stretcher. F. "Ambulance Driver" means any person who meets the requirements of Chapter 401.281 Florida Statutes. G. "Basic Life Support (BLS)" means treatment of life threatening medical emergencies by a qualified person through the use of techniques such as patient assessment, basic cardiopulmonary resuscitation, splinting, obstetrical assistance, bandaging, administration of oxygen, application of medical antishock trousers, and other techniques described in the Emergency Medical Technician Basic Training Course Curriculum of the United States Department of Transportation. "Basic Life Support" also includes esophageal intubation if the emergency medical technician performing the intubation has been trained in the skill of esophageal intubation and is performing the intubation under the medical direction of a licensed physician. Cardiac monitoring, telemetry, and the monitoring and maintenance of an intravenous fluid may be performed by a certified emergency medical technician if such person is trained in these skills and performs them under the direction of a licensed physician. H. "Basic Life Support Service" means any emergency medical transport service which uses basic life support techniques as defined in this ordinance. I. "Board" means the Board of County Commissioners of Monroe County, Florida. J. "Certificate" means a certificate of public convenience and necessity issued pursuant to this ordinance. K. "County" means the incorporated and unincorporated areas of Monroe County, Florida. L. "Dispatch Centers" means Board approved dispatch centers in Monroe County, Florida. M. "Emergency Medical Service" means any person, firm, corporation, association, volunteer organization, or governmental entity owning or acting as agent for the owner of any business or service which furnishes, operates, conducts, maintains, advertises, engages in, proposes to engage in, or professes to engage in the business or service of providing advanced life support and/or basic life support services, as defined in this ordinance. N. "Emergency Medical Technician (EMT)" means any person who is trained in basic life support and who is certified by the Department of Health and Rehabilitative Services, State of Florida, to perform such procedures in emergency situations. 0. "Medical Direction" means direct physician supervision through two-way voice communication or, when such voice communication is unavailable, through established standing orders, pursuant to Chapter 401 Florida Statutes and Chapter 1OD-66 Florida Administrative Code. P. "Medical Director" means a licensed physician, employed or contracted by an advance life support or basic life support service, who provides medical supervision, not to include administrative and managerial functions, for daily operations and training pursuant to the provisions of Chapter 401 Florida Statutes, Chapter 1OD-66 Florida Administrative Code, and this ordinance. Q. "Non -emergency Medical Transportation Service" means any person, firm, corporation, association, volunteer organization or governmental entity owning or acting as agent for the owner of any business or service which furnishes, operates, conducts, maintains, advertises, engages in, proposes to engage in, or professes to engage in the business or service of air, land, or water transportation of persons who are confined to wheelchairs or stretchers and whose condition is such that these persons do not need, nor are likely to need, immediate medical attention during transport. R. "Non -emergency Medical Transportation Vehicle" means any privately or publicly owned air, land or water vehicle that is designed, constructed, re -constructed, maintained, equipped, or operated for, and is used for, or intended to be used for, air, land or water transportation of persons who are confined to wheelchairs or stretchers and whose condition is such that these persons do not need, nor are likely to need, immediate medical attention during transport. S. "Paramedic" means a person certified by the Department of Health and Rehabilitative Services, State of Florida, to perform basic and advanced life support procedures. T. "Physician" means a practitioner licensed under the provisions of Chapter 458 or Chapter 459 Florida Statutes." Section 4. That Section 6.5-4 of Chapter 6.5 of the Code of Ordinances of Monroe County, Florida, be amended to read as follows: "Sec. 6.5-4. Certificates required. A. It is unlawful and subject to the penalties as provided herein, for any person, business organization or public agency to represent herself/himself or itself as an emergency medical service or non -emergency medical transportation service to engage in the business of conducting an emergency medical service or non -emergency medical transportation service without first obtaining an appropriate certificate of public convenience and necessity from the Board as provided herein. B. There shall be two categories of certificates of public convenience and necessity in Monroe County. 1. Certificates of public convenience and necessity for business and agencies that conduct an emergency medical service, titled Class A, and 2. Certificates of public convenience and necessity for business and agencies that conduct a non -emergency medical transportation service, titled Class B." Section 5. That Section 6.5-5 of Chapter 6.5 of the Code of Ordinances of Monroe County, Florida, be amended to read as follows: "Sec. 6.5-5. Procedure for obtaining certificate. A. Application for Class A certificate shall be made on forms provided by the Administrator. Such applications shall include: 1. Name of service, business mailing address and telephone number. 2. The name, age, address and telephone number of each owner of the emergency medical service, or if the service is a corporation, then the directors of the corporation and of each stockholder of the corporation; or if the service is a volunteer organization, then the officers of the organization. 3. The date of incorporation or formation of the business association. 4. Level of care to be provided. Specify BLS or ALS. If ALS, specify whether service is to include transport or nontransport capabilities. 5. The zone(s) that the service desires to serve. 6. The applicant's present and proposed base station and all substations. 7. The names of all emergency medical technicians, paramedics, and drivers to be utilized by the applicant; the roster will include the State of Florida certification number, date of certification expiration and any other relevant training of said personnel. 8. The year, model, type, Department of Health ambulance permit number, mileage and State of Florida vehicle license number of every ambulance vehicle used by this applicant. 9. A description of the applicant's communication systems including its assigned frequency, call numbers, mobiles, portables, other frequencies in use and a copy of all FCC licenses held by the applicant. 10. The names and addresses of three U.S. citizens who will act as reference for the applicant. 11. A schedule of rates which the company will charge during the certificate period. 12. Verification of adequate insurance coverage, during the certificate period. 13. An affidavit signed by the applicant or an authorized representative stating that all the information contained in the application to the best of their knowledge is true and correct. 14. A copy of the applicant's contract with a medical director. 15. A copy of all standing orders as issued by the medical director. 16. Such other pertinent information as the Administrator may request. 17. An initial nonrefundable application fee of $50.00. 18. An audit to be provided to the County Administrator by an independent certified public accountant of the accounts and records of the service involved, said audit to be done annually to coincide with the end of the business year of the service. B. Application for Class B certificate shall be made on forms provided by the Administrator. Each application shall include: 1. Name of service, business mailing adress and telephone number. 2. The name, age, address and telephone number of each owner of the nonemergency medical transportation service, or if the service is a corporation, then the directors of the corporation and of each stockholder of the corporation; or if the service is a volunteer organization, then the names of its officers. 3. The date of incorporation or formation of the business association. 4. The year, model, type, Department of Health vehicle permit number, mileage, passenger capacity, State of Florida vehicle license number of every vehicle that will be used for patient transport. 5. The location of the place or places from which the applicant will operate and geographic area or areas to be served by the applicant. 6. A description of the applicant's communication system, if any, including its assigned frequencies, mobiles and portables and a copy of each FCC license issued for those frequencies. 7. The names and addresses of three U.S. citizens who will act as reference for the applicant. B. A schedule of rates which the applicant will charge during the certificate period. 9. Verification of adequate insurance coverage during the certificate period. 10. An affidavit signed by the applicant or an authorized representative stating that all information provided in the application to the best of their knowledge is true and correct. 11. A statement indicating the method of screening that will be used to assure that all calls responded to require only transportation as may be provided by a nonemergency medical transportation service and vehicle. 12. Such other pertinent information as the Administrator may request. 13. An initial nonrefundable application fee of $50.00. 14. An audit to be provided to the County Administrator by an independent certified public accountant of the accounts and records of the service involved, said audit to be done annually to coincide with the end of the business year of the service. C. Upon receipt of the application, the Admini- strator shall review the application and conduct an investigation of each applicant. The Administrator shall also make an investigation as to the public convenience and necessity for an emergency medical service or non -emergency medical transportation service within the zone or area requested. D. Requirement of Board approval in granting Class A or Class B certificate: 1. The Board shall schedule public hearings to consider all applications for certificates. The Administrator shall notify the applicant and all current holders of certificates by mail of the date, time and place of the public hearings at least one week in advance. 2. At the hearing, the Board may receive the report of the Administrator, testimony from the applicant or any other interested party and any other relevant information. The Board will consider the public's convenience and necessity for the service in the zone or area requested and whether the applicant has the ability to provide the necessary service. The Board will consider recommendations from municipalities within the applicant's requested service zone or area. The Board shall then authorize the issuance of the certificate with such conditions as are in the public's interest or deny the application setting forth the reasons for denial." Section 6. That Section 6.5-6 of Chapter 6.5 of the Code of Ordinances of Monroe County, Florida, be amended to read as follows: "Sec. 6.5-6. Rights and duties granted by certificate. A. Class A and Class B certificates granted by the Board shall be valid for two (2) calendar years and shall be personal to the applicant and not transferable. In the case of a corporation or business entity, a new certificate must be applied for if twenty-five per cent (25%) of the outstanding share of the corporation or other incidents of ownership of the business association are transferred or undergo a change in ownership. B. Class A certificates permit the certificate holder to provide basic life support and/or advanced life support services, whichever is applicable, within his assigned zone and inter -hospital transfers and/or inter -county transfers throughout the County irrespective of zones, providing the service complies with all applicable laws, ordinances and rules and regulations. C. Class B certificates permit the certificate holder to provide non -emergency medical transportation service throughout the County, providing the service complies with all applicable laws, ordinances and rules and regulations. D. Acceptance of a Class A certificate by the applicant shall obligate the applicant to: 1. Provide continuous basic life support and/or advanced life support services, whichever is applicable, on a 24-hour, 7-day week basis within his assigned zone(s). 2. Provide mutual assistance responses to adjoining zones, when requested to do so by the dispatch center for calls when the certificate holder for that zone is unable to respond or has vehicles insufficient in number to render the services needed. 3. To respond to all calls issued to it, unless all vehicles are in service on other ambulance business, incapacitated, or insufficient in number to render the services needed. 4. Abide by all requirements of this ordinance and rules and regulations adopted by the Board and all State and local laws. 5. Provide access to the applicant's business for inspection by the Administrator at reasonable times. 6. Keep posted at his place of business a copy of the fee schedule required by this ordinance. 7. Notify the Administrator of any changes in the fee schedule. 8. Notify the Administrator at least thirty (30) days prior to termination or reduction of any service. E. The acceptance of a Class B certificate by the applicant obligates the applicant to: 1. Operate in accordance with this ordinance and the rules and regulations adopted pursuant to this ordinance and all State and local laws. 2. Provide access to the applicant's business for inspection by the Administrator at reasonable times. 3. Notify Administrator at least thirty (30) days in advance of termination or reduction of service. 4. Notify the Administrator of any changes in the fee schedule. Section 7. That Section 6.5-7 of Chapter 6.5 of the Code of Ordinances of Monroe County, Florida, be amended to read as follows: "Sec. 6.5-7. Renewal of certificate. A. Applications for renewal of certificates of public convenience and necessity shall be made on forms provided by the Administrator and filed no earlier than 90 days nor less than 60 days prior to the expiration date of the applicant's current certificate. B. All requirements applicable to initial applica- tions for a certificate shall be applicable to certifi- cate holders seeking to renew them. C. Renewal certificates may be approved by the Board upon recommendation of the Administrator without public hearings or notice to certificate holders. However, any actions to change zones, modify, suspend, revoke or otherwise change a certificate, shall be handled as a new certificate of public convenience and necessity. D. Recommendations from municipalities within the certificate holder's assigned zone(s) will be considered. E. Each application for renewal of certificate shall be accompanied by a $25.00 renewal fee." Section 8. That Section 6.5-8 of Chapter 6.5 of the Code of Ordinances of Monroe County, Florida, be amended to read as follows: "Sec. 6.5-8. Rules and regulations. The Administrator is hereby authorized to prepare such rules and regulations necessary to carry out the purpose of this ordinance and shall present these rules and regulations for the consideration by the Board of County Commissioners at a public hearing. The Board shall consider recommendations from municipalities within its jurisdiction. The Board may adopt and subsequently amend rules and regulations adopted herein by motion, and its bi-weekly public meeting provided notice of the proposed change is given by publication not less than one week prior to consideration by the Board." Section 9. That Section 6.5-11 of Chapter 6.5 of the Code of Ordinances of Monroe County, Florida, be amended to read as follows: "Sec. 6.5-11. Certificate revocation, modification, suspension. Every certificate issued pursuant to this ordinance is subject to revocation, modification or suspension where it is found that any of the following has occured: A. The certificate holder has failed or neglected to render services as required by the certificate, this ordinance or the rules and regulations promulgated by the Board, or Chapter 401 Florida Statutes. B. The application submitted to secure a certificate from the Board of County Commissioners contains false representations, omitted facts. C. The certificate holder or its agent has demanded money or other compensation in excess of that established in its schedule of fees filed with the Board pursuant to this ordinance. D. The certificate holder has failed to adequately serve the public's convenience and necessity. E. The certificate holder has failed to comply with a correction order issued under Section 10 of this ordinance." Section 10. That Section 6.5-14 of Chapter 6.5 of the Code of Ordinances of Monroe County, Florida, be amended to read as follows: "Sec. 6.5-14. Exclusion from certificate requirement. Certificates shall not be required for: A. A privately owned vehicle not ordinarily used in the business of transporting persons who are sick, injured, wounded, incapacitated, or helpless. B. A vehicle rendering services as an ambulance in the event of a major catastrophe or emergency when ambulances with permits based in the locality of the catastrophe or emergency are incapacitated or insufficient in number to render the services needed. C. Ambulances based outside the County which pick up a patient in the County and transport said patient out of the County, or which pick up a patient outside the County and transport said patient into the County. D. Ambulances owned and operated by the State of Florida or Federal Government. E. Vehicles operated by the Monroe County Transportation Program. F. A vehicle under the direct supervision of a licensed physician used as an integral part of a private industrial safety, emergency, or disaster plan within a privately owned and controlled area, which vehicle may from time to time be used to transport persons in need of medical attention, but which is not available to the general public and which does not routinely transport patients. G. A fire department vehicle which is used as an integral part of a fire suppression response unit, which vehicle may from time to time be used to transport fire fighters in need of medical attention; however, basic or advanced life support units shall not be deemed to be exempt under this section. H. Any organization or person that provides wheel- chair transport services, if: 1. The service is a public bus system. 2. The service is a public or private school bus system whose major business is that of transporting school children to and from school or school - related activities. I. Any hospital utilizing its own vehicles in transporting, to or from a hospital or a medical facility, if the hospital does not charge a fee for this service, nonemergency patients whose medical condition is such that they are confined to a wheelchair or to a stretcher but who do not need, nor are likely to need, medical attention during transport." Section 11. That Section 6.5-15 of Chapter 6.5 of the Code of Ordinances of Monroe County, Florida, be amended to read as follows: "Sec. 6.5-15. Turning in a false alarm. Whoever, without reasonable cause, by telephone or otherwise, summons any emergency medical services vehicle pursuant to this ordinance or reports that such a vehicle is needed when such person knows or has reason to know that the services of such a vehicle are not needed, shall be guilty of violation of this ordinance subject to punishment as provided herein." Section 12. That Section 6.5-16 of Chapter 6.5 of the Code of Ordinances of Monroe County, Florida, be amended to read as follows: "Sec. 6.5-16. Penalties. Any person who violates, or who fails to comply with, any provision of this ordinance is guilty of a misdemeanor and, upon conviction, shall be subject to a fine not to exceed Five Hundred Dollars ($500.00) and/or imprisonment in the County Jail for not more than sixty (60) days, or both such fine and imprisonment. A separate and distinct offense shall be deemed to have been committed each time a violation occurs." Section 13. If any section, subsection, sentence, clause or provision of this Ordinance is held invalid, the remainder of this Ordinance shall not be affected by such invalidity. Section 14. All ordinances or parts of ordinances in conflict with this Ordinance are hereby repealed to the extent of said conflict. Section 15. The provisions of this Ordinance shall be included and incorporated in the Code of Ordinances of the County of Monroe, Florida, as an addition or amendment thereto, and shall be appropriately renumbered to conform to the uniform numbering system of the Code. Section 16. This Ordinance shall take effect immediatley upon receipt of official notice from the Office of the Secretary of State of the State of Florida that this Ordinance has been filed with said Office. (SEAL) Attest: LFiI IVJ i , CLEERi M-P o e I ADOPTED: September 30, 1983 FILED WITH SECRETARY OF STATE: EFFECTIVE DATE: BOARD OF COUNTY COMMISSIONERS OF MONROE COUNTY, FLORIDA By Zaf-n APPROVED AS TO FORM AAID LEGAL SUFFXWhCY. BY Ano►sys Office