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HomeMy WebLinkAboutR15-056 Ambulance Licensing and Appointments RETAC Commissioners moved adoption of the following resolution: BOARD OF COUNTY COMMISSIONERS COUNTY OF EAGLE, STATE OF COLORADO RESOLUTION NO. 2015- M c. RESOLUTION CONCERNING AMBULANCE LICENSING STANDARDS AND APPOINTMENT TO THE REGIONAL EMERGENCY TRAUMA ADVISORY COUNCIL WHEREAS, the General Assembly of Colorado enacted the Colorado Emergency Medical and Trauma Services Act, C.R.S. § 25-3.5-101 et seq; and WHEREAS, the Act requires the Board of County Commissioners of each County to adopt by resolution, rules and regulations governing the licensure of ambulance services and emergency services personnel; and WHEREAS, the Board of County Commissioners for Eagle County ("County") desires to appoint members to the Regional Emergency Trauma Services Advisory Council ("RETAC") based on their positions held or agencies represented; and WHEREAS, the terms and conditions of this Resolution are intended to reaffirm Eagle County's commitment to and implementation of the General Assembly's declaration that it is in the public interest to provide available, coordinated, quality, sufficient and reliable emergency medical services to the state's residents. NOW, THEREFORE, BE IT RESOLVED BY THE BOARD OF COUNTY COMMISSIONERS OF THE COUNTY OF EAGLE, STATE OF COLORADO: THAT, the County hereby appoints the following positions as members to the RETAC. Such positions shall be appointed by the corresponding agency below based on the position held or agency represented. Notwithstanding anything to the contrary herein, any such appointment shall serve at the pleasure of the County and may be removed, with or without cause, upon notice to the appointing agency. Upon such notice, the agency shall reappoint a new member. The County may appoint such new member upon an agency's failure to timely fill vacancies. //remainder of page intentionally left blank// Trauma Nurse Coordinator Vail Valley Medical Center Trauma Physician Vail Valley Medical Center Emergency Room Physician Vail Valley Medical Center Two Representatives Eagle County Health Service District One Representative Colorado Mountain College One Representative Vail Mountain Rescue Group One Representative Eagle County Public Health One Representative Eagle County Public Safety Council THAT, the Board hereby adopts Rules Pertaining to Emergency Medical Services in the form as set forth in Exhibit "A" attached hereto and made a part hereof by this reference. THAT, the Board finds, determines and declares that this Resolution is necessary for the public health, safety and welfare of the citizens of the County of Eagle, State of Colorado. MOVED,READ AND ADOPTED by the Board of County Commissioners of the County of Eagle, State of Colorado, at its regular meeting held the (4 day o JUL`-►, 2015. COUNTY OF EAGLE, STATE OF 4 �coett COLORADO, By and Through Its 1117: t BOARD OF COUNTY COMMISSIONERS ATTEST: 4t 90 CO Ole' 110a-AL: w V c_._.a t - By: ,.11ALI a I L.LILL. 11 Clerk to the Board of Kathy j ndler-Henry County Commissioners Chairman "anne MccQueene o v•-1ne /illian H. Ryan Commissioner Commissioner VIA& seconded adoption of the foregoing resolution. The roll having been called, the vote was as follows: Commissioner Chandler-Henry t` Commissioner McQueeney -0• Commissioner Ryan " This resolution passed by ` vote of the Board of County Commissioners of the County of Eagle, State of Colorado. EXHIBIT A EMERGENCY MEDICAL SERVICES AMBULANCE LICENSING STANDARDS ARTICLE I: AUTHORITY, PURPOSE AND INTENT A. These Rules and Standards are adopted pursuant to the authority granted the Board of County Commissioners "Board" under the Colorado Emergency Medical Services Act, Section 25-3.5-101, et seq., C.R.S., and Section 30-11-107(1)(q), C.R.S. The Board finds that the emergency transportation of sick, injured or otherwise incapacitated or helpless persons is a matter closely affecting the public interest and welfare and declares that it is in the best interest of the public health, safety and welfare, and in accordance with the law, that these Rules and Standards be adopted. B. The purpose of these Rules and Standards is to set forth the requirements for the inspection, licensure and operation of ambulance services, ambulance personnel and ambulance vehicles operating in Eagle County pursuant to the Colorado Emergency Medical Services (EMS) Act. C. Nothing in these Standards shall be construed to create a cause of action or civil liability remedy in any person. These Standards shall not be construed to create a duty to any third party where no such duty otherwise existed. It is the express intention of the Board that any third party receiving services or benefits under these Standards shall be deemed to be an incidental beneficiary only. D. If any of the provisions of these Standards are determined to be invalid, such determination shall not affect the remaining provisions of these Standards. ARTICLE II: DEFINITIONS The Definitions as used in these Rules and Standards are defined in Colorado State Board of Health Rules pertaining to Emergency Medical Services: 6CCR 1015.3 Chapter 1 Section 2 and Chapter 4 Section 2. Other Definitions: A. "Accredited": means any licensed ambulance service that holds a valid certificate of accreditation from the Commission of Accreditation of Ambulance Services (CAAS) or the Commission on Accreditation of Medical Transport Systems (CAMTS). B. "Ambulance Transport Agency": Any public agency, volunteer organization or commercial enterprise licensed as an ambulance service by the Board of County Commissioners of any Colorado county, sometimes referred to herein as a "licensed ambulance service." C. "Ambulance — advanced life support": A vehicle equipped in accordance with Chapter 4 Section 3.4.2 of the rules pertaining to Emergency Medical Services, 6CCR1015-3, and operated by an ambulance service authorizing the vehicle to be used to provide ambulance service limited to the scope of practice of the Emergency Medical Technician-Intermediate or Emergency Medical Technician-Paramedic as defined by the Emergency Medical Practice Advisory Council (EMPAC) in Chapter 2, 6CCR 1015-3. D. "Ambulance — basic life support": A vehicle equipped in accordance with Chapter 4 Section 3.4.2 of the rules pertaining to Emergency Medical Services, 6CCR1015-3, and operated by an ambulance service authorizing the vehicle to be used to provide ambulance service limited to the scope of practice of the Emergency Medical Technician-Basic as defined by the Emergency Medical Practice Advisory Council (EMPAC) in Chapter 2, 6CCR1015-3. E. "Authorized Representative": The Public Health Manager, as designated by the Director of Eagle County Public Health and Environment. This individual is responsible for coordinating the licensure of ambulances and the administration of these standards. F. "Based": An ambulance service headquartered, having a substation, office ambulance post or other location in the county. G. "Board": Means the Board of County Commissioners for Eagle County. H. "Council": State Emergency Medical and Trauma Services Advisory Council (SEMTAC) I. "County": Eagle County J. "Department": Colorado Department of Public Health &Environment (CDPHE). K. "Director": The Director of Eagle County Public Health and Environment. L. "Disaster Aid": In the event of an all hazards event, including but not limited to air transport crash, terrorist attack, natural disaster earthquake, ambulances may be called upon by another jurisdiction or county in which they are not licensed to serve, to provide emergency support. No formal contracts or mutual aid agreements for assistance or additional licenses are needed for this type of disaster response during a catastrophic event. M. "Emergency": Actual or self-perceived event that threatens life, limb or well-being of an individual in such a manner that immediate medical care is needed. N. "Emergency Call": A real or self-perceived event where the EMS system is accessed by the 9-1-1 emergency access number or its local equivalent, or an interfacility transfer where the patient's health or well-being could be compromised if the patient is held at the originating facility indefinitely. 0. "Emergency Facility": A general hospital, trauma center, or free-standing emergency facility with an emergency department staffed twenty-four (24) hours a day, seven (7) days per 2 week, with a licensed physician; or an emergency medical outpatient facility staffed twenty-four (24) hours a day, seven (7) days per week with a licensed physician or registered nurse with direct medical supervision by a licensed physician; or an emergency facility with a licensed physician who responds on an on-call basis. P. "License": The authorization issued by the appropriate authority to operate an ambulance service in the County. The license may not be assigned, sold or otherwise transferred. Q. "Licensee": The legal entity that has been issued a license by the appropriate authority to provide ambulance service in the County. R. "Mutual Aid": A written, contractual agreement between two licensees to supplement services in each other's response districts. A mutual aid agreement does not exempt an Ambulance from the licensing requirements of the local government within which mutual aid is provided. S. "Patient": Means any individual, who is sick, injured, has experienced a traumatic injury, or is in need of immediate professional medical attention and who has been treated. T. "Service Area": means the geographic area of the County where an ambulance service provides services. Boundaries for service areas may be defined by customary practice or legally established by a Special District or other political subdivision. U. "To Operate in Eagle County": The providing of Ambulance service or transport of patients within the boundaries of Eagle County. ARTICLE III: STANDARDS A. Ambulance Service License Required: No person shall provide ambulance service, publicly or privately, in the County unless that person or firm holds a valid license to do so issued by the Board as hereinafter provided. The Board reserves the right to amend these Rules and Standards, and any other individual conditions of licensing as applied to any particular license, as needed in keeping with its legislative function and in order to implement the policy of the State of Colorado that the regulation and control or ambulance licenses is in the exclusive purview of the Board. B. Ambulance Crew Members: No patient shall be transported in an ambulance operating in the County unless the ambulance is staffed by a person meeting certification as an EMS Provider as defined in the Rules Pertaining to EMS Education and Certification at 6 CCR 1015- 3, Chapter One. The minimum requirement for the ambulance driver shall be a valid driver's license. C. Ambulance Equipment: Each ambulance shall contain all equipment, as adopted by the agency, which includes the minimum equipment requirements established by the Colorado Department of Public Health and Environment 6CCR 1015-3 Chapter Four, Section Nine. Equipment must be kept in good working order at all times. 3 D. Ambulance Permit: No ambulance shall be operated within the County unless a permit has been issued as hereinafter provided. This includes but not limited to; 911 calls, standby for special events and interfacility transports from any health facility, free standing emergency department, skilled nursing facility, long term care facility, clinic or urgent care. Health facilities are defined in 6 CCR 1011-1 Chapter Two—Twenty-five et seq. E. Ambulance Specifications: Ambulances permitted by the County prior to the effective date of these Standards may continue to be used as ambulances provided that they continue to meet minimum standards for suitability, construction and general condition as determined by the Board. 1. Each ambulance shall clearly display permanent markings on both sides showing the name of the ambulance service under which they are licensed. 2. Each ambulance shall be maintained at all times in a safe operating condition and in compliance with Colorado motor vehicle statutes, rules or Standards. At the time of application for permit the ambulance service shall submit to the County a certificate prepared by a qualified mechanic certifying the ambulance is in a safe operating condition. F. Exceptions to Licensing and Permits Required: The provisions of the licensing and permit paragraphs, (A) and(B) above, shall not apply to the following: 1. Vehicles used by other agencies including quick response teams and rescue units that do not routinely transport patients and are only used to transport patients, for extrication from areas inaccessible to a permitted ambulance. Vehicles used in this capacity may only transport patients to the closest practical point for access to a permitted ambulance or hospital. 2. Vehicles, including ambulances from another jurisdiction, used during a major catastrophe or mass casualty incident when permitted ambulances are insufficient. 3. An ambulance service that does not transport patients from points originating in Eagle County, or transporting a patient originating outside the borders of Eagle County. 4. Vehicles used or designated for the scheduled transportation of convalescent patients, individuals with disabilities, or persons who would not be expected to require skilled treatment or care while in the vehicle. 5. Vehicles used solely for the transportation of intoxicated persons or persons incapacitated by alcohol as defined in Section 25-1-302, C.R.S. (2006), but who are not otherwise disabled or seriously injured and who would not be expected to require skilled treatment or care while in the vehicle. 6. Vehicles used for the transportation of persons injured at a mine when the personnel used on the vehicles are subject to the mandatory safety standards of the Federal Mine Safety and Health Administration, or its successor agency. 7. Ambulances operated by a department or an agency of the federal government, originating from a federal reservation for the purpose of responding to, or transporting patients under federal responsibility. 4 8. Ambulances duly licensed by another jurisdiction providing services in Eagle County pursuant to a mutual aid or automatic aid agreement with an ambulance service licensed in Eagle County or otherwise summoned to assist by an ambulance service licensed in Eagle County. G. Insurance: 1. No ambulance service shall operate in the County unless it is covered by workers' compensation insurance, commercial or comprehensive general liability insurance, complying motor vehicle liability insurance, medical malpractice or professional liability insurance, and other insurance policies as may be required by law, in amounts that meet or exceed limits specified in the Workers' Compensation Act, the Governmental Immunity Act, the Motor Vehicle Financial Responsibility Act, or other applicable statutes, furnished by an insurance carrier appropriately licensed to write such policies in Colorado. Every insurance policy required shall provide for continuing liability of thereunder to the full amount, notwithstanding any recovery thereon, that the liability of the insured shall not be affected by the insolvency or bankruptcy of the insured and that the insurance company will not be relieved from liability on account of nonpayment of premiums, failure to renew the ambulance service license, or any act of omission of the insured unless the policy is canceled, terminated or revoked with appropriate written notification as required in these Standards. 2. In addition to the coverage described above, each ambulance service shall maintain insurance coverage for each and every ambulance owned, operated or leased by the ambulance service providing coverage for injury or death of persons in accidents resulting from any cause for which the owner of the ambulance should be liable on account of any liability imposed on him by law, regardless of whether the ambulance was being operated by the owner, his agent or lessee, or any other person, and coverage as against damage to the property of another, including personal property, under like circumstances, in the following minimum amounts: Public Liability and Bodily Injury: Each Person $1,000,000 Each Accident $2,000,000 Property Damage: Each Accident $1,000,000 Professional Liability: Each Person $1,000,000 Each Accident $2,000,000 3. The County shall be notified, in writing, thirty(30) days prior to any cancellation, termination, revocation or other material change in coverage. Proof of insurance shall be filed with the County with the application for an ambulance service license as required in these Standards. A certificate of insurance, with the County 5 named as certificate holder, shall indicate the vehicles covered by the policy, type of insurance, policy number(s), policy effective date and expiration date and amount of coverage. Notification of any changes in insurance, including vehicles covered under the policy, shall be made to the County in writing, and a new certificate of insurance forwarded to the Board with thirty (30) days of the changes. 4. Each ambulance service shall provide written notice to all personnel regarding the amount of professional liability insurance the ambulance service carries. Ambulance services must attest to and provide if requested, documentation regarding the process used to inform ambulance staff of the amount of professional liability insurance carried by the service. 5. The Board may require reasonable additional coverage and proof of insurance at any time it deems necessary to promote the public health, safety and welfare. The requirements herein may be satisfied through an umbrella policy acceptable to Eagle County containing equivalent or greater amounts. H. Medical Direction: All ambulance services shall have a medical director meeting the requirements established by 6CCR1015-3 Chapter Two et seq. The medical director shall be notified in writing by the Board, or their authorized representative, of any violations of these Standards by the ambulance service or alleged complaints or violations by individual medical providers operating on an ambulance service. The Board shall be informed within five (5) business days, in writing, of any changes in medical director during the term of the ambulance service license. The Medical Director shall attest to his or her willingness to provide medical oversight and a medical continuous quality improvement for the ambulance service in writing. I. Standards: An application for an ambulance service license shall be submitted to the County and shall contain the following information, supporting documents and application fees: 1. Type of license: BLS ambulance service or ALS ambulance service. The type of license will describe the maximum level of service that could be provided at any time by the ambulance service. 2. The name, address and telephone number(s) of the owner of each ambulance. 3. The name, address and telephone number(s) of the person applying for the license, hereinafter referred to as the applicant. 4. The name, address and telephone number(s) of the person who will be in charge of the operation of the ambulance service. 5. Accreditation certificate and type of accreditation including date of renewal and last inspection by accrediting body. 6. If the owner of an ambulance or the applicant is a partnership, the name and address of each partner. If the owner of an ambulance or the applicant is a corporation, the name and address of each stockholder owning ten percent (10%) or more of the outstanding stock of each such corporation and the name and address of each director of the corporation. If the owner of an ambulance or the 6 applicant is a government, the name and address of each member of the governing board. 7. The trade or other name, if any, under which the applicant does business or proposes to do business. 8. Completed ambulance vehicle permit application for every ambulance to be used by the applicant in providing service in the County. 9. The location and description of the place or places from which it is intended to operate the ambulance service or a copy of the District boundaries if applicant is a Title 32 Special District. 10. For a new application, certificates of inspection or other documentation that the physical inspection of the ambulances, equipment and location of the applicant has been completed and the ambulance(s), equipment and location(s) were found to be in compliance with the provisions of these Standards. 11. The area to be served by the ambulance service. 12. The name, address and telephone number(s) of the ambulance service medical director. 13. Attestation by the medical director of willingness to provide medical oversight and a medical continuous quality improvement program for the ambulance service. 14. For a new license application, a service plan demonstrating the need for services to be provided, pro forma income statements, balance sheets, bank records or other financial information as may be reasonably requested by the Board sufficient to demonstrate the ambulance service's ability to operate and respond within the area to be served. 15. For a renewal license application, an income statement, balance sheet and other financial information for the last fiscal year sufficient to demonstrate the ambulance service's ability to continue operations and respond within the area to be served. 16. Certificates of insurance as required by these Standards. J. Inspection items: The following shall be available for inspection: 1. The list of all emergency personnel who may be called upon to respond to an emergency with the ambulance service. This list shall include complete name, address, date of birth, and current training level. 2. The ambulance service shall maintain documentation for all emergency personnel who may be called upon to respond to an emergency with the ambulance service demonstrating their qualifications. The documentation shall include the a copy of a current Colorado Emergency Medical Technician certificate, or a First Responder course completion certificate; Cardiopulmonary Resuscitation card issued a nationally-recognized training program; an Advanced Cardiac Life Support card issued by a nationally-recognized training program, if applicable; and a copy of a valid Colorado driver's license. 3. Protocols: Complete copy of the ambulance service's medical treatment protocols. A copy shall be provided to the Board upon request. 7 4. Accredited Agencies: If the ambulance agency is accredited, they shall supply the certificate and have available any findings or deficiencies from last inspection by the accrediting body. If the licensee is in good standing, there shall not be an inspection by Eagle County Public Health and Environment unless it is determined that such inspection take place. K. Issuance of a New Ambulance Service License: Upon receipt of a complete application for a license to provide ambulance services, the Board, or its designee, shall review the application, the applicant's record and hold a public hearing to allow input from interested parties. For purposes of these Standards, the Eagle County Public Health shall be the Board's designee for the issuance of licenses and all required hearing herein. Notwithstanding the foregoing, the Board may determine to hear any new license application or required hearing upon notice to its designee. No license shall be granted unless the application demonstrates complete compliance with this resolution, supplies adequate documentation on need for the service, satisfactory compliance with Section T hereunder, and applicable laws. Each license shall be granted by resolution of the Board and shall be valid for a period of twelve (12) months following the date of issue providing that the ambulance service personnel, vehicle(s), equipment, and location comply with the requirements of these Standards. L. Issuance of limited license permit to operate for purposes of special event or standby coverage: The County may issue a permit to operate for a specific time period for special event or standby coverage for an entity that meets the criteria for licensure and files an application with the Eagle County Public Health and Environment no later than thirty (30) days prior to event. The Special Permit Licensee shall comply with Article III (U) of this resolution. M. Renewal of Ambulance Service License: Unless revoked by the Board, any license issued by the County may be renewed by submitting to Eagle County Public Health and Environment a completed application for renewal containing the required information, necessary supporting documents and application fees. Application for renewal shall be filed annually, but not less than thirty(30) days before the date the license expires. If re- application is not received at least thirty(30) days prior to license expiration, County shall issue a temporary suspension notice and the applicant shall cease operation until license is reissued. If re-application is received, license will not be suspended pending administration and completion of the renewal process. N. Issuance of a Renewal Ambulance Service License: License renewals shall be issued administratively unless Eagle County Public Health and Environment or the applicant requests a full hearing. Then the process shall be as follows: 1. The Board shall review the application, the applicant's record and hold a public hearing to allow input from interested parties. License renewal shall be granted by resolution of the Board and shall be valid for a period of twelve (12) months following the date of issue providing that the ambulance service personnel, 8 vehicle(s), equipment, and location comply with the requirements of these Standards. 0. Ambulance Vehicle Permits: Permits shall be issued administratively. An application for an ambulance permit shall be submitted to Eagle County Public Health and Environment and shall contain the following information, supporting documents and application fees, if any: 1. Type of permit: BLS ambulance or ALS ambulance. The type of permit will describe the maximum level of service that could be provided at any time by that vehicle and appropriate staff. 2. The name, address and telephone number(s) of the owner of the ambulance. 3. The name, address and telephone number(s) of the person applying for the license, hereinafter referred to as the applicant. 4. The trade or other name, if any, under which the applicant does business or proposes to do business. 5. A description or photographs of the ambulance, including make, model, year of manufacture, vehicle identification number, Colorado license plate number for the current year, the length of time the vehicle has been in use, and the color scheme, insignia, name, monogram, and other distinguishing characteristics used to designate the vehicle. 6. Certificate of inspection or other documentation that the physical inspection of the ambulance equipment has been completed and the ambulance and equipment were found to be in compliance with the provisions of these Standards. 7. Certificate of inspection by a qualified mechanic. P. Issuance of Ambulance Vehicle Permits: Eagle County Public Health and Environment shall review the application. An ambulance vehicle permit shall be valid for a period of twelve (12) months following the date of issue or the remaining term of the applicant's ambulance service license providing that the vehicle and equipment comply with the requirements of these Standards. Q. Transfer of License or Permits: No license or permit issued by the County shall be sold, assigned, or otherwise transferred. R. Change of Ownership: Change of ownership shall require a new application license and payment of license fees. Any sale or exchange of stock in excess of twenty-five percent (25%) of the total outstanding stock of a corporation to anyone other than an existing stockholder at the time of the original issuance of license shall be deemed a change of ownership for the purpose of these Standards. Any change of ownership of any transfer of stock ownership of ten percent (10%) or more shall be reported in writing to Eagle County Public Health and Environment within thirty(30) days of such change or transfer. S. Reciprocity: 9 1. Eagle County Public Health and Environment may issue an ambulance service license and ambulance permit(s) to an ambulance service licensed by another Colorado county upon a finding that the requirements in the county are substantially equivalent, and the ambulance service agrees to comply in full with these Standards. An ambulance service license and ambulance permit(s) may be issued by completing the application requirements and payment of the appropriate fee, if any, as specified in these Standards. 2. Based on the finding that the requirements of Pitkin County are substantially equivalent to the requirements of Eagle County, Ambulance service providers not licensed by Eagle County, but who are licensed by and in good standing with Pitkin County, may operate within those portions of the Basalt and Rural Fire Protection District that are within the jurisdiction of Eagle County. T. Service Area: The Board finds that in order to protect the health, public safety and welfare of the citizens and visitors to the county that duplication of services within areas served by existing licensed providers should be avoided. The Board desires mutual cooperation and coordination among providers. Accordingly, prior to issuing a new license, the Board will consider the following in its decision to grant a new license: 1) the boundaries of the area to be served, 2) the efforts toward coordination and any resulting cooperative agreements with existing providers within the area to be served, 3) the sufficient existing or projected need for additional service in the proposed area to be served and the proposed impacts to existing providers, 4) that the proposed ambulance service is capable of providing economical and sufficient service to the proposed area that enhances the overall cohesive provision of services in Eagle County, 5) the proposed service to be provided including what proportion of Emergency Calls generating from the 9-1-1 center and interfacility transports in the area are to be made, 6) that the requirements of Article III(I)(xiv) have been met. The Board shall consider the level of compliance to the above standards along with any additional information it deems relevant in determining to grant any additional licenses. Notwithstanding the foregoing, no license will be granted without a showing that it will provide an overall advantage to the residents of Eagle County in terms of ensuring quality and cost-effective ambulance service. U. Standby and special event coverage: No person or agency, private or public, shall transport a patient from any point within Colorado in an ambulance unless that person or agency holds a valid license and permits issued by the county where the service is based and where the patient originates. Accordingly, no ambulance agency may operate for the sole purposes of providing event standby or special event coverage in the County without a limited license permit to operate for the time period expressed in the application. Eagle County Public Health and Environment may issue such a limited license upon a showing that the provider will either 1) substantially meet these Standards, 2) be licensed in another jurisdiction with adequate licensing standards in the discretion of Eagle County, 3) be accredited by the CAAS, or 4) otherwise show Eagle County that they can perform the service in a manner at least equivalent to the Standards contained herein. Due to the expedited review of such limited license permits, the county shall assess a fee of$150 for issuing such special event limited license permit. V. Penalty for non-compliance: Ambulance agencies that operate in the county in violation of any provision herein are subject to revocation and suspension as set forth in Article V herein. 10 Additionally, failure to operate in the county without a valid license is a class 3 misdemeanor pursuant to C.R.S. §25-3.5-306. W. Inspections: 1. The designee of Eagle County Public Health and Environment shall inspect any and all ambulances owned, leased, or operated by a licensed ambulance service annually, or more often if required by the Board, to assure compliance with applicable rules and Standards. Inspections may be performed at any time. Any inspection shall be for the purpose of determining that each vehicle is being properly maintained and contains the equipment specified in these Standards. Maintenance records shall be made immediately available upon the County inspector's request. Such inspections shall be in addition to other safety or motor vehicle inspections requiredu nder Colorado law. 2. Any inspection necessary for application or renewal must be completed prior to the acceptance of the application or renewal application. 3. New vehicles shall be inspected prior to the vehicle being operated and used in the course of providing emergency medical services. 4. It is the responsibility of the ambulance service operator to have each vehicle inspected prior to licensing. An appointment must be made in advance to the performance of an inspection. 5. Inspections may be waived if the service is Accredited and the determination is made that an inspection need not occur. This does not waive the right of the county to inspect any vehicle, records or service at any time. X. General Standards: 1. All ambulance services shall have an ongoing medical continuous quality improvement program consistent with the requirements established by the Department 6CCR1015-3 Chapter Two et seq. or its successor. 2. Each ambulance service licensed in the County shall complete a patient care report and transmit said records to CDPHE in the prescribed method including the minimum prehospital care data set described in 6 CCR 1015-3 Chapter Three et. seq., or its successor, for each patient assessed and each call received. 3. Each ambulance service licensed in the County shall complete and submit an agency profile to the Department per 6 CCR 1015-3 Chapter Three et. seq., or its successor, on an annual basis. 4. All personnel shall be readily identifiable as to their ambulance service and level of training at the scene of a call and while treating a patient. 5. The medical director for each ambulance service shall establish destination guidelines that conform to state and regional requirements, generally accepted standards of medical care for patients transported by ambulance or as otherwise mandated by rule, regulation or statute. 6. All ambulance services licensed by the County are required to agree to and comply with all provisions of these Standards, or any amendments thereto, any other conditions pertinent to the license reasonably imposed by the Board, all 11 rules, Standards and plans developed by the Central Mountains RETAC and adopted by the County and all applicable provisions of Federal, State and local laws, rules and Standards in order to maintain licensure. The Board may also consider medical practices that deviate significantly from accepted standards of care and business practices that pose a risk to the public health, safety and welfare as a violation of these Standards. ARTICLE IV: COMPLAINTS A. Origination of Complaints: Alleged violation of these Standards by a licensed or unlicensed ambulance service, individual medical providers on a licensed ambulance service, or of an ambulance service operating in the County without a license, may be made in writing by any party and addressed to the Board, or by the Board on its own initiative. Any individual bringing a matter of medical competency to the Board shall waive the right of patient confidentiality as a condition of complaint submission and subsequent investigation. If any legal action is filed against a licensed ambulance service in a court of the United States, the State of Colorado or any of its political subdivisions, the licensee shall notify the Board within ten (10) business days. A violation of these Standards shall not be presumed based on the allegation. In the event that a judgment is entered against the licensee, the licensee shall file a copy of the findings of fact, conclusions of law and order of the court with the Board within ten (10) business days. If an action against an ambulance service license is undertaken by another jurisdiction, the licensee shall notify the Board within ten (10) business days. A violation of these Standards shall not be presumed based on the action. If the action results in a suspension or revocation of the ambulance service license by another jurisdiction, the licensee shall file a copy of the record of the adverse action with the Board within ten (10) business days. B. Validation of Complaints: The Board, or its designee, shall complete an initial review of the complaint, judgment or adverse action within five (5) business days to determine if it constitutes a violation of these Standards and has sufficient foundation to warrant a complete investigation. Any apparent violation of these Standards having sufficient factual basis shall be fully investigated by the Board. Allegations of violations outside the purview of the Board shall be returned to the complainant for referral to the appropriate authority or jurisdiction. The Board shall notify the complainant in writing if the allegation lacks sufficient basis to warrant investigation. The Board shall notify the licensee in writing if a judgment or adverse action filed with the Board does not constitute a violation of these Standards. C. Investigation of Complaints: The Board shall notify the complainant in writing that the allegation is sufficient to warrant a full investigation. Upon initiation of a full investigation, the Board shall notify the ambulance service and the medical director for the ambulance service of the alleged violation in writing. The Board shall commence action against the ambulance service or unlicensed ambulance service if the allegation is determined to be a violation of these Standards or, at its discretion, may provide a reasonable period of time for the licensee to cure any violation or to implement corrective measures to bring the licensee's business activities into conformance with these Standards before commencing action to suspend or revoke a license or permit. The Board may forego further hearing or action against the license or permit upon confirmation that the licensee has cured the violation and satisfied any conditions reasonably 12 imposed by the Board. The Board shall notify the complainant in writing if an investigation determines that the allegation fails to constitute a violation of these Standards or that the licensee has cured the violation. If an unlicensed ambulance service or vehicle is found to be operating in the county, the Board may also report them to the county in which they are licensed and to the Department. ARTICLE V: PROCEDURES FOR REVOCATION OR SUSPENSION A. The Board may, on its own initiative or upon written complaint made by any party, temporarily suspend, suspend for a definite period, or revoke any license or permit issued pursuant to these Standards upon a determination that a violation of these Standards by a licensed ambulance service or by individual medical providers on a licensed ambulance service has occurred. B. Temporary Suspension: Without prior notice to the licensee and upon determination that a violation that poses immediate threat to the public health, safety and welfare has occurred, the Board may temporarily suspend any license or permit. Such temporary suspension shall be effective upon delivery of written notice to the licensed ambulance service by the Board. No temporary suspension shall be valid for more than thirty (30) days or until a final decision by the Board concerning suspension or revocation, whichever period is longer. Any written notice of temporary suspension shall also provide notice of the time, date, and place of a hearing before the Board to consider the suspension or revocation of the license. Except upon written consent of the licensee, the hearing shall be held not more than ten (10) business days following the effective date of the temporary suspension. The Board shall secure an equal level of service to the area that was covered by the suspension and fund the provision of EMS to maintain adequate coverage based on the traditional service provided during the suspension. C. Suspension for Definite Period or Revocation of License: Following notice to the licensee and a public hearing at which the licensee shall be afforded an opportunity to be heard, the Board may suspend or revoke any license or permit. Any suspension or revocation shall require a finding by the Board of a violation of these Standards based upon the evidence presented at the hearing. Suspension shall be for a specific and definite period of time not to exceed any remaining current license period. The County shall bear the burden of proof of a violation justifying any suspension or revocation of a license or permit. Issuance of a temporary suspension shall not be a prerequisite to the conduct of a hearing to consider the suspension or revocation of a license or permit. The Board shall secure an equal level of service to the area that was covered by the suspension and fund the provision of EMS to maintain adequate coverage based on the traditional service provided during the suspension. D. Hearings: All suspension or revocation hearings shall be open to the public and shall be conducted in accordance with the Colorado Open Meetings Act. The Board shall be authorized to administer oaths and issue subpoenas to require the attendance of witnesses and the production of papers,books, and records necessary to the determination of any issue at any hearing. 13 E. Surrender of License or Permit: Following receipt of a written notice of suspension or revocation, the licensee shall surrender and deliver its license and all ambulance permits to the Board within forty-eight (48)hours. F. Notices: Any notice issued pursuant to these Standards shall be made in writing and provided to the licensee and the medical director at the address listed in the application for license. The Board shall use its best efforts to immediately notify in writing any communications center, and notify within three (3) business days any first response agencies, mutual aid agencies, local law enforcement agencies, hospitals and medical directors of any suspension or revocation. The Board may send notice to the County Emergency Medical Services Council, Regional Emergency Medical and Trauma Services Advisory Council Coordinator, Colorado Board of Medical Examiners, Colorado Department of Public Health and Environment or other interested parties; provided, however, that such notice shall not entitle these parties to a right to participate in any hearing concerning suspension or revocation of a license. ARTICLE VI: MISCELLANEOUS PROVISIONS A. Severability: If any provision of these Rules and Standards is found by a court of competent jurisdiction to be invalid, the remaining provisions of the Rules and Standards shall continue in full force and effect. B. No Third Party Beneficiary: Nothing in these Rules and Standards shall be construed to create a cause of action and/or civil liability remedy in any person. These Rules and Standards shall not be construed to create a duty to any third party where no such duty otherwise existed. It is the express intention of the Board that any third party receiving services or benefits under these Rules and Standards shall he deemed to be an incidental beneficiary only. 14