Loading...
HomeMy WebLinkAboutOrdinance 9510,. '~ .. ORDINANCE NO. ~~ AN ORDINANCE REPEALING CHAPTER 6 OF THE CODE OF THE CITY OF FORT WORTH (1964), AS AMENDED, AND ENACTING A NEW CHAPTER 6 IN LIEU THEREOF, ENTITLED "AMBULANCES," AND PROVIDING FOR THE ESTABLISHMENT OF COMPETITIVELY AWARDED SINGLE- PROVIDER AMBULANCE SYSTEM FOR THE CITY AND THE OPERATIONAL AND MEDICAL REGULATION THEREOF; PROVIDING A PENALTY CLAUSE; PROVIDING A SEVERA- BILITY CLAUSE; PROVIDING FOR PUBLICATION AS REQUIRED BY LAW; PROVIDING FOR THE ISSUANCE OF INTERIM CERTIFICATES OF PUBLIC CONVENIENCE AND NECESSITY FOR OPERATION OF AMBULANCES; AND PROVIDING EFFECTIVE DATES. BE IT ORDAINED BY THE CITY COUNCIL OF THE CITY OF FORT WORTH, TEXAS: SECTION I. That Chapter 6 of the. Code of the City of Fort Worth, as .amended, is hereby repealed and there is hereby enacted in lieu thereof a new Chapter 6, entitled "Ambulances," to read as follows: "Chapter 6 AMBULANCES ARTICLE I. DEFINITIONS '"~ Section 6.01. Definitions. For the purposes of this chapter, the following words and phrases shall have the meanings respectively ascribed to them by this section: A. Ambulance. Any motor vehicle equipped with facilities to convey infirm or injured persons in a reclining position to or from health care facilities. B. Authority. The Fort Worth Ambulance Authority. C. Base station physician. A physician licensed to practice medicine in the State of Texas, knowledge- able in the medical protocols, radio procedure and general operating policies of the Fort Worth, Texas, ambulance system, and a person from whom ambulance personnel may take medical direction by radio or other remote communications device. n ~- ~ Jf ~~ r ] ~ f„ _ l • aA~ J '~ ' ~~ • . 1 D. Emergency medical technician (EMT). Ambulance person- nel licensed by the State of Texas as a basic or specially skilled emergency medical technician. E. Emergency Physicians Advisory Board (EPAB). The board empowered to recommend and promulgate the various standards, rules and regulations related to the medi- cal and clinical aspects of ambulance service in Fort Worth, Texas, and to perform medical audits. F. EMS Control Center or control center. The single facility designated by the authority as the central communications center from which all ambulances operating in the city shall be dispatched and con- trolled. G. First responder. Any person, fire department vehicle, police vehicle or non-transporting ambulance unit capable of providing appropriate pre-hospital care, as evidenced by certification as may be required for first responder designation by the EPAB. H. Fort Worth Ambulance Authority The public administra- tive agency established to oversee the operation of the ambulance system established by this chapter. I. Helicopter rescue unit. Any rotary wing aircraft pro- viding basic or advanced life support and transports- , tion. J. Licensing officer. The city health director serving as licensing officer for certification of ambulance, dispatch, and other personnel under approved stan- dards formulated by EPAB. K. Medical audit. An official inquiry into the circum- stances involving an ambulance run or request for service, conducted by the EPAB or licensed physician designated thereby. -2- r,. _ r L. Medical control. Direction given ambulance personnel by a base station physician through direct voice con- tact, with or without vital sign telemetry, as re- .. quired by applicable medical protocols promulgated by the EPAB. M. Medical Director. The licensed physician appointed by the EPAB serving as administrative officer in carrying out the duties and powers of the EPAB. N. Medical protocol. Any diagnosis-specific or problem- oriented written statement of standard procedure, or algorithm, promulgated by the EPAB as the normal standard of pre-hospital care for a given clinical condition. O. Mutual aid call. Request for emergency ambulance service issued by an ambulance dispatcher in one political jurisdiction to an ambulance dispatcher or ambulance crew in a neighboring political jurisdic- tion. P. Paramedic. A person licensed by the State of Texas as a paramedic emergency medical technician. Q. Response time. The actual elapsed time between re- ceipt of notification at the EMS Control Center that an ambulance is needed at a location and the arrival of that ambulance at that location. R. Senior paramedic in charge. That person among the certified personnel assigned to an ambulance, not the driver, who is a certified paramedic designated as the individual in command of the ambulance. S. Special use permit. A permit required, under appli- cable regulation promulgated -by the EPAB, for the provision of specialized pre-hospital care. -3- r ~', .~ .+ ARTICLE II. FORT WORTH AMBULANCE AUTHORITY Section 6.02. Fort Worth Ambulance Authority created. There is hereby created the Fort Worth Ambulance Authority, a public administrative agency which shall oversee and supervise all non-medical aspects of the emer- gency ambulance system in such manner as to provide high quality ambulance service, at the lowest cost consistent with medical quality, to all persons within the City of Fort Worth. Section 6.03. Board; qualifications; term. A. The Authority shall be governed by a Board of Directors, which shall be composed of five (5) direc- tors, one (1) of whom shall be the Medical Director as designated by the Emergency Physicians Advisory Board (EPAB). The other four (4) directors shall be selected and appointed by the City Council. B. Initially, two (2) directors shall be appointed for one (1) year terms and two (2) directors shall be appointed for two (2) year terms. Thereafter, each director (other than the Medical Director) shall serve for a term of two (2) years. C. No director (other than the Medical Director) shall serve for a total of more than three ( 3 ) consecutive two (2) year terms. Section 6.04. Powers and duties of Authority. The Authority shall have the following powers and duties: A. To issue licenses for the operation of ambulance ser- vice within the City of Fort Worth; B. To conduct a competitive bid process in accordance with the standards contained in this chapter and to -4- i ~'~ '" { ,, ~ .. r formulate a recommendation to be submitted to the City Council regarding the selection of an operator for the system; C. Administer and disburse any funds which are appro- priated by the City Council by way of subsidy for the ambulance system, said funds to be used to improve services, reduce grices and meet other necessary goals of the system. D. Formulate recommendations for the consideration of the City Council regarding rates/subsidy tradeoff options for both emergency and non-emergency service, said rates and subsidy level being subject to City Council approval; E. To enter into contracts for the purchase of equip- ment, facilities and supplies reasonably necessary to perform its functions hereunder, subject to appropri- ation of funds to pay for same by the City Council and subject to all applicable requirements for the approval of contracts by the City Council under the City Charter and ordinances. l F. Administer funds received by the accounts receivable trust created pursuant to this chapter, including any late-run penalties, said funds to be employed to pay for the cost of facilities, equipment and other aspects of the system infrastructure and to improve service. G. To govern rates charged by the licensee, taking into consideration the subsidy level, the quality of ser- vice and other relevant factors and to require licen- see to charge and collect additional fees to be used by the Authority to pay for the costs of facilities, equipment and other aspects of the system infrastruc- ture, and to improve services. -5- H. In the event of an emergency in which the public health and safety are threatened by the inadequate performance by the existing licensee, or by the absence of qualified bids at reasonable costs for the performance of the required services, the Authority may conduct the operations of the ambulance system for the duration of the emergency but in no event longer than one (1} year. Section 6.05. May contract with other jurisdictions. A. The Authority may enter into contracts with other jurisdictions to provide ambulance services, provided that: 1. Uniform clinical standards are maintained; 2. Each participating jurisdiction shall be subject to medical control by the Emergency Physicians Advisory Board and the Medical Director designated thereby; 3. A fair means of sharing in the costs of medical control and regulation is established. 4. Each participating jurisdiction shall have the option of selecting its own unique price/subsidy combination, provided that the combined finan- cial effect shall be substantially the same for all jurisdictions served. The purpose of this subsection is to prevent cross-jurisdictional subsidization of services. B. When, in the discretion of the Board of Directors, there is such a substantial amount of service to warrant reorganization of the Authority, the Authority shall develop a plan for reorganization in accordance with the Interlocal Cooperation Act [Art. 4413 (32c), R.C.S.J and present same to the governing bodies of the participating jurisdictions for their consideration.. -6- { ~ •f ARTICLE ITI. EMERGENCY PHYSICIANS ADVISORY BOARD Section 6.06. Emergency Physicians Advisory Board cre- ated. There is hereby established an Emergency Physicians Advisory Board (EPAB) which shall serve as an advisory, regulatory and fact-finding body for the Authority in re- gard to medical control of the ambulance system instituted in accordance with this chapter. The EPAB may be created by contract or agreement with the local medical society at the discretion of the City Council, and may be formed as a separate corporate entity. Section 6.07. Board; qualifications. A. The EPAB shall consist of a board whose membership shall be composed of the medical director, or his designee, of each hospital emergency department which is located within the corporate limits of the city and which maintains an emergency medical services program staffed by in-house physicians and provides twenty-four (24) hour coverage, seven (7} days a week. Each director shall have one (1) vote in the governance of the affairs of the EPAB. The EPAB shall determine, in its discretion, the qualifications for membership on the Board. Section 6.08. Medical Director. The EPAB shall appoint a medical director who shall be responsible for the day-to-day affairs of the EPAB in carrying out its duties under this chapter. The Medical Director shall be a licensed physician with training and experience as a practicing emergency physician. The Medical Director shall serve for such period of time as shall be prescribed by the EPAB, but shall be removable at the discretion of the EPAB, which decision shall be final. In the case of absence or disability of the Medical -7- l? h Director, the EPAB shall designate a similarly-qualified physician to perform the duties of the Medical Director. Section 6.09. Powers and duties of EPAB. The EPAB shall have the following powers and duties: A. To establish criteria and make recommendations con- cerning the issuance, renewal, suspension and revoca- tion of all licenses, permits and certificates issued under this chapter; B. To establish standards for patient care, including standards for vehicles and on-board equipment; C. To develop medical protocols and periodically revise same; D. To develop control center protocols and periodically revise same; E. To conduct medical audits and develop standards and procedures for the conduct of such audits; F. To develop and periodically revise and administer both written and practical tests for the certifica- tion of emergency medical services personnel; G. To develop and periodically revise and administer educational material, programs and/or tests to insure that base station physicians are appropriately knowl- edgeable of the local ambulance system and to certify qualified physicians; H. To conduct inspections of vehicles, equipment and supplies on both an announced and unannounced basis; I. To monitor response time performance and develop the necessary procedures for the acquisition and analysis of data necessary thereto; J. To develop standards and procedures for the resolu- tion of any disputes regarding exemptions from penalties to be assessed to the ambulance service provider for failure to meet response time standards; -8- K. To conduct intensive reviews of specific clinical types on a periodic basis to analyze system perfor- mance and facilitate protocol revision; and L. To present annual written and oral reports to the Authority concerning the state of clinical perfor- mance of the ambulance system. Section 6.10. May be aided by other committees. The EPAB may establish such other committees as may be necessary in order to aid it in the performance of its powers and duties. Such committees shall be composed of persons experienced in the delivery of emergency care or the treatment of major trauma in an emergency situation. Section 6.11. Promulgation of initial system standards. A. In promulgating initial standards for patient care, including but not limited to standards for vehicles, on-board equipment, supplies, personnel certification and training, medical protocols and response time standards, the EPAB shall utilize those standards for patient care as provided and offered by the winning bidder in the competitive bid process conducted by the Authority. B. The EPAB shall consult with the Authority regarding any proposed changes to standards for patient care as contained in the winning bidder's proposal, and the Authority and the EPAB may negotiate mutually accept- able adjustments to the initial standards offered by said winning bidder, provided that any increase in said standards, if necessary, shall be-accompanied by higher rates to be charged by licensee to cover the costs resulting from such higher standards. ARTICLE IV. SYSTEM STANDARDS Section 6.12. General purposes and intent. A. It is the purpose of this ordinance to establish a regulated ambulance service system that can provide _g_ each ambulance patient with the best possible chance of survival without disability or preventable compli- cation. B. It is the intent of the City Council of Fort Worth, Texas: 1. To provide for a competitively selected sole provider ambulance system because it is un- reasonable to have unnecessarily high rates and/or public subsidy to make needed improve- ments to ambulance service in the city when a more efficient system design could achieve the same results; 2. That the most efficient design to achieve the goals of high-quality service, at the lowest cost consistent with such quality, and perfor- mance security in the event of contractor default, is the implementation of the system described herein; 3. That competition which will benefit the consumer of ambulance services is regular competition by a competitive bid process for the market rather than street-level competition; 4. That street-level competition has been shown to inevitably result in the establishment of a two-tiered system of emergency ambulances and so-called non-emergency ambulances, which mis- directs resources to the more lucrative non- emergency sector, so as to make the burden of taxpayer subsidy inevitable, while simultaneous- ly reducing the quality of patient care and the system's disaster readiness; 5. That the system implemented herein will facili- tate performance security by reason of the -10- public ownership of certain facilities and com- munications infrastructure, and ownership or primary leasing of vehicles and equipment and the establishment of an accounts receivable trust arrangement; 6. That more effective system performance will be achieved through the selection of a private operator through competitive bids than through governmental operation; 7. That more effective medical control may be achieved through the establishment of a board of experienced emergency physicians to regulate the medical aspects of the system. Section 6.13. License required. No person shall operate an ambulance on any street of the city without having obtained a license to operate an ambulance service from the Authority, except as provided herein. Section 6.14. Term of license. A. The license shall have a primary term of four (4) years. At the discretion of the Authority, and upon approval by the City Council, the license may be extended for up to two (2) additional two (2) year renewal terms. In addition, the Authority shall have the power to extend the term, or renewal term, of any license granted hereunder for a period not to exceed ninety (90) days when necessary in the public interest. B. The license granted hereunder shall be granted only to an operator selected by a competitive bid process conducted by the Authority and approved by the City Council. Any contract with an operator shall not exceed the term of any license granted by the Authority hereunder. -11- C. The Authority may issue the initial license hereunder for a primary term exceeding four (4) years, said excess period not to exceed ninety (90) additional days, as necessary to adjust the procurement cycle with business and advertising cycles. Section 6.15. General standards required for license. A. In order to receive a license hereunder, an operator must meet or exceed all state standards for staffing or equipment in regard to ambulance services and, in addition, meet all standards which are stricter than said state standards which are required herein. B. The licensee shall, in addition, meet the following standards: 1. Licensee shall respond to all calls for ambu- lance service within the city and shall not engage in any form of screening calls. 2. Licensee shall not refuse transport of any patient to any hospital within the city. Pro- vided, however, that the Authority may promul- gate reasonable procedures and regulations for dealing with the abuse or potential abuse of the system by any person and allow exceptions to this requirement in conformance therewith. 3. Licensee shall serve all parts of the city in an equitable manner. In this regard, licensee shall furnish and manage its resources in such manner as to provide emergency and non-emergency ambu- lance service throughout the city and shall take any and all actions which are reasonably neces- sary to minimize any differences in response time performance among the various parts of the city. Licensee shall take all necessary steps to eliminate any continuing pattern of apparent -12- discrimination in response time performance to any part of the city. 4. Licensee must transport any patient without regard to the ability to pay. 5. Licensee shall make no on-scene collections on any calls in which the point of origin and the point of destination are within the city. Licensee shall be permitted to make on-scene collections on any call in which the point of origin or the point of destination is not within the city. 6. All vehicles operated as ambulances by the licensee shall meet or exceed Mobile Intensive Care Unit (MICU) standards as prescribed by applicable state law or regulation and shall, in addition, meet or exceed any vehicular, staffing and equipment standards prescribed by the , Authority or by the EPAB. 7. Licensee shall meet all response time standards set by the Authority on recommendation of the Medical Director. 8. Licensee shall be subject to any late-run pen- alties which are established by the Authority. 9. Licensee shall meet all personnel certification standards which are prescribed by the EPAB. Section 6.16. Mandatory requirements for contract. The Authority shall conduct its competitive bid pro- cess so as to create an ambulance system with the follow- ing mandatory characteristics: A. The services rendered must at all times be in compli- ance with the provisions of this chapter; B. The ownership of all vehicles and on-board equipment must be vested in the Authority or leased to the Authority as primary lessee; -13- C. The authority shall establish a trade name in accor- dance with applicable law, the rights to said trade name to be owned by the city, the use of said trade name to be licensed to the competitively selected operator with appropriate protective provisions to be included in the contract so as to protect the city's rights to said trade name; D. All billings and collections, including but not limited to all legal proceedings which are necessary, shall be the responsibility of the private operator; E. An accounts receivable trust arrangement shall be created to allow the Authority to take possession of accounts receivable in the event of declared default of the private operator; and F. A qualified private company shall be selected by the City Council to serve as the single provider of ambu- lance service. Section 6.17. Revocation or suspension of license; emer- gency takeover. A. In the event that the Authority determines that a major breach of the contract by the licensee has occurred, and that the public health and safety are threatened thereby, the authority may, upon notice to the licensee, declare a state of emergency and pre- sent the matter to the EPAB for review. B. If, after a hearing and investigation of the matter, the EPAB determines that a major breach has occurred and that the public health and safety are threatened thereby, the Authority may revoke or suspend the license held by licensee and effect a takeover of all ambulance operations conducted by licensee. Such takeover shall be effected within seventy-two hours after such finding by the EPAB. -14- C. Licensee shall cooperate fully and immediately with the Authority and the EPAB in regard to any such declared state of emergency and the hearings and investigation conducted in accordance therewith; and shall cooperate fully and immediately with regard to any takeover of operations by the Authority in accor- dance with the provisions of this section and the operations contract. Section 6.18. Exceptions to Licensing Requirement. The following shall be excepted from the licensing requirements of this chapter: A. Any ambulance owned and operated by the United States government; B. Any ambulance rendering requested assistance to ambu- lances currently licensed by the Authority in cases of disaster or major emergency, or pursuant to provi- sions of a 'mutual aid agreement' approved by the Authority; C. 'Industrial ambulances' as defined by state law; D. An ambulance owned and operated by a licensed hos- pital or licensed nursing home and used exclusively for specialized mobile intensive care or for inter- institutional transfers of their own patients or residents who are admitted and not discharged, pro- vided that said ambulance is not for hire by the general public on a fee-for-service or prepaid basis. E. Any ambulance used for standby coverage at special events, provided that no separate charge may be made for the transportation of any patient by the operator thereof; F. Any ambulance owned and operated by or contracted and paid for by a hospital to provide inter-hospital transfers eligible for reimbursement under applicable -15- Medicare D.R.G. (diagnosis related group) regula- tions. G. Any ambulance engaged in the process of inter-city transfer of patients originating outside the corpo- rate limits of the City of Fort Worth. Section 6.19. Helicopter and special licensure provi- sions. A. The EPAB may establish standards for the licensing and permitting of helicopter rescue units. '"All licensed helicopter rescue units shall be required to submit to the control of the local control center established by the Authority when in Fort Worth and not dispatched to a non-Fort Worth call. B. The EPAB may establish standards for the special licensure of any exempt units as described in Section 6.18. All such standards and requirements shall be complied with in regard to such units. Any such special licenses and permits shall be clearly restricted to the special purposes contemplated. Such standards for special licensure may include, but are not limited to, requirements that any such unit meet requirements for mobile intensive care units (MICU), as defined by state law, and that any such unit con- tain compatible communications equipment to facili- tate disaster preparedness. ARTICLE V. STANDARDS FOR VEHICLES, ON-BOARD EQUIPMENT AND SUPPLIES Section 6.20. Permit required. No ambulance regulated by this chapter shall be used to provide ambulance service unless a permit has been issued therefor by the Authority. Section 6.21. Standards for vehicles, on-board equipment and supplies. Standards for vehicles, on-board equipment and sup- plies shall be prescribed by the authority on recommenda- -16- tion by the EPAB. Provided, however, that all ambulances shall, at minimum, meet the standards for Mobile Intensive Care Units (MICU) under state law. Unless the vehicle is owned or leased by the Authority, or by an exempt person as provided herein, no permit may be issued. ARTICLE VI. PERSONNEL CERTIFICATION STANDARDS Section 6.22. Minimum standards required. All ambulance personnel, including but not limited to paramedics, EMT's, drivers and dispatch personnel, shall: A. Meet all standards for certification under applicable state law or regulation; and B. Meet all standards for local certification which are prescribed by the EPAB. Section 6.23. Standards to be prescribed by the EPAB. A. The EPAB shall prescribe standards for the local cer- tification of all ambulance personnel, including but not limited to paramedics, EMT's, drivers and dis- patch personnel. B. The EPAB may require examination testing the appli- cant's knowledge of local medical protocols, special disaster procedures, the local ambulance system in general, and other matters appropriate to determining the applicant's fitness. A physical examination and a practical skills examination may also be required. C. The EPAB may require that all ambulance personnel maintain certification under the National EMT and Paramedic Registry Program. D. The EPAB shall promulgate recommended standards to be utilized by the city health director for the revoca- tion or suspension of any certification authorized hereunder. Section 6.24. Licensing officer: city health director. A. The city health director shall serve as licensing officer for the certification of paramedics, EMT's, -17- drivers, dispatch personnel and other personnel under approved standards formulated by the EPAB. B. Applications for local certification shall be made on forms supplied by the city health director and accom- panied by a non-refundable fifteen dollar ($15.00) application fee. Nothing in this article shall be construed as requiring the city, the Authority or EPAB to be responsible for the cost of any required physical examination. ARTICLE VII. BASE STATION PHYSICIAN Section 6.25. Standards for certification as base station physician. The EPAB shall promulgate standards for certification as a base station physician and standards for certifica- tion of the facilities to be used by base station physicians, including but not limited to communication equipment, telemetry equipment and recording equipment. Section 6.26. Medical supervision and control by base station physician. The personnel employed by the licensed ambulance operator hereunder shall accept medical supervision and control by means of radio or other remote communications equipment only from a base station physician certified by the EPAB. ARTICLE VIII. CONTROL CENTER STANDARDS Section 6.27. In general. The Authority shall be authorized to acquire all necessary facilities and communication equipment for the centralized dispatching of ambulance units and to provide for the radio and other remote communication necessary for effective medical control of such ambulance units. Section 6.28. Standards for control center and communica- tions. The EPAB shall promulgate standards and protocols for effective control center, dispatch and radio and other -18- remote communication facilities, including but not limited to telephone protocols, pre-arrival instructions, phone patch procedures, first responder alert standards and standards for training or retraining of first responder personnel. ARTICLE IX. MISCELLANEOUS PROVISIONS Section 6.29. Traffic laws; exemption. When the driver of an ambulance has reasonable grounds to believe that an emergency exists, the driver of the ambulance may: A. Park or stand, irrespective of the otherwise appli- cable provisions of law, ordinance or regulations; B. Proceed past a red or stop signal or stop sign, but only after slowing down as may be necessary for safe operation; C. Exceed. the maximum speed limits permitted by law, ordinance or regulation; provided, however, that any governing directives issued by the chief of police are obeyed and that life and property are not endan- gered thereby; D. Disregard laws, ordinances and regulations governing directions or movements or turning in specified directions. Provided, however, that any exemption herein granted shall apply only when such ambulance is operating with siren or red light and when such audible and visual signals meet the requirements of law, ordinance or regula- tion; and provided further, that the foregoing provision shall not operate to relieve the driver of any ambulance from the duty to drive with due regard for the safety of all persons, nor shall such provisions protect the driver from the consequences of his reckless disregard for the safety of others. -19- r i Section 6.30. Insurance. No ambulance shall be operated in the city unless there is at all times in full force and effect insurance coverage as follows: A. Public liability insurance in an amount not less than One Hundred Thousand Dollars ($100,000) for injury to, or death of, each person; Three Hundred Thousand Dollars ($300,000) for each accident; and Fifty Thousand Dollars ($50,000) for property damage to secure payment of all lawful and proper claims aris- ing out of the operations of the ambulance service authorized hereunder; B. Uninsured motorist coverage in an amount equal to the bodily injury liability limits set forth in Sub- section A above; C. Malpractice insurance in an amount not less than Five Hundred Thousand Dollars ($500,000) for each claim; D. A Ten Million Dollar ($10,000,000) umbrella policy providing additional coverage to all underlying liability policies; E. Said insurance policies required hereunder shall be submitted to the City Attorney for approval. Satis- f actory evidence that such insurance is at all times in full force and effect shall be furnished to the City Attorney, in such form as he may specify; F. Every insurance policy required hereunder shall extend for the period to be covered by the license granted for the operation of ambulance service here- under, and the insurer shall be obligated to give not less than thirty (30) days' written notice to the Authority and the Medical Director before any can- cellation or other termination of any such policy earlier than its termination date; -20- G. The cancellation or other termination of any policy of insurance required hereunder shall automatically revoke and terminate the license for ambulance ser- vice granted hereunder, unless another insurance policy complying with the provisions of this section shall be provided and be in full force and effect at the time of such cancellation or other termination; H. Each insurance policy required hereunder shall name as additional insureds the city, the Authority, the EPAB, in addition to the operator of the vehicle. Section 6.31. Fees required. A fee of Three Dollars ($3.00) per ambulance run shall be charged and collected by the operator, which sum shall be paid to the EPAB to defray the costs of medical regulation of the system. Payments shall be made monthly or as otherwise directed by the EPAB. Section 6.32. Professional conduct. Paramedics, EMT's, drivers, dispatch personnel and all other personnel employed by the licensee hereunder, including all persons involved in billing and collection activities, shall, at all times, conduct themselves in a professional manner as generally described in rules of professional conduct which shall be written and compiled by the EPAB and which shall be made available to all holders of professional certifications at the time such certification is issued and to all other personnel covered hereunder. Section 6.33. Conflict of interest. A. No person shall serve on the board of directors of the Authority, nor as a voting member of the EPAB, nor as Medical Director, if such person is an offi- cer, director, employee, or is otherwise affiliated with, directly or indirectly, any ambulance operator whose activities are regulated hereunder. J -21- B. No person shall serve upon the board of directors of the Authority, nor as a voting member of the EPAB, nor as Medical Director, if such person is an offi- cer, director, employee, or otherwise affiliated with, directly or indirectly, a hospital, health services provider, or any other organization which is affiliated with, directly or indirectly, any ambu- lance operator whose activities are regulated here- , under. C. The licensed operator hereunder shall be required to produce monthly status reports which shall show hos- pital disposition by geographic origin for all ambu- lance runs. D. The licensed operator hereunder shall show no pattern of favoritism regarding hospital destinations or post locations. E. Upon the written request of any hospital in the city, the EPAB shall investigate any alleged impropriety in regard to the selection of hospitals or other facil- ities as destinations for ambulance runs. Section 6.34. Patient and at-scene management. Authority for patient management in a medical emer- gency shall be vested in the senior paramedic in charge. Authority for the management of the scene of a medical emergency shall be vested in the appropriate public safety officials. The scene of a medical emergency shall be managed in a manner calculated to minimize the risk of death or health impairment to the patient and to other persons who may be exposed to the risk as a result of the emergency condition, and priorities shall be placed in the interests of those persons exposed to the more serious risks of life and health. Public safety officials shall ordinarily consult with the senior paramedic in charge at -22- '~ - . the scene in the determination of the relevant risk factors. In the event a licensed physician is present at the scene and desires to assume direction and control of patient care, the licensed physician may do so but shall be required to sign a form approved by the EPAB releasing the senior paramedic in charge from responsibility for directing patient care and declaring that such responsi- bility has been assumed by the signer. Section 6.35. Destination procedures. The EPAB shall formulate a set of protocols for de- termining the destination facility and hospital selec- tion. Section 6.36. Unlawful operations. A. It shall be unlawful to intentionally or knowingly: 1. Operate or cause to be operated an ambulance on any street of the city without first having obtained a license therefor in accordance with this chapter or unless exempted therefrom by the provisions of this chapter. 2. Operate or cause to be operated an ambulance on any street of the city without first having obtained a valid permit for said ambulance in accordance with the provisions of this chapter. 3. Request the services of any ambulance which is not licensed or permitted in accordance with the provisions of this chapter or exempted therefrom by the provisions of this chapter. 4. Perform duties as an ambulance driver, attendant (EMT or paramedic), or dispatcher without cur- rent certification issued by the licensing offi- cer in accordance with this chapter. 5. Permit or allow a person to perform duties as an ambulance driver, attendant (EMT or paramedic), -23- ~ ., ., _ _., or dispatcher without current certification issued by the licensing officer in accordance with this chapter. 6. Giving false information to induce the dispatch of an ambulance or helicopter rescue unit. B. Penalties. 1. Any person convicted of violating the provisions of this section shall be fined in an amount not to exceed Two Hundred Dollars ($200.00) for each violation. 2. Each day that any violation of this section is committed or permitted to continue shall consti- tute a separate offense. 3. This section shall not serve to limit any other remedies available to the City in law or equity." SECTION II. If any provision of this ordinance or the application thereof to any person or circumstance shall be held invalid, void, illegal, ineffective or unconstitutional by a court of competent jurisdic- tion, such holding shall not affect the other provisions or applica- tions of this ordinance which can be given effect without the invalid, void, illegal, ineffective or unconstitutional provision or application, and to this end the provisions of this ordinance are declared to be severable. SECTION III. The City Secretary of the City of Fort Worth, Texas, is hereby directed to publish the caption and Sections I and IV of this ordi- nance for two (2) days in the official newspaper of the City of Fort Worth, Texas, as authorized by Art. 1176b-1, Revised Civil Statutes of Texas. SECTION IV. A. Except as provided below, this ordinance shall be in full force and effect from and after the date of April 1, 1986. -24- ,, ~ _ ,~, - ~ -. `%. ~ . y s' r B. Provided, however, that the Fort Worth Ambulance Authority and the Emergency Physicians Advisory Board, as provided for in this ordinance, may be established from and after ,the date of passage of this ordinance for the purpose of initial organization, conduct of the initial procurement process to facilitate selection of an opera- for for the system, and promulgation of necessary system standards to go into effect on the effective date of this ordinance. Provided, further, that the initial membership of the Board of the Fort Worth Ambulance Authority shall be composed of the Emergency Medical Services Subcommittee of the Fort Worth City Council, as heretofore appointed by said Council, and said members shall serve as the Board of said Authority on an interim basis until April 1, 1986. C. Provided, that the City Council, in order to effect the orderly implementation of the ambulance system provided for by this ordinance, shall have the power to issue certificates of public con- venience and necessity for operation of ambulances under the current Chapter 6 of the Code of the City of Fort Worth (1964), as amended, for the interim period from January 1, 1986, to April 1, 1986, the effective date of this ordinance, and the provisions of the current Chapter 6 are hereby amended to such extent as to allow for such interim permits. APPROVED AS TO FORM AND LEGALITY: City Attorney Date: ADOPTED :_ ~~~~/~~ EFFECTIVE: -25-