Ambulance Franchise Ordinance
AN ORDINANCE WITH RESPECT TO THE FRANCHISING OF
AMBULANCE SERVICES IN RANDOLPH COUNTY
Section 1. Purpose.
In the public interest and for the promotion of the public health, safety,
welfare and convenience and pursuant to statutory authority contained in
N.C.G.S. §153A-250, 153A-123, and other applicable laws, the following
rules are adopted, which rules set forth the conditions, limitations,
restrictions, and requirements under which a person may provide
ambulance services or operate an ambulance in Randolph County.
Section 2. Definitions.
For the purposes of this ordinance, the following words, phrases, terms,
abbreviations, and their derivations shall have the meaning given herein.
When not inconsistent with the context, words used in the present tense
include the future tense, words in the plural number include the singular
number, words in the singular number include the plural number, and
words in the masculine, feminine or neuter gender include each of the
other genders. The word “shall” is always mandatory and not merely
directory.
(a). “Ambulance” shall mean any privately or publicly owned motor
vehicle, aircraft, or vessel that is specially designed, constructed, or
modified and equipped and is intended to be used for and is maintained
or operated for the transportation of patients on the streets or highways,
waterways, or airways of this state, in accordance with N.C.G.S. §131E-
155.
(b). “Ambulance Provider” shall mean an individual, firm, corporation or
association who engages or professes to engage in the business or service
of transporting patients in an ambulance.
(c). “Approved” shall mean approved by the state’s Medical Care
Commission pursuant to its rules and regulations promulgated under
Chapter 143, Article 56 of the North Carolina General Statutes.
(d). “Board” shall mean the Randolph County Board of County
Commissioners.
(e). “County” shall mean Randolph County, North Carolina.
(f). “Credentialed Personnel” shall mean an individual who holds a valid
certification from the state that allows them to practice at any of the
following levels: Medical Responder, EMT, EMT (epinephrine), EMT-D,
EMT-I, and/or EMT-P, as defined in North Carolina General Statutes and
any rules promulgated pursuant thereto.
(g). “Department” shall mean the North Carolina Department of Health
and Human Services.
(h). “Dispatcher” shall mean a person who is available at all times to
receive requests for emergency services, to dispatch emergency services,
and to advise fire departments, law enforcement agencies and emergency
medical facilities of any existing or threatened emergency.
(i). “Emergency” and “Emergency Transportation Service” shall mean the
use of an ambulance, the equipment and personnel to provide medical
care transportation of a patient who is in need of immediate medical
treatment in order to prevent loss of life or further aggravation of
physiological or psychological illness or injury.
(j). “Non-emergency Transportation Services” shall mean the operation of
an ambulance for any purpose other than transporting emergency
patients.”
(k). “Owner” shall mean any person or entity who owns an ambulance.
(l). “Patient” shall mean an individual who is sick, injured, wounded, or
otherwise incapacitated or helpless such that the needfor some medical
assistance might be anticipated, in accordance with N.C.G.S. §131E-155.
(m). “Person” shall mean any individual, firm, partnership, corporation,
association, company, group of individuals acting together for a common
purpose, or organization of any kind, including any governmental agency
of the United States.
(n). “State” shall mean the State of North Carolina.
Section 3. Standards.
(a). Standards for credentialed personnel shall be as developed by the
State Medical Care Commission, the North Carolina Office of Emergency
Medical Services, and the Randolph County Emergency Medical Services
System, and shall be applied to the same as if incorporated herein by
reference.
(b). Standards for vehicles and equipment shall be as developed by the
State Medical Care Commission, the North Carolina Office of Emergency
Medical Services and the Randolph County Emergency Medical Services
System, and shall be applied to the same as ifincorporated herein by
reference.
Section 4. Communications and Dispatch Requirements.
(a). Each ambulance shall be equipped with communications
compatible with those used by Randolph County Emergency Services.
Randolph County Communications shall assign frequencies and record
movements of applicant’s ambulances.
(b). Each ambulance shall be required to render assistance to Randolph
County Emergency Medical Services (EMS) in the case of a major
catastrophe or emergency or when Randolph EMS units are unavailable to
respond to emergency calls.
(c). Assigned emergency calls will have priority over scheduled non-
emergency calls.
(d). When Randolph EMS units are dispatched to an emergency scene
and an applicant’s ambulance is available, closer to the scene, that
ambulance is authorized to respond to the scene and provide assistance
prior to Randolph EMS if:
(1). The County Communication Center is notified; and
(2). The applicant’s ambulance is dispatched.
(e). If, on arrival, it is found that the situation is not an emergency, the
patient may be transported by applicant’s ambulance. Randolph EMS will
continue to the scene if there is any question of the patient’s actual
condition. Patient’s medical needs will be given priority. When
necessary, patient will be released to Randolph EMS for treatment and
transport.
(f). Any call received at a base or office of the applicant will be
immediately referred to County Communications and the appropriate
response will be determined.
Section 5. Insurance.
(a). No ambulance franchise shall be issued under this ordinance, nor
shall such franchise be valid after issuance, unless the franchisee has at
all times in force and effect insurance coverage issued by an insurance
company licensed to do business in this state.
(b). This coverage shall provide:
(1). Appropriate Statutory Workmen’s Compensation
(2). Auto Liability Coverage in an amount equal to or greater than
that carried by Randolph County Emergency Services.
(3). General Liability Coverage in an amount equal to or greater
than that carried by Randolph County Emergency Services.
(4). Medical Malpractice Coverage in an amount equal to or
greater than that carried by Randolph County Emergency Services.
(c). Along with their application, the applicant shall provide the County
with a copy of the Certificate of Insurance for the above. The insurance
policy must list the County as a party to be notified in the event that the
applicant’s insurance is revoked, withdrawn, canceled, or allowed to
lapse, or in the event that there is any change whatsoever in the above-
described coverage amounts.
Section 6. Rates and Charges.
Each franchisee who charges for services shall set his rates and
fees in accordance with those rates and fees set by the Board of County
Commissioners for the County Department of Emergency Services.
Section7. Franchise Required.
(a). It shall be unlawful for any person to provide ambulance services
in Randolph County or to operate an ambulance in the County unless
such person shall have first obtained and shall currently hold a valid
franchise granted pursuant to this ordinance.
(b).No franchise shall be required for:
(1).Any entity rendering assistance to a franchised ambulance
service in the case of a major catastrophe, mutual aid or
emergency with which the services franchised by the County
are insufficient or unable to cope;
(2). Any entity operated from a location or headquarters outside
of the County in order to transport patients who are picked
up beyond the limits of the County to facilities located within
the County, or to pick up patients within the County for
transporting to locations outside the County;
(3). Any ambulance owned and operated by an agency of the
United States Government;
(4). Vehicles owned and operated by rescue squads chartered by
the state as nonprofit corporations or associations or by
rescue squads which are not regularly used to transport sick,
injured, wounded, or otherwise incapacitated or helpless
persons except as a part of rescue operations.
(c). Any person who is providing ambulance services in the County or
in any portion thereof on the effective date of the adoption of this
ordinance is also entitled to a franchise to continue to service that part of
the County in which the service is being provided. The Board of
Commissioners has determined that Piedmont Triad Ambulance and
Rescue Service and Ash-Rand Rescue and EMS, Inc. are the only
ambulance services other than those operated by the County that are
currently in operation in Randolph County and that both are in
compliance with Chapter 131E, Article 7 and Chapter 143, Article 56 of
the North Carolina General Statutes and any rules promulgated pursuant
thereto and are each hereby granted a franchise to operate under the
terms of this ordinance, upon the County’s receiving proof of insurance
in accordance with Section 5 above. Moses Cone Carelink is also
currently operating an ambulance base in the County and is hereby
granted a franchise to operate under the terms of this ordinance upon
the County’s receiving proof of insurance in accordance with Section 5
above, provided however that Moses Cone Carelink shall not be
dispatched by the County nor shall they be subject to the provisions of
Section 6 (Rates and Charges) above.
Section 8. Application.
(a). Application for a franchise to operate an ambulance in the County
shall be made by the ambulance provider upon such forms as may be
prepared or prescribed by the County and shall contain, but not be
limited to, the following information:
(1). The name and address of the ambulance provider and the
owner(s) of the ambulance(s);
(2). The trade or other fictitious names, if any, under which the
applicant does business, along with a certified copy of an
assumed name certificate stating such names or articles of
incorporation stating such names;
(3). A resume of the training and experience of the applicant in
the transportation and care of patients;
(4). A full description of the type and level of service to be
provided, including detailed plans stating the method of
implementation and operation of service;
(5). An audited financial statement of the applicant as same
pertains to the operations in the County, such financial
statement to be in such forms and detail as the County
may require;
(6). A list of employees, job status, and North Carolina motor
vehicle operator license numbers. This list must be kept
current at all times;
(7). A list of vehicles, including the model, year and license
numbers for each;
(8). Proof of required insurance;
(9). Proof of registered state certification for vehicles and
employees; and,
(10). The address and physical location of all places where
business is conducted; and,
(11). A consent form allowing the Director of County Emergency
Services to inspect the applicant’s stations, vehicles,
equipment, and attendants’ state medical certification cards
during the term of the franchise.
(b). Application for a franchise to operate an ambulance in the County
shall be accompanied by an application examination fee of one thousand
dollars ($1,000.00).
Section 9. Issuance and Renewal of Franchise.
(a). Upon receipt of an application for a franchise, the County shall
schedule a time and place for hearing the applicant prior to an
investigation. Within thirty (30) days after such hearing, the County shall
cause such investigation as it may deem necessary to be made of the
applicant and his proposed operations.
(b). A franchise may be granted if the County finds that:
(1). The applicant meets state standards and the standards
outlined in this ordinance; and,
(2). A need exists for the proposed service in order to improve
the level of ambulance services available to residents of the
County and that this is a reasonable and cost effective
manner of meeting the need. Where a franchise is to be
issued to an existing service, there must be a need to
maintain the existing level of service.
(c). The authority hereby granted to provide ambulance services in the
County is not and shall not be deemed to be an exclusive right or
permission. The County expressly reserves the right to grant similar non-
exclusive franchises to other persons, firms, or corporations at any time
or for any period of time. No additional franchise granted by the County
shall in any wise affect the obligations of the grantee hereunder.
(d). Each franchise shall be valid for two years from the date of its
issuance.
(e). Each franchise may be renewed by submission of the renewal
application to the office of the Emergency Services Director at least
ninety (90) days prior to the expiration date of the franchise. After
approval of said application by the Board of County Commissioners and
upon payment of a renewal examination fee of five hundred dollars
($500.00), the applicant shall be issued a renewal certificate which shall
validate the applicant’s franchise for an additional two years.
Section 10. Termination.
(a). Either party, at its option, may terminate a franchise granted under
this ordinance upon one hundred twenty (120) days prior written notice
to the other party. After a notice of termination is given, the ambulance
provider may reapply for a franchise if continued service is desired.
(b). The acceptance of a franchise by an operator constitutes an
agreement to comply with required standards at all times. Each
franchised ambulance service shall comply at all times with the
requirements of this ordinance, the franchise granted hereby, and all
applicable federal, state, and local laws relating to health, sanitation,
safety, equipment, and ambulance design and all other laws and
ordinances, including but not limited to Chapter 131E, Article 7 and
Chapter 143, Article 56 of the North Carolina General Statutes, and the
Emergency Medical Services System Plan adopted by Randolph County.
Failure to comply will result in sanctions as provided in this ordinance up
to and includingthe revocation of the franchise by the County.
(c). Upon suspension, revocation, or termination of a franchise granted
hereby, such franchised ambulance service shall immediately cease
operations. Upon suspension, revocation, or termination of a driver’s
license or attendant’s certification, such persons shall immediately cease
to drive an ambulance or to provide medical care in conjunction with the
ambulance service.
(d). Upon any change in ownership of a franchised ambulance service
made without prior written approval by the County, the County shall
have the option to terminate the franchise effective immediately. No
franchise shall be sold, assigned, mortgaged, or otherwise transferred, in
whole or in part, without the prior written approval of the County. The
County shall have the option to terminate the franchise, in either case,
requiring a new application to be submitted, and a finding of
conformance with all requirements of this ordinance as upon original
franchising.
Section 11. Enforcement and Revocation of Franchise.
(a). Inspection. It shall be the duty of the Director of Randolph County
Emergency Services to periodically inspect the stations and ambulances
licensed under this ordinance in order to determine any violations of its
provisions. Any ambulance provider applying for or holding an
ambulance franchise pursuant to this ordinance shall allow the
Emergency Services Director or his designee to inspect its stations,
records, equipment and ambulances at any time with or without prior
notice.
(b). Criminal Penalties. A violation of this ordinance, or the terms of
any franchise granted hereunder, shall be a misdemeanor as provided by
North Carolina General Statute 14-4.
(c) Injunctive Relief. The County may pursue any appropriate
equitable remedy, a mandatory or prohibitory injunction, or an order of
abatement as authorized by North Carolina General Statute 153A-123. If
applicable, the County may execute an order of abatement if the violator
does not comply with such order, and the costs of execution shall be a
lien on the property in the nature of a mechanic’s or materialman’s lien.
(d ).Civil Penalties. The County may pursue civil penalties through the
issuance of citations for violations as provided below:
1.Penalties. When a violation occurs, the Emergency Services
Director shall issue a written warning, citation, suspension or
other violation penalty in accordance with the Violation and
Penalty Matrix depicted below.
2.Service.Anywritten warning, notice or citation issued
pursuant to this ordinance shall be delivered to the violator
by:certified mail to its official headquarters.
3.Contents. Anycitation issued pursuant to this ordinance
shall include the nature of the violation, the amount of the
civil penalty, information about where to pay the civil
penalty, the deadline for payment, notification of daily
penalties for continuing violations, and the notification of
possible civil and criminal enforcement.
4.Penalty Amount. Along with any citation issued pursuant to
this ordinance, the Emergency Services Director shall assess
a civil penalty of up to five hundred dollars ($500.00).
Determination of the amount of the civil penalty shall be
based upon the Violation and Penalty Matrix depicted below.
5.Deadline for Paying Civil Penalties. All civil penalties shall be
paid on or before thirty (30) days after receipt of the
issuance of the citation. Failure to pay civil penalties within
said deadline may subject the violator to a civil action in the
nature of a debt.
6.Continuing Violations. The citation shall also include notice
that a daily penalty of up to five hundred dollars ($500.00)
shall be assessed for each dayof continued violation and
that the penalty shall be cumulative. If the violation
continues for more than fifteen (15) days after receipt of the
citation,the violator’s franchise may be suspended pending
further investigation or recommended for termination in
accordance with paragraph (b)below.
7.Settlement of Violations. Once a violation has been
corrected, the Emergency Services Director may waive
payment of a single civil penalty or, in the case of a
continuing violation, may reduce the amount to a single-day
civil penalty, if one or more of the following factors are
present:
a)The violator has not previously received a citation for a
similar violation;
b)The violation does not directly impact the public
health and safety of the community;
c)The violation was difficult to correct in an expeditious
manner; or
d)The degree of noncompliance was not substantial.
If the violation has not been corrected, payment shall not
release a violator from potential civil enforcement, criminal
prosecution, injunctive relief, or an order of abatement.
8.Appeals. All appeals of citations must be filed in writing
within thirty (30) days after the date of receipt of the citation
by letter to the Randolph County Board of Commissioners.
The appeal shall be heard at the next regularly-scheduled
meeting of the Randolph County Board of Commissioners,
provided said notice is received more than ten (10) days in
advance of said meeting. If the notice of appeal is received
ten (10) days or less from the date of the nearest regularly-
scheduled meeting, then the appeal shall be heard the
following month at the regularly-scheduled Board of
Commissioners meeting.
9.Judicial Action to Collect Civil Penalty. The County may file
a civil action in the nature of a debt in any court of
competent jurisdiction to collect an unpaid civil penalty after
the thirty (30) day deadline for paying the civil penalty, set
out in the citation, has expired. Additional civil actions in
the nature of a debt may be filed to collect an unpaid civil
penalty for a continuing violation lasting more than thirty
(30) days after the receipt of the citation.
(b). In the event that a provider has a single violation lasting for more
than fifteen (15) days after receiving notice thereof or has a history of
repeated violationsof such nature and frequency as to indicate a pattern
of disregard for compliance , the Director of County Emergency Services
may notify the Board of County Commissioners and recommend
revocation of provider’s franchise.. The Board shall then determine if
there is sufficient danger to the morals, public health, safety, or general
welfare of the citizens and residents of the County to warrant revocation
of the ambulance provider’s franchise.
(c). Upon a determination that there is probable cause for revocation
and after notification to the ambulance provider of such determination
and the reasons therefore, the Board shall schedule a hearing at which
the ambulance provider or his representative shall be afforded the
opportunity to show good cause why his franchise should not be
revoked. Upon the ambulance provider’s failure to show such good
cause, the Board shall revoke the franchise.
This ordinance, first introduced on April 7, 2003, was unanimously
adopted by the Randolph County Board of Commissioners on May 5,
2003.
This ordinance was amended on November 5, 2012.
I, Cheryl A. Ivey, Clerk to the Board of the Randolph County Board of
Commissioners, do hereby certify that the foregoing ordinance was duly
adopted by the Randolph County Board of Commissioners at a regular
meeting thereof, a quorum being present.
th
This the 5 day of November, 2012.
____________________________________
Clerk to the Board
Amendments Summary:
This ordinance was amended on November 5, 2012 to incorporate
changes that will strengthen the reliability of each agency and the
regulation authority that the County should have. The changes are as
follows:
1.Section 1 – Added General Statute 153A-123 for reference authority.
2.Section 3 a & b –Added the NC Office of EMS.
3.Section 4 a –Removed UHF and VHF two-way radio requirement.
4.Section 5 c – Added “Along with their application” and removed
“annually.”
5.Section 8 b –Increased the initial application fee from $300 to $1,000.
6.Section 9 e –Added “Emergency Services Director” and removed
“County Manager.”
7.Section 9 e –Increased the franchise renewal fee from $150 to $500.
8.Section 11 a –Added language allowing Director to inspect stations,
records, equipment and ambulances at anytime with or without prior
notice.
9.Section 11 b –Added criminal misdemeanor penalties.
10.Section 11 c –Added injunctive relief statement.
11.Section 11 d, 1-10 – Added descriptions of how the County may pursue
civil penalties for violations.
VIOLATION and PENALTY MATRIX
VIOLATIONFIRST OCCURANCESECOND OCCURANCE THIRD OCCURANCE
Refusal of response, patient care Immediate Suspend franchise for Recommend the Board
and/or transport. (Each incident suspension pending two days, plus $500 of Commissioners
will be reviewed and will exclude investigation with citation.permanently suspend
incidents due to vehicle failure, on-franchised supervisor the franchise for a
duty personnel who become ill or and issuance of period of six months –
injured, and etc.) citation. then require new
application.
Unit not available at scheduled $100 citation. $500 citation. Suspend franchise for
time (3 or more times within a 90 two days, plus $500
day period). citation.
Unit going off-duty prior to Written Warning. $100 citation. $500 citation.
scheduled time without prior
notification (notification made by
Agency Supervisor at the beginning
of the shift).
Negligent or willful failure to $100 citation per $500 citation per day. Suspend franchise
maintain necessary and required day. until equipment is in
equipment in proper working working order.
order.
Failure to follow radio procedures, Written warning. Immediate suspension $500 for each repeat
policies, or rules and/or improper pending investigation occurrence.
use of radio equipment. with franchised
supervisor and $100
citation per day while
suspended.
Failure to meet the equipment $100 citation per day $500 citation per day Suspend franchise
standards as define by NCOEMS until corrected, up to until corrected, up to until equipment is in
and Randolph County Emergency suspension.suspension. working order.
Services
Failure to maintain the staff Written warning. $100 citation per day $500 citation per day
credentialing requirements as until corrected. until corrected.
define by NCOEMS and Randolph
County Emergency Services
Failure to attend 75% of the Written warning. $100 citation. $500 citation.
quarterly Randolph County EMS
Quality Management Committee
meetings
Failure to meet NCOEMS and Written warning. $100 citation per day $500 citation per day
Randolph County Emergency until corrected. until corrected.
Services call times policies in the
EMS System Patient Care Manual.
Fails to operate according to the Written warning up $100 citation per day, Recommend the Board
protocol standards established by to suspension. up to suspension. of Commissioners
NCOEMS and the Randolph County permanently suspend
EMS System Patient Care Manual.the franchise for a
period of six months –
then require new
application.
All other violations not listed Written warning. $100 citation per day $500 citation per day
above.until corrected. until corrected.