* Editor’s note: Before Ord. 11806 amended Ch. IV of Ord. 5860 in its entirety, the following ordinances comprised the chapter; these ordinances are still in effect and underlie the provisions of Ord. 11806 even though they cannot, due to changes in section numbering, be shown following specific sections: Ords. 5958 § 12, 1952; 6223 §§ 1--3, 1953; 7153 § 1, 1957; 7159 §§ 8, 9, 1957; 7182 §§ 1, 2, 1957; 7462 § 18, 1959; 7474 §§ 1, 2, 1959; 7479 § 1, 1959; 7545 § 2, 1959; 778 § 4, 1960; 7939 § 1, 1961; 8073 §§ 9--15, 1961; 8097 § 6, 1961; 8283 § 2, 1962; 8485 §§ 3, 4, 1963; 8593 § 1, 1968; 9714 § 15, 1969; 9807 § 8, 1969; 10217 § 10, 1971; 10578 § 1, 1972; 10932 § 1, 1974; 11058 § 1, 1974; 11209 § 1, 1975; 11228 § 1, 1975 and 11410 § 1, 1975 and 11410 § 1, 1976.

A. It is the board's intent in amending this chapter to undertake the prescribed functions and responsibilities of a local government entity concerning ambulance services as authorized by the state of California pursuant to, among other authority, Health and Safety Code Sections 1443 and 1797, et seq., Welfare and Institutions Code Section 17000, Vehicle Code Section 2512, and case law.
B. It is the board's further intent in enacting this chapter to exercise the full extent available to it under the laws of the state of California its discretion and authority to regulate, set rates, and issue licenses for all ground ambulance services and to issue licenses for all EMS Aircraft, regardless of services level, throughout all the unincorporated areas and incorporated cities of the county of Los Angeles.
C. It is the board's further intent that, within six (6) months of the adoption of this amended section, all existing ambulance operators conducting business within any incorporated city or unincorporated area of the county which do not currently hold county business licenses apply for all appropriate licenses.
D. No part of this chapter shall apply to a governmental agency in the provision of ambulance services in response to emergency calls on an emergent or code 3 basis.
E. Enacting this chapter does not preclude an incorporated city from regulating private ground ambulance and EMS Aircraft operators within its jurisdiction if a business license has been issued by the County of Los Angeles. (Ord. 2011-0031 § 1, 2011: Ord. 88-0181 § 5, 1988.)

For the purpose of this chapter, the following terms are defined and shall be construed as set forth in this section, unless the context clearly indicates otherwise:
A. “Advanced life support “(ALS)” means special services designed to provide definitive prehospital emergency medical care, including, but not limited to, cardiopulmonary resuscitation, cardiac monitoring, cardiac defibrillation, advanced airway management, intravenous therapy, administration of specified drugs and other medicinal preparations, and other specified techniques and procedures administered by authorized personnel under the direct supervision of a base hospital as part of a local EMS system at the scene of an emergency, during transport to an acute care hospital, during interfacility transfer, and while in the emergency department of an acute care hospital until responsibility is assumed by the emergency or other medical staff of the hospital.
B. “Ambulance” means a motor vehicle specially constructed, modified, equipped, or arranged for the purpose of transporting sick, injured, convalescent, infirm, or otherwise incapacitated persons, authorized by the state as an emergency vehicle, and used, or having the potential for being used, in emergency or nonemergency medical service to the public, regardless of level of service. An ambulance includes a ground ambulance and EMS Aircraft.
C. “Ambulance attendant” means any person other than the ambulance driver who is employed to accompany an ambulance driver while transporting any person needing medical attention or services.
D. “Ambulance driver” means any person who drives an ambulance in which any person needing medical attention or services is transported.
E. “Ambulance operator” means any person or entity who for any monetary or other consideration, or as an incident to any other occupation, transports in one or more ambulances one or more persons needing medical attention or services.
F. “Ambulance services” means the transportation of any person for monetary or other consideration in an ambulance.
G. “Basic life support (BLS)” means emergency first aid and cardiopulmonary resuscitation procedures which, as a minimum, include recognizing respiratory and cardiac arrest and starting the proper application of cardiopulmonary resuscitation to maintain life without invasive techniques until the victim may be transported or until advanced life support is available.
H. “Code 2” or non-emergent means a request for ambulance transport which is urgent and is nonemergency and which cannot be scheduled more than one hour in advance.
I. “Code 3” or emergent means the authorized use of red lights and siren during a response or transport.
J. “Critical care transport” or “critical care transport provider” means any transport or person who transports a patient from one health care facility, trauma center, or acute care facility to another where the skill level required in the care of that patient during transport exceeds the basic life-support, Emergency Medical Technician (EMT) and Emergency Medical Technician-Paramedic (Paramedic) level and scope of training.
K. “Director of health services” or “director” shall include the County Director of Emergency Medical Services or his or her designee.
L. “Emergency call” means a request for an ambulance where an individual has a need for immediate medical attention, or where the potential for such need is perceived by emergency medical personnel or a public safety agency.
M. “Emergency Medical Services” means the services needed to provide immediate medical attention in a condition or situation in which an individual has need for such services or where the potential for such need is perceived by emergency medical personnel. Emergency medical services shall include all such services for all such persons in the incorporated and unincorporated areas of the county.
N. “EMS Aircraft” means any aircraft utilized for the purpose of prehospital emergency patient response and transport services. EMS Aircraft includes air ambulances and all categories of rescue aircraft as defined by state regulations.
O. “Enforcement Officer” shall mean any county employee or agent designated by the director to enforce any provision of this chapter.
P. “Hearing Officer” shall mean the person appointed by the director to conduct the administrative hearings provided for in this chapter. The hearing officer shall not be the enforcement officer who issued the notice of administrative fine that is the subject of the administrative hearing or his/her immediate supervisor.
Q. “Local EMS agency” or “agency” means the county of Los Angeles department of health services, designated by the board as the local EMS agency pursuant to Health and Safety Code Sections 1797, et seq.
R. “Nonemergency call” means a request for the transport of a stretcher patient to or from a medical facility in a licensed ambulance and which is neither an emergency call nor a critical care transport.
S. “Response time” means the interval of time between the moment the basic items of dispatched information have been obtained by an operator to the moment the operator's ground ambulance arrives at the scene of pickup. Response time for nonemergency or scheduled calls, or both, shall be within 90 minutes of the time of the call or the scheduled pickup, whichever applies.
T. “Special events” means any situation where a previously announced event or activity creates a need to have one or more ambulances present because of risks of physical harm to participants in the event or activity, or to others in attendance there, or to both such groups. (Ord. 2011-0031 § 2, 2011: Ord. 2003-0058 § 2, 2003.)

The department of health services in consultation with any other department, agency or body which the board of supervisors designates, may establish and adopt such rules and regulations on the type of ambulance, the type of equipment used, the condition of vehicles, the allowable special charge rates, and any other aspects of ambulance operations, which the director of the department of health services finds is necessary for the preservation of the health and safety of the patients of any ambulance operator and those using the highways. (Ord. 88-0181 § 7, 1988: Ord. 83-0017 § 3 (part), 1983: Ord. 11806 § 1 (part), 1978: Ord. 5860 Ch. 4 § 1022, 1951.)

Every ambulance operator shall procure and maintain a license and pay an annual license fee in the amount set forth in Section 7.14.010 of this code under the appropriate heading in order to operate in any incorporated city or unincorporated area of the county. (Ord. 2011-0031 § 3, 2011: Ord. 91-0002 § 4, 1991: Ord. 83-0017 § 3 (part), 1983: Ord. 11806 § 1 (part), 1978: Ord. 5860 Ch. 4 § 1003, 1951.)

A. Every ground ambulance used for transporting any person needing medical attention or services, in which a person entered or was placed in such ambulance at any location, either in an incorporated city or unincorporated area of the county for either: (1) emergency medical attention or emergency services as a result of a 9-1-1 response or (2) nonemergency transportation services, shall have and conspicuously display on the left rear portion of such vehicle a county seal issued by the local EMS agency.
Ambulance vehicles are also required to carry the following documents:

1. Original or copy of California Department of Motor Vehicles Registration;

2. Insurance identification card;
3. Original or copy of current county business license or temporary authorization;
4. Copy of the most recent California Highway Patrol (CHP) inspection sheet; and
5. Original or copy of valid CHP ambulance identification certificate. For new fleet vehicles, a copy of the CHP inspection sheet shall serve as the temporary operating authorization for 30 days following the date of inspection by the CHP.
B. Every EMS Aircraft used for transporting any person needing medical attention or services, in which a person entered or was placed at any location either in an incorporated city or unincorporated area of the county for either: (1) emergency medical attention or emergency services as a result of a 9-1-1 response or (2) nonemergency transportation services, shall have and conspicuously display on the vehicle, in a manner which does not obscure the pilot's vision, a county seal issued by the local EMS agency, in addition to any other required documents as specified in Los Angeles County prehospital care policies and procedures.
C. Failure to provide current vehicle documentation upon request to local EMS agency representatives shall result in the ambulance immediately being taken out of service at the conclusion of the call until such time as current documentation is placed in the ambulance. Company shall provide documentation of current information to the local EMS agency no later than 5:00 p.m. the next business day.
D. Ambulances, staffed at the emergency medical technician-paramedic (EMT-P or Paramedic) advanced life support or critical care transport level, which pick up patients at any location in Los Angeles County, must have a county license and otherwise meet the requirements of this section. (Ord. 2011-0031 § 4, 2011: Ord. 96-0067 § 3, 1996: Ord. 88-0181 § 8, 1988: Ord. 83-0017 § 3 (part), 1983: Ord. 11806 § 1 (part), 1978: Ord. 5860 Ch. 4 § 1003.1, 1951.)

No ambulance operator and no ambulance vehicle license is required where the ambulance operator is a governmental agency. (Ord. 91-0002 § 5, 1991: Ord. 88-0181 § 9, 1988: Ord. 83-0017 § 3 (part), 1983.)

The director of the department of health services may waive in writing any one or more of the licensure procedures or conditions defined in Sections 7.16.020, 7.16.050, 7.16.051, 7.16.060, and 7.16.070, and grant a license to an ambulance operator, if the director finds that adherence to such procedure(s) or condition(s) will either prevent or delay the securing by the county of cost-effective and efficient emergency ambulance services which the director has determined are immediately needed to serve county residents. As a requirement to the waiver of any such procedure or condition, however, either a county contract for the provision of emergency ambulance services to county residents must be executed by the operator and by the board or the director must find that the ambulance operator provides special events services only. (Ord. 2011-0031 § 5, 2011: Ord. 96-0067 § 4, 1996: Ord. 89-0096 § 1, 1989.)

Every application for an ambulance operator's license shall be signed by the applicant and filed with the local EMS agency. In addition to the requirements of Section 7.06.020 of this title, the application shall contain the following information:

A. Evidence of Applicant's Financial Capability.
1. Financial statements for established applicants which have been in operation for more than one (1) year: current profit and loss statements, and current balance sheet, both of which must be prepared by a certified public accountant, shall be provided for the last two (2) fiscal years.
2. Financial statements for new or start up applicants, which have been in business for less than one (1) year: current profit and loss statements and current balance sheet, both of which must be prepared by a certified public accountant, shall be provided. Pro forma profit and loss statements shall also be provided.
3. The financial statements shall demonstrate that the applicant has adequate financial health, based on liquidity, profitability, and sustainability, to maintain ambulance service operations.
4. Data shall be submitted showing the estimated average cost of operating one trip and the number of trips per day a vehicle must be run to be profitable; the costs per trip should be itemized. The use of break-even-type formulas may be used to show the economic feasibility of the proposed operation.
B. The applicant, except for those operators providing special events or EMS Aircraft services only, must agree to respond to requests for service within the following county response time standards:
1. Emergency calls: Maximum response times:
Urban: all census tracts with a population density of 100 or more persons per square mile; or census tracts and enumeration districts without census tracts which have a population density of 100 or more persons per square mile: eight minutes, fifty-nine (59) seconds.
Rural: all census tracts with a population density of 10 to 99 persons per square mile; or census tracts and enumeration districts without census tracts which have a population density of 10 to 99 persons per square mile: 20 minutes, fifty-nine (59) seconds.
Wilderness: census tracts and enumeration districts without census tracts which have a population density of less than 10 persons per square mile: as quickly as possible.
In accordance with Section 7.16.345 of this chapter, the director of the department of health services may waive in writing one or more of these response time requirements for any operator for a prescribed period. However, any change in the maximum response times defined in Section 7.16.050 will require a new agreement waiver.
2. Critical care transport and nonemergency calls: Maximum response time: 90 minutes of the time of the call or the scheduled time to pickup, whichever applies;
C. Testimony (written or verbal, or both) presented in support of the application from responsibly positioned people, institutions, or users of the service;
D. Evidence that the applicant's company has technically qualified management. This evidence shall include the manager's resume showing type and duration of transportation experience, including at least five years of increasingly responsible experience in the operation or management of a basic life support or advanced life support service;
E. Areas within which the applicant proposes to operate;
F. The number and type, age, condition, and patient capacity of each ambulance proposed to be operated by the applicant, and a description of the premises which are to serve as the base of operations;
G. A certificate or other evidence of insurance coverage satisfactory to county confirming that the license applicant carries an insurance policy with coverages and limits that are in accordance with the requirements of Section 7.16.180;
H. The color scheme and insignia to be used to designate the ambulance(s) of the applicant;
I. Evidence concerning applicant's adherence to rules and regulations.
1. Identification of all licenses and franchises held during past 10 years,
2. Disclosure of whether the applicant or the principals of the applicant have ever been investigated by any governmental agency and disclosure of the nature of the investigation,
3. Disclosure of whether the applicant or the principals of the applicant have ever had licenses revoked or whether any of them has been convicted of any misdemeanor or felony, or whether there are any pending criminal proceedings at the time of application.
4. Applicant must show proof of any current business license issued by any United States jurisdiction, and
5. Applicant must show proof that its business location is properly zoned for the incorporated city or unincorporated area in which it is located.
J. A copy of the CHP emergency ambulance operator's license and results of most recent CHP inspection for all ground ambulances.
K. Dispatch logs for the thirty (30) day period immediately prior to the date of application.
L. Dispatch policies and procedures and qualifications for dispatchers.
M. Affirmation that applicant will adhere to all applicable federal, state, and local rules, regulations and laws, including Los Angeles County prehospital care policies and procedures.
N. EMS Aircraft applicants shall submit the following additional information:
1. A copy of the Federal Aviation Regulations Part 135 Certificate issued by the Federal Aviation Administration.
2. The level or levels of service which applicant proposes to provide, as identified in Los Angeles County prehospital care policies and procedures.
3. Any such additional information as required in Los Angeles County prehospital care policies and procedures.
O. Any such further information requested by either the county sheriff or the local EMS agency.
P. The local EMS agency shall reserve the right to inspect the on-site records and operations of applicant.
Q. Neither the local EMS agency nor any applicant for an exclusive emergency ambulance or advanced life support operating area under provisions of Health and Safety Code Sections 1797, et seq., is required to adhere to the procedures defined in this code for application for and granting of any such exclusive operating area, unless the local EMS agency chooses to impose one or more of these procedures as part of the process for selecting a grantee for an exclusive operating area. (Ord. 2011-0031 § 6, 2011: Ord. 98-0006 § 1, 1998: Ord. 96-0067 § 5, 1996: Ord. 88-0181 § 10, 1988: Ord. 83-0017 § 3 (part), 1983: Ord. 11806 § 1 (part), 1978: Ord. 5860 Ch. 4 § 1004, 1951.)

A. Every application for an ambulance operator's license for special events services shall be signed by the applicant and filed with the local EMS agency. In addition to the requirements of Section 7.06.020 of this title, the application shall contain the following information:
1. Applicant agrees to provide special events services only;
2. Testimony (written or verbal, or both) presented in support of the application from responsibly positioned people, institutions, or users of the service is optional;
3. Evidence that the applicant's company has technically qualified management. This evidence shall include the manager's resume showing type and duration of transportation experience, including at least five years of increasingly responsible experience in the operation or management of a basic life support or advanced life support service;
4. The number and type, age, condition, and patient capacity of each ambulance proposed to be operated by the applicant, and a description and address of the premises which are to serve as the base of operations;
5. A certificate or other evidence of insurance coverage satisfactory to county confirming that the license applicant carries an insurance policy with coverages and limits that are in accordance with the requirements of Section 7.16.180;
6. The color scheme and insignia to be used to designate the ambulance(s) of the applicant;
7. Evidence concerning the applicant's adherence to rules and regulations, including the following information:
a. Identification of all licenses and franchises held during the past 10 years,
b. Disclosure of whether the applicant or the principals of the applicant have ever been investigated by any governmental agency and disclosure of the nature of the investigation, and
c. Disclosure of whether applicant or the principals of the applicant have ever had licenses revoked; whether they have been convicted of any misdemeanor or felony; and whether there are any pending criminal proceedings at the time of application.
d. Applicant must show proof of any current business license issued by any United States jurisdiction, and
e. Applicant must show proof that its business location is properly zoned for the incorporated city or unincorporated area in which it is located.
8. A copy of the CHP emergency ambulance operator's license and results of most recent CHP inspection for ground ambulances.
9. Affirmation that applicant will adhere to all applicable federal, state, and local rules and regulations and county prehospital care policies and procedures.
10. Any such further information requested by either the county sheriff or the local EMS agency.
B. Ambulance operators providing services for special events only, and who do not respond to calls from the general public, are exempt from 24-hour availability as a licensing prerequisite.
C. A special events operator shall notify the director of the department of heath services or his or her designee, at least seven days prior to providing standby services for any special event in Los Angeles County, of the location and duration of such services.
D. Rates for special events ambulance services shall be determined by agreement between the events promoter and the special event ambulance operator. Rates charged to the general public for special events transport shall not exceed the general public rates specified in Section 7.16.280, 7.16.290, and Section 7.16.310 of this chapter.
E. A special events operator must submit a new application in order to provide any additional ambulance services. (Ord. 2011-0031 § 7, 2011: Ord. 96-0067 § 6, 1996.)

A license required of an ambulance operator shall not be granted until the department of health services or other agency designated by the director of that department holds a public hearing, notice of the time and place of which shall be given to the applicant as provided in Section 7.10.100 of this title. Notice of the time and place of the public hearing shall be sent to all licensed ambulance operators. (Ord. 96-0067 § 7, 1996: Ord. 88-0181 § 11, 1988: Ord. 83-0017 § 3 (part), 1983: Ord. 11806 § 1 (part), 1978: Ord. 5860 Ch. 4 § 1003.7, 1951.)

Every application for an ambulance operator’s license shall be referred to the sheriff, the department of health services, the department of agricultural commissioner/weights and measures, and any other officer, department, or body that the board designates. (Ord. 96-0067 § 8, 1996: Ord. 88-0181 § 12, 1988: Ord. 83-0017 § 3 (part), 1983: Ord. 11806 § 1 (part), 1978: Ord. 5860 Ch. 4 § 1004.1, 1951.)

Every ambulance operator licensee shall provide the director of the department of health services or his designee with reasonable access to the operator’s books and records including, but not limited to financial, dispatch, and personnel records, for the purpose of determining whether the operator is in compliance with this chapter and whether the operator’s personnel are in compliance with state law and regulations. (Ord. 88-0181 § 15, 1988.)

Every ambulance operator, except an ambulance operator providing special events services only, shall provide emergency ambulance service on a continuous 24-hour-per-day basis, and shall immediately advise the department of health services, the sheriff, and the Los Angeles County fire department, and, if applicable, the ambulance operator’s local city communication center, of any disruption in the availability of such service and the reasons therefor. (Ord. 96-0067 § 10, 1996: Ord. 83-0017 § 3 (part), 1983: Ord. 11806 § 1 (part), 1978: Ord. 5860 Ch. 4 § 1020, 1951.)

A. No ambulance operator shall:
1. Fail to dispatch an ambulance within a reasonable time in response to an emergency call from a public agency or authorized emergency transportation operator for that geographical area, unless such entity is immediately advised of a delay in responding to a call;
2. Fail, neglect, or refuse to disclose to any entity requesting an emergency response that an ambulance is not available, if indeed an ambulance or appropriate staffing therefore is not then available;
3. Fail, neglect, or delay to provide transportation of the patient to the most accessible and appropriate medical facility in accordance with state law and with department of health services policies in an emergency case;
4. Use a scanner or radio monitoring device for the purpose of responding to an emergency call when not authorized or requested to respond to that call by the appropriate public safety agency;
5. Use a red light and siren (i.e., Code 3 or emergent operation) for response to calls received as nonemergencies;
6. Permit the operation of an ambulance in any manner contrary to the provisions of this title or any rule or regulation adopted pursuant thereto and any section of the California Vehicle Code, Titles 13 and 22 of the California Code of Regulations, the Federal Aviation Regulations, and the statutes, rules, and regulations of the Medicare and MediCal programs;
7. Perform the services of a paramedic advanced life support or critical care transport provider unless that operator has first been approved for the provision of such services by the local EMS agency;
8. Fail to respond to emergency and nonemergency calls within the time parameters set forth in Section 7.16.050 of this chapter, except as may otherwise be specified either in a county contract with the operator or in other sections of this chapter;
9. Provide paramedic advanced life support critical care transport services to any person or institution under any circumstances without a contract with the county for the provision of such services; and
10. Respond to any emergency call that would normally be considered an emergency 9-1-1 call for the authorized emergency transportation operator for that geographical area, unless the call is from either a public entity or such authorized emergency transportation operator requesting backup services. If, upon arrival at the scene of pickup in response to a call for nonemergency services, and after assessment of the patient it is determined that a higher level of prehospital care intervention is needed, the appropriate 9-1-1 dispatching agency shall be notified immediately.
B. The commission of any prohibited act, as set forth in this chapter, by an operator or operator's employee or agent shall subject the operator to the imposition of administrative fines pursuant to Section 7.16.125, et seq., of this code in addition to any other applicable administrative, civil, or criminal remedy. (Ord. 2011-0031 § 9, 2011: Ord. 96-0067 § 10, 1996: Ord. 88-0181 § 16, 1988: Ord. 83-0017 § 3 (part), 1983: Ord. 11806 § 1 (part), 1978: Ord. 5860 Ch. 4 § 1021, 1951.)

A. The director may place on probation, suspend, or revoke an ambulance operator license for failure by the licensee to comply, and maintain compliance with, or for violation of, any applicable provisions, standards, or requirements of state statute or regulation, of this code, or of any regulations promulgated hereunder. Probation or suspension of a license is not a condition precedent to revocation of a license.
B. Before probation, the director of the department of heath services shall give written notice to the licensee. Said notice shall:
1. Specify the reasons for which the probation action is to be taken. Such reasons shall include, but are not limited to:
a. Any violation of this title or any federal, state, or local law or regulation related to the provision of emergency medical services,
b. Failure to make, keep, maintain, and provide upon request any records or documents required by this section (including records of current CHP inspections and licenses),
c. Use of unlicensed vehicles or noncertified Emergency Medical Technicians (EMTs) or other unlicensed medical personnel, and
d. Failure to pay required fees or fines within thirty (30) days of due date;
2. Set forth the term of the probation period not to exceed 120 days;
3. Request a plan of correction for the violation(s) specifying the reasons the action is being taken; and
4. Written notice shall be served on the licensee, either by delivery to its principal place of business or to its designated agent for service of such notices, if any.
C. Before suspension or revocation, the director of heath services shall give written notice to the licensee. Said notice shall:
1. Specify the reasons for which the action is to be taken. Such reasons include, but are not limited to:
a. Any violations of this chapter or any federal, state, or local law or regulation related to the provision of emergency medical services,
b. Failure to maintain insurance coverage as defined in Section 7.16.180,
c. Repeated and continuous minor violations,
d. Conviction of a felony by the licensee,
e. Conviction of an offense related to the use, sale, possession, or transportation of narcotics,
f. Aiding or abetting an unlicensed or uncertified person to evade the provisions of this title,
g. Presenting a threat to public health and safety including, but not limited to, using unlicensed or uncertified personnel,
h. Failure to pay any fine or fee imposed by any provision of this chapter,
i. Failure to maintain and/or provide records as required by this chapter, or
j. Debarment by the Centers for Medicare and Medicaid (CMS).
2. Set a hearing date, of not more than 15 county working days nor less than seven county working days after the date of delivery of the notice to the licensee;
3. Specify the date, time, and place of the hearing; and
4. Be served on the licensee, either by delivery to its principal place of business or to its designated agent for service of such notices, if any.
D. If the licensee, subsequent to service of such a probation, suspension, or revocation notice under this section, remedies some or all of the conditions to which the notice refers, the director of the department of health services may rescind the probation, suspension, or revocation at any time.
E. At the hearing, the department of heath services has the burden of proof and may present evidence as to why such action should be taken and to answer the evidence presented by the licensee.
F. The director of the department of health services may reduce the period of time for hearing under a suspension or revocation notice to no less than 24 hours when the director makes written preliminary findings that such action is necessary to protect the public health, safety, and welfare. When, as a result of such an emergency proceeding, a license is suspended or revoked, the licensee may request an additional hearing at which the licensee will have the burden of establishing renewed compliance justifying reinstatement of the license. Such additional hearing will be commenced within five days of the licensee's written request to the director. The request for, and the scheduling of, an additional hearing shall not stay operation of the suspension or revocation order.
G. Hearings conducted pursuant to this section shall be conducted before an impartial hearing officer designated by the director of the department of health services who is not an employee of the department. At the conclusion of said hearing, the hearing officer shall expeditiously prepare a written summary of the evidence and proposed findings, conclusions, and recommendations for consideration by the director.
H. The director of the department of health services shall issue a written decision within 15 county working days after conclusion of the hearing.
I. Except as may be specifically provided by this section or by other provisions of this title, the hearing and appeal rules and regulations reflected in Chapters 7.10 and 7.12 of this title are applicable to the license suspension or revocation proceedings referenced in this section. (Ord. 2011-0031 § 10, 2011: Ord. 96-0067 § 11, 1996: Ord. 88-0181 § 17, 1988.)

A licensed ambulance operator may provide service rendered by an ambulette operator without the necessity of an additional license. (Ord. 11806 § 1 (part), 1978: Ord. 5860 Ch. 4 § 1019, 1951.)

No ambulette operator shall permit the operation of any ambulette in any manner contrary to the provisions of this title or any rule or regulation adopted thereto. (Ord. 11806 § 1 (part), 1978: Ord. 5860 Ch. 4 § 1021.2, 1951.)

Whenever an enforcement officer determines that a violation of any provision of this chapter has occurred, the enforcement officer is authorized to issue a notice of violation to the operator, and to any attendant or driver in those cases where it is determined that such attendant or driver has violated any provision in this Chapter. The notice of violation may specify a correction period if, in the judgment of the enforcement officer, a correction period is warranted. (Ord. 2011-0031 § 11, 2011: Ord. 88-0181 § 18, 1988.)

A. Any person who provides ambulance services without an ambulance operator's license may be charged with a misdemeanor pursuant to chapter 1.24 of this code in addition to an administrative fine of five thousand dollars ($5,000.00) per occurrence.
B. Except as provided in Section 7.16.160(C) of this Chapter, any violation of any section of this chapter by an operator or operator's employee or other agent may subject that operator to an administrative fine in an amount up to five thousand dollars ($5,000.00). Such administrative fine may be issued in addition to any other remedy available to the local EMS agency, including license revocation, suspension, probation, or referral for criminal prosecution.
C. Administrative fines shall be due within thirty (30) days of issuance of the notice of violation. (Ord. 2011-0031 § 12, 2011.)

A. Whenever the enforcement officer determines that a violation has occurred, the director may issue an administrative fine to the operator.
B. Each notice of administrative fine shall contain the following information:
1. A statement that an administrative fine is being imposed on the operator pursuant to this chapter of the code;
2. The name of the operator;
3. The section violated;
4. The address of location where the code violation occurred;
5. A description of the code violation;
6. The name of the enforcement officer issuing the violation;
7. The amount of the administrative fine and the procedure for paying the fine; and
8. The procedure for requesting an administrative hearing to contest the imposition of the administrative fine.
C. Unless the operator requests an administrative hearing to contest the imposition of the fine, pursuant to Section 7.16.128, the notice of administrative fine shall constitute the final administrative order of the county with respect to said administrative fine, and the fine shall be due and payable to the director within thirty (30) calendar days following service of the notice of administrative fine.
D. The director shall serve a notice of administrative fine by either of the following methods:
1. By personal delivery to the operator or operator's employee or agent. Service shall be deemed effective at the time of the personal delivery; or
2. By first class mail to operator at operator's place of business. Service shall be deemed effective five (5) calendar days after the date of mailing.
E. Payment of the administrative fine shall not excuse the operator from correcting the violation when required by the director. (Ord. 2011-0031 § 13, 2011.)

A. Any operator served with a notice of administrative fine may request an administrative hearing before a hearing officer to contest the imposition and/or amount of the administrative fine. The request must be in writing and be filed with the local EMS agency director within ten (10) calendar days following service of the notice of administrative fine and shall include a statement indicating the basis on which the operator contests the imposition of the administrative fine, together with any evidence the operator would like the hearing officer to consider.
B. The written request for administrative hearing must be accompanied by a deposit equal to the full amount of the administrative fine(s) specified in the notice of administrative fine. Failure to deposit this amount concurrently with the request for administrative hearing shall constitute a waiver of the operator's entitlement to the administrative hearing. The hearing request and fee deposit shall be deemed filed on the date received by the local EMS agency.
C. After receiving a timely hearing request and the full amount of fine deposit, the local EMS agency shall schedule an administrative hearing. The operator shall be given not less than ten (10) calendar days prior written notice of the date, time, and location of the administrative hearing and the name of the hearing officer who will conduct the administrative hearing. (Ord. 2011-0031 § 14, 2011.)

A. The hearing officer shall be appointed by the director.
B. Hearings shall be conducted by the hearing officer on the date, time and place specified in the notice provided for in Section 7.16.128. The hearing officer may, in his or her discretion, grant a continuance of the hearing date upon written request and a showing of good cause. The request must be received by the hearing officer at least two (2) business days prior to the hearing. In no event shall the continuance be longer than forty-five (45) calendar days from the originally scheduled hearing date.
C. At the hearing, the operator shall have the opportunity to present evidence relevant to the hearing officer's determination of the matter. The failure of the operator to appear at the administrative hearing shall constitute an abandonment of the hearing request and a failure to exhaust administrative remedies to judicially challenge the imposition of the administrative fine. If the administrative hearing is abandoned, the issuing department shall keep the funds deposited with the hearing request.
D. The notice of violation, notice of administrative fine, and any other reports prepared by or for the enforcement officer concerning the code violation, shall be accepted by the hearing officer as prima facie evidence of the code violation and the facts stated in those documents.
E. After considering all the evidence and testimony submitted at the hearing and within ten (10) calendar days after the close of the hearing, the hearing officer shall issue a written decision that confirms or cancels the administrative fine. The written decision shall include a statement of the reasons for the decision and shall be served personally or by first-class mail. The hearing officer's written decision shall constitute the final administrative decision of the county.
F. If the hearing confirms the imposition of the full amount of the administrative fine, the local EMS agency shall keep the funds deposited with the hearing request.
G. If the hearing officer cancels the administrative fine, the local EMS agency shall refund the entire amount of the funds deposited with the hearing request to the operator within twenty (20) calendar days from the date of the written decision. (Ord. 2011-0031 § 15, 2011.)

The department of health services shall not issue an ambulance operator's license to any privately owned emergency hospital, any privately owned urgent care center, or any private hospital, nonprofit hospital, or physician group.
The director of the department of health services may make individual exceptions to this limitation if a waiver of the provision is requested. Granting of a request for waiver would be based on a finding that the public convenience and necessity requires issuance of the ambulance operator's license. (Ord. 2011-0031 § 16, 2011: Ord. 88-0181 § 19, 1988: Ord. 83-0017 § 3 (part), 1983: Ord. 11806 § 1 (part), 1978: Ord. 5860 Ch. 4 § 1021.1, 1951.)

A. Every ground ambulance driver shall possess a valid California Ambulance Driver's Certificate.
B. Every ground ambulance driver and every ground ambulance attendant shall possess a valid Emergency Medical Technician (EMT) certificate or Paramedic license.
C. The medical flight crew of an EMS Aircraft shall possess valid licensure and/or certification as specified in Los Angeles County prehospital care policies and procedures. (Ord. 2011-0031 § 17, 2011: Ord. 91-0002 § 7, 1991: Ord. 88-0181 § 20, 1988: Ord. 83-0017 § 3 (part), 1983: Ord. 11806 § 1 (part), 1978: Ord. 5860 Ch. 4 § 1021.1, 1951.)

Any person who is licensed by the state of California as a physician or registered nurse employed as an ambulance attendant shall not be required to have Emergency Medical Technician certification. (Ord. 83-0017 § 3 (part), 1983: Ord. 11806 § 1 (part), 1978: Ord. 5860 Ch. 4 § 1006.1, 1951.)

A. Every ground ambulance driver and every ground ambulance attendant shall carry and produce such documents for inspection upon request by the director of the department of health services, or his or her designee, during ambulance service working hours, the following documents:
1. Current California driver's license (driver);
2. Current California ambulance driver's certificate (driver);
3. Current California medical examination card (DL-51)-(driver);
4. Current state of California Emergency Medical Technician (EMT) certification card or current Paramedic license (both driver and attendant);
5. Current Paramedic Los Angeles County accreditation--Paramedics only.
B. Every medical flight crew member of an EMS Aircraft shall carry and produce for inspection upon request by the director of the department of health services, or his or her designee, during ambulance service working hours, his or her applicable licensure and or certification documents, as specified in Los Angeles County prehospital care policies and procedures.
C. Failure to provide current licenses and certification, as listed in Section 7.16.160(A) or (B), to a local EMS agency representative upon request shall be deemed a violation of this code and shall subject the driver and/or attendant, and applicable medical flight crew member, to an administrative fine in an amount up to two hundred fifty dollars ($250.00) in addition to the applicable provisions of chapter 7.04. Any notice of violation shall be issued pursuant to the requirements of Section 7.16.125, et seq., of this chapter. The operator shall also be notified by telephone. The employee shall be removed from service until he or she has all current licenses and certifications in his or her possession. The operator or the employee shall provide documentation of the employee's current certifications to the EMS agency within five days of the issuance date of the citation.
D. Every ambulance operator shall be responsible for promulgating and enforcing employee rules to ensure compliance with this section. An ambulance operator failing to promulgate or to enforce employee rules hereunder shall be subject to an administrative fine in an amount up to five thousand dollars ($5,000.00) per occurrence as well as the appropriate penalties and fines defined in Chapter 7.04. (Ord. 2011-0031 § 18, 2011: Ord. 96-0067 § 12, 1996: Ord. 91-0002 § 8, 1991: Ord. 88-0181 § 21, 1988: Ord. 83-0017 § 3 (part), 1983: Ord. 11806 § 1 (part), 1978: Ord. 5860 Ch. 4 § 1007, 1951.)

No ambulance operator, ambulance driver, or ambulance attendant shall transport any sick, injured, convalescent, infirm, or otherwise incapacitated person in any ground ambulance unless there is present in such ambulance an ambulance driver and an ambulance attendant who are appropriately licensed and certified in accordance with the requirements of Section 7.16.140. (Ord. 2011-0031 § 19, 2011: Ord. 91-0002 § 9, 1991: Ord. 83-0017 § 3 (part), 1983: Ord. 11806 § 1 (part), 1978: Ord. 5860 Ch. 4 § 1007.1, 1951.)

A. Every ambulance operator shall obtain and maintain in full force and effect throughout the term of the license the minimum insurance coverage types and limits listed below. Such insurance shall be primary to and not contributing with any other commercial insurance policies or self-insurance programs maintained by the county. Such insurance shall be provided by insurer(s) satisfactory to the county. The general and auto liability insurance policies shall name the county of Los Angeles as an additional insured. Certificates or other evidence of such insurance shall be attached to the application and shall provide that the local EMS agency be given written notice at least 30 days in advance of the cancellation of any policies.
B. The minimum insurance coverage type and limit requirements for ground ambulance operators are:
1. General liability insurance with limits of not less than one million dollars ($1,000,000.00) each occurrence and two million dollars ($2,000,000.00) aggregate.
2. Automobile liability insurance with limits of not less than one million dollars ($1,000,000.00) of each accident; such insurance shall cover all vehicles used by the operator.
3. Workers' compensation and employers' liability insurance, or an equivalent program of self-insurance coverage which complies with California Labor Code requirements.
4. Professional liability insurance covering operator's errors and omissions with limits of not less than one million dollars ($1,000,000.00) per each claim and two million dollars ($2,000,000.00) aggregate.
C. The minimum insurance coverage type and limit requirements for EMS Aircraft operators are:
1. Comprehensive aviation liability insurance including bodily injury and property damage liability with a combined single limit of not less than fifty million dollars ($50,000,000.00) each occurrence and aggregate.
2. General liability insurance with limits of not less than one million dollars ($1,000,000.00) each occurrence and two million dollars ($2,000,000.00) aggregate.
3. Workers' compensation and employers' liability insurance, or an equivalent program of self-insurance coverage which complies with California Labor Code requirements.
4. Professional liability insurance covering operator's errors and omissions with limits of not less than one million dollars ($1,000,000.00) per each claim and two million dollars ($2,000,000.00) aggregate.
D. The director, at his or her sole option, reserves the right to change these insurance requirements at any time during the license term by giving the operator ninety (90) days advance written notice of any such change. (Ord. 2011-0031 § 20, 2011: Ord. 96-0067 § 13, 1996: Ord. 88-0181 § 22, 1988: Ord. 86-0102U § 1, 1986: Ord. 83-0201 § 2, 1983: Ord. 83-0017 § 3 (part), 1983: Ord. 11806 § 1 (part), 1978: Ord. 5860 Ch. 4 § 1011, 1951.)

As a condition of the license, the licensee agrees to indemnify, defend, and save harmless the county of Los Angeles, its agents, officers, and employees from and against any and all liability, expenses, including defense costs and legal fees, and claims for damages of any nature whatsoever, including but not limited to, bodily injury, death, personal injury, or property damages arising from or connected with the licensee’s activities. Such indemnification shall not apply to claims for damages arising from acts or omissions of other contractors, its subcontractors, its agents, officers, and employees. (Ord. 88-0181 § 23, 1988: Ord. 83-0017 § 3 (part), 1983: Ord. 11806 § 1 (part), 1978: Ord. 5860 Ch. 4 § 1011, 1951.)

The director of the department of health services or his or her duly authorized designee shall not grant or issue an ambulance vehicle license for any ground ambulance which at the time of application is more than eight years old as defined by the initial date the vehicle was first put into service, provided that the date is not greater than one year from the date of its manufacture.
However, the director of the department of health services or his or her duly authorized designee may make individual exceptions to the eight-year-old age limitation where the public convenience and necessity would be served, provided that the vehicle meets all other inspection requirements for licensure. (Ord. 2011-0031 § 22, 2011: Ord. 96-0067 § 15, 1996: Ord. 88-0181 § 25, 1988: Ord. 83-0017 § 3 (part), 1983: Ord. 11806 § 1 (part), 1978: Ord. 5860 Ch. 4 § 1014, 1951.)

A. Ground ambulance design, equipment, and ancillary equipment shall meet Department of Transportation, California Vehicle Code, CHP, and other local equipment and feature specifications.
B. The patient compartment of a ground ambulance shall at a minimum, have:
1. An interior height from floor to ceiling of not less than 60 inches;
2. A distance of not less than twelve (12) inches from the base of the squad bench to the frame of the cot;
3. A distance of not less than twelve (12) inches from the cot to the rear door (measured at floor level);
4. A distance of not less than twelve (12) inches from the face of the attendant seat to the cot;
5. Interior patient length (measured at floor level) of not less than one hundred thirteen (113) inches from the patient compartment partition to the rear door; and
6. A rear loading doorway vertical clearance of not less than 46 inches.
C. EMS Aircraft design, equipment, and ancillary equipment shall meet Federal Aviation Administration and local EMS agency equipment and feature specifications.
D. Interior storage configuration shall be at the operator's discretion.
E. Provided, however, that the director of the department of health services or his or her designee may make individual exceptions to these limitations if a waiver is requested. Granting of a request for waiver would be based on a finding that public convenience and safety requires issuance of the ambulance vehicle license. (Ord. 2011-0031 § 23, 2011: Ord. 96-0067 § 16, 1996.)

The director of the department of health services shall not issue any ambulance license for a ground ambulance until it has verified with the California Highway Patrol that the ambulance has been inspected and that it complies with all of the safety regulations of the State Department of Motor Vehicles and of the California Highway Patrol. The director of the department of health services shall be further assured that the ambulance meets all pertinent requirements imposed by this title before issuing a license for the vehicle. (Ord. 2011-0031 § 24, 2011: Ord. 88-0181 § 26, 1988: Ord. 83-0017 § 3 (part), 1983: Ord. 11806 § 1 (part), 1978: Ord. 5860 Ch. 4 § 1015, 1951.)

The director of the department of health services or his/her designee(s) shall have the right, at any time, to conduct vehicular inspections of any and all ambulances operated by any licensed ambulance operator to determine whether proper and sufficient medical equipment and medical supplies exist for the level of emergency care provided by the licensed ambulance operator. (Ord. 88-0181 § 27, 1988.)

A. Every ambulance operator making any charges based on mileage shall have the odometer of each ambulance tested and certified annually by the department of agricultural commissioner/weights and measures in accordance with the procedures of that department as defined in county code Chapter 2.40. In the event that the department of agricultural commissioner/weights and measures does not have the testing equipment available at the time an operator applies for a new or replacement vehicle license, operator shall register the vehicle with the department of agricultural commissioner/weights and measures and may obtain a temporary operating authorization from the local EMS agency pending testing by that department. The operator must, however, provide the local EMS agency with a copy of the device registration certificate issued for that vehicle and a certificate of accuracy from a state certified testing agency. Final license approval will be held pending testing and certification by the department of agricultural commissioner/weights and measures. For renewal licenses, the operator shall have the odometer tested by the department of agricultural commissioner/weights and measures. A copy of the current paid device registration certificate shall be submitted at the time of license renewal.
B. Ambulance operators licensed by the county, whose primary location is outside of Los Angeles County, must comply with the odometer testing requirements of the county of origin, and must provide the local EMS Agency with a current copy of that county's certification at time of application for a new ambulance vehicle license, replacement vehicle status or ambulance license renewal. If the county of origin does not require odometer testing by county, the ambulance operator shall provide a copy of certificate from a state certified agency documenting the accuracy of each vehicle odometer.
C. EMS aircraft-only operators are exempt from the odometer testing requirement. (Ord. 2011-0031 § 25, 2011: Ord. 96-0067 § 17, 1996: Ord. 88-0181 § 29, 1988: Ord. 83-0017 § 3 (part), 1983: Ord. 11806 § 1 (part), 1978: Ord. 5860 Ch. 4 § 1018, 1951.)

A. A ground ambulance operator shall charge no more than the following rates for one patient:

B. This section does not apply to a contract between the ambulance operator and the county where different rates or payment mechanisms are specified. (Ord. 2011-0031 § 26, 2011: Ord. 2003-0058 § 3, 2003: Ord. 94-0038 § 1, 1994: Ord. 91-0071 § 2, 1991: Ord. 90-0088 § 1, 1990: Ord. 89-0092 § 2, 1989: Ord. 88-0170 § 1, 1988: Ord. 87-0131U § 1, 1987: Ord. 86-0111 § 1, 1986: Ord. 85-0171 § 1, 1985: Ord. 85-0120U § 1, 1985: Ord. 83-0201 § 3, 1983: Ord. 83-0017 § 3 (part), 1983: Ord. 82-0105 § 1, 1982: Ord. 12077 § 1 (part), 1980: Ord. 11993 § 1, 1979; Ord. 11806 § 1 (part), 1978: Ord. 5860 Ch. 4 § 1008, 1951.)

A. For multiple loads from the same point of origin to the same destination, a ground ambulance operator shall charge one-half of the base rate and one-half of the mileage rate for each additional patient. The total charges shall then be divided equally among the patients.
B. For multiple loads with either different points of origin or destinations, a ground ambulance operator shall charge one-half the base rate and one-half the mileage rate for each additional patient. The total charges shall be computed and proportionately prorated among the patients.
C. This section does not apply to a contract between a ground ambulance operator and the county where different rates or payment mechanisms are specified. (Ord. 2011-0031 § 27, 2011: Ord. 88-0170 § 2, 1988: Ord. 83-0017 § 3 (part), 1983: Ord. 11806 § 1 (part), 1978: Ord. 5860 Ch. 4 § 1009, 1951.)

*A. A ground ambulance operator shall charge no more than the following rates for special ancillary services:

B. Where other special services are requested or needed by any patient or authorized representative thereof, a reasonable charge commensurate with the cost of furnishing such special service may be made, provided that the ambulance operator shall file with the director of the department of health services a schedule of each special service proposed and the charge therefore, which charge shall be effective unless modified, restricted, or denied by the director of the department of health services. Special services are defined as services provided to a patient that are unique and individual to a specific patient’s needs, and are performed on a limited basis.
C. Charges for special services provided to patients that are new services, but will become an industry standard, must be reviewed and a rate commensurate with the service developed prior to ambulance operators charging such rate to the general public. Such rates shall not be charged to patients until approved by the board of supervisors.
D. This section does not apply to a contract between an ambulance operator and the county where different rates or payment mechanisms are specified. (Ord. 2011-0031 § 28, 2011: Ord. 2003-0058 § 4, 2003: Ord. 96-0067 § 18, 1996: Ord. 94-0038 § 2, 1994: Ord. 91-0071 § 3, 1991: Ord. 90-0088 § 2, 1990: Ord. 89-0092 § 3, 1989: Ord. 88-0181 § 33, 1988; Ord. 88-0170 § 3, 1988: Ord. 87-0131U § 2, 1987: Ord. 86-0111 § 2, 1986: Ord. 85-0120U § 2, 1985: Ord. 83-0201 § 4, 1983: Ord. 83-0017 § 3 (part), 1983: Ord. 82-0105 § 3, 1982: Ord. 12077 § 1 (part), 1980: Ord. 11806 § 1 (part), 1978: Ord. 5860 Ch. 4 § 1010, 1951.)

The total charges shall be the sum of the appropriate base rate plus the mileage rate applied to the distance actually traveled, plus the time rate applied to requested waiting or standby time, plus any special charges which apply. Ground ambulance operators who choose to use computer-based mileage calculations to provide consistency in mileage billing in lieu of the distance recorded by the ambulance vehicle driver, shall request authorization from the local EMS agency prior to implementation of such a program. As part of the authorization process, the operator shall provide the local EMS agency with a quality assurance program that details the operator's plan for periodic reviews of both the computer mileage assisted calculations and the data entry process to insure that the patient is not overcharged. The local EMS agency will approve or reject use of a computer-based mileage calculation program within 30 days of receipt of a request for approval. All rates, including computer-based mileage charges, are to be computed from the time the ground ambulance arrives for hire until the ground ambulance is discharged by the patient or his or her authorized representative. (Ord. 2011-0031 § 29, 2011: Ord. 96-0067 § 20, 1996: Ord. 83-0017 § 3 (part), 1983: Ord. 11806 § 1 (part), 1978: Ord. 5860 Ch. 4 § 1025, 1951.)

The maximum rates chargeable to the general public as set forth in Sections 7.16.280 and 7.16.310 of this chapter shall be adjusted effective July 1, 1992, and on July 1st of each year thereafter, to reflect changes in the value of the dollar. For each of the one year periods respectively beginning July 1, 1992 and July 1, 1993 such adjustments shall be made by multiplying the base amounts by the percentage change in the transportation portion of the Consumer Price Index for All Urban Consumers, Western Region, as compiled and reported by the Bureau of Labor Statistics for the 12-month period ending with the last day of the prior month of February. Beginning July 1, 1994, and on each July 1 thereafter, such adjustments shall be determined by multiplying the base amounts by the average of the percentage changes of the transportation portion and of the medical portion of the Consumer Price Index for All Urban Consumers, Western Region, as compiled and reported by the Bureau of Labor Statistics for the 12-month period ending with the last day of the prior month of February. The result so determined shall be rounded to the nearest $0.25 and added or subtracted, as appropriate, to the rate. The director of the department of health services shall initiate implementation of these rate changes by notifying in writing each licensed private ambulance operator in Los Angeles County thereof, and any other individual or agency requesting such notification from the director. Such notice shall be sent by first class mail no later than June 15 of the prior period. (Ord. 94-0038 § 3, 1994: Ord. 91-0071 § 4, 1991: Ord. 88-0170 § 4, 1988: Ord. 83-0017 § (part), 1983: Ord. 11806 § 1 (part), 1978: Ord. 5860 Ch. 4 § 1017, 1951.)

The maximum base rates for ALS and BLS services, as reflected in Section 7.16.280, shall be reviewed in accordance with the following procedures, and adjusted, if appropriate, effective first on January 1, 2005 and later, also if appropriate, on January 1 of every other year thereafter.
On or about July 1 of the year prior to the January 1 adjustment date, the director of the department of health services shall review the ALS and BLS ambulance rates of all other counties in California to determine the average rates for these services in effect for these counties as of the review date. If the Los Angeles County rates are equal to or above average, no adjustment to the Los Angeles County Code rates will be made under this provision. If one or both of the Los Angeles County rates are less than the average, then an appropriate adjustment to the rate or rates shall be made to bring it (them) to the average. Any required adjustment shall be rounded to the nearest $0.25.
The director of the department of health services shall initiate implementation of these rate adjustments by notifying in writing each licensed private ambulance operator in Los Angeles County thereof, and any other individual or agency who has requested such notification from the director. Such notice shall be sent by first class mail no later than December 15 of the prior rate period.
Nothing herein is intended to prevent licensed ambulance operators from demonstrating that ALS and BLS rates in Los Angeles County fail to provide operators with a reasonable rate of return on their investment. A licensed operator at any time may submit to the director of the department of health services its cost and revenue data, and other pertinent documentation which the director may require for this purpose.
If this information evidences to the director’s satisfaction that the ALS rate or BLS rate, or both, fail to provide the operator with a reasonable rate of return, the director shall propose a different base rate structure to the board of supervisors for consideration. (Ord. 2003-0058 § 5, 2003.)

Licensed ground ambulance operators shall meet in 90 percent or more of all ambulance runs during any calendar month the maximum response times defined in Section 7.16.050 of this chapter. The director of the department of health services may waive in writing one or more of these response time requirements for any operator for a prescribed period. In determining whether to grant any such waiver, the director must find that one or more of the following geographical or other special or unusual conditions for the area for which the waiver is sought prevented the operator from satisfying the response time requirement(s):
A. Physical isolation of the area;
B. Topographical conditions;
C. Road conditions;
D. Adverse weather conditions.
E. Multiple Casualty Response when at least one (1) other unit has previously been dispatched and arrived within the required response time to the same incident. (Ord. 2011-0031 § 30, 2011: Ord. 88-0181 § 34, 1988.)