City of Houston Ordinance

City of Houston, Texas, Ordinance No. 2004-

AN ORDINANCE AMENDING CHAPTERS 1 AND 4 OF THE CODE OF ORDINANCES, HOUSTON, TEXAS, RELATING TO THE PROVISION OF AMBULANCE SERVICE IN THE CITY; CONTAINING FINDINGS AND OTHER PROVISIONS RELATING TO THE FOREGOING SUBJECT; PROVIDING FOR SEVERABILITY; DECLARING CERTAIN CONDUCT TO BE UNLAWFUL AND PROVIDING PENALTIES AND DECLARING AN EMERGENCY.

* * * *

WHEREAS, the City Council finds that the rendition of Emergency Medical

response and transportation services are a critical need of the residents of the City;

and

WHEREAS, the staffing and equipment used for Emergency Medical

Services are subject to state regulation, but state law expressly allows a municipality

To adopt stricter standards than those imposed by state law; and

WHEREAS, the City Council finds that the City should take an active part

In the regulation of Emergency Medical Services in order to enhance the health,

Safety and welfare of its inhabitants; NOW, THEREFORE, BE IT ORDAINED BY THE CITY COUNCIL OF THE CITY OF HOUSTON, TEXAS:

Section 1. That the findings contained in the preamble of this Ordinance are

Determined to be true and correct and are hereby adopted.

Section 2. That Chapter 4 of the Code of Ordinances, Houston, Texas, is hereby

Amended to read as follows:

Chapter 4

AMBULANCES

ARTICLE I. IN GENERAL

Sec. 4-1. Definitions.

As used in this chapter, the following words and terms shall have the meanings ascribed in this section, unless the context of their usage clearly indicates another meaning:

Ambulance means a ground motor vehicle used, designed or redesigned, and equipped for the primary purpose of the transportation of sick or injured persons that require medical care, observation, or treatment, whether functioning at a basic life support, advanced life support or mobile intensive care unit service level as provided by state law and this chapter. The term does not include an ambulance that is owned by the state or federal government or an agency or subdivision thereof and operated by its employees.

Committee means the Emergency Medical Services Advisory Committee created under article II of this chapter.

Department means the department of Health and Human Services.

Director means the director of the department or the director’s designee.

Emergency medical services (EMS) means services used to respond to an individual’s perceived need for immediate medical care and to prevent death or aggravation of physiological or psychological illness or injury.

Sec. 4-2. Cumulative effect

This chapter is cumulative of applicable state laws and regulations. This chapter establishes standards for the staffing and equipping of ambulances that are stricter in many respects than those provided by applicable state laws and regulations. To the extent of any difference in the standards for staffing and equipping an ambulance between this chapter and state standards, then the more restrictive shall apply.

Sec. 4-3. Alternative equipment and materials

(a) The provisions of this chapter with respect to the design, construction and equipping of ambulances are intended to set a standard for the protection of the health, safety, and welfare of the public. However, it is not the intent of this chapter to prevent the use of any alternative vehicle, equipment or supply item that is approved in writing by the director. The director shall approve an alternative upon the written request of any person and demonstration by that person that the alternative is at least equivalent to that specified in this chapter in suitability, durability, safety, and sanitation and that its use as intended is not prohibited by applicable state of federal laws or regulations. The expense of any tests required to establish the suitability of an alternative shall be borne by the person requesting its use. In the event that the request is denied, the director shall provide notice of the grounds in writing.

(b) For convenience, this chapter adopts certain nationally recognized standards and certifications of the Society of Automotive Engineers, Inc., Ambulance Manufacturers Division of the National Truck Equipment Association, Underwriters’ Laboratory, and National Institute for Automotive Service Excellence. Their adoption is not intended to be exclusive. Nothing herein shall be construed to preclude acceptance of standards and certifications of other societies, agencies, and laboratories upon demonstration of their equivalency to the director.

Sec. 4-4. Hearing

Any interested person who is aggrieved by a decision made by health officer or the under this chapter, for which decision an appeal is not otherwise provided in this chapter or in section 1-9 of this Code, may request a hearing by filing a request for the hearing in the office of the director within ten days of the person’s receipt of notice of the decision upon which the hearing is requested. The hearing shall be conducted informally by an impartial hearing official under rules promulgated by the director. The director shall cause the hearing to be conducted and a decision to be made within fifteen days from the date of receipt of the request, unless the appellant requests an extension of time in writing.

Sec. 4-5. Penalty.

When in this chapter, an act is prohibited or made or declared to be unlawful or an offense or whenever the doing of any act is required or the failure to do anything is prohibited or declared unlawful and no, specific penalty is provided, the violation of the provision shall be punishable by a fine not exceeding $2,000. Provided, any conduct

that also constitutes a violation of state law shall be punishable as provided in the applicable state law. Each day that any violation of this chapter continues shall be punishable as a separate violation.

Sec. 4-6—4-10. Reserved.

ARTICLE II. EMERGENCY MEDICAL SERVICE

ADVISORY COMMITTEE

Sec. 4-11. Committee created.

There is hereby created an emergency medical services advisory committee.

The committee is intended to represent diverse groups of the emergency medical services providers and community health care facilities.

Sec.4-12. Membership.

(a) The committee consists of seven members. The seven positions shall be filled as follows:

(1) Position number one shall be filled by the city’s emergency medical services medical director.

(2) Position number two shall be filled by a person recommended to the mayor by the Harris County Medical Society.

(3) Position number three shall be filled by a person recommended to the mayor who is appointed by the Greater Houston EMS Council.

(4) Position number four shall be filled by the fire chief or his designee from the Houston Fire Department EMS Division.

(5) Position number five shall be filled by the police chief or his designee from the Houston Police Department .

(6) Position number six shall be filled by a person recommended to the mayor by the city council who represents the citizens of the city and the potential consumers of ambulance services.

(7) Position number seven shall be filled by a designee from the Houston Emergency Communications Center.

(b) The members in positions two and six shall be appointed by the mayor. Each of those members shall serve for two-year term to commence on January 1 of each even-numbered year and end on December 31 of the following odd-numbered year. A vacancy shall be filled for the unexpired term. The members in positions one, four, and six shall serve as standing members. Any member who is unable to attend a meeting may give written notice to the secretary and designate an alternative who shall serve in his place at the meeting. The member in position four shall serve ex officio and thus represents a non-voting member.

Sec. 4-13. Organization.

(a) The member in position four shall serve as the chair at the first meeting of each calendar year. At its first meeting of each calendar year the committee shall elect a chair, vice chair, and secretary.

(b) The committee may establish rules of procedure.

(c) A quorum of the committee is four persons and a majority of the voting members present constituting a quorum may decide any matter.

(d) The committee shall meet at least one time per calendar quarter at the call of the chair.

Sec. 4-14. Duties

(a) The committee shall act in an advisory capacity to the mayor and city council regarding:

(1) Minimum requirements for the provision of emergency medical services within the city;

(2) Professional performance standards for the training of emergency medical service providers, the design and equipping of ambulances, and the issuance of protocols and procedures for the provision of emergency medical services;

(3) Any revisions to this chapter that may be suggested regarding current ambulance provider licensing processes.

(b) The committee shall perform any other advisory functions that may be assigned by the mayor, the city councilor the director.

Sec. 4-15—4-20. Reserved.

ARTICLE III. CITY AMBULANCE SERVICES.

Sec. 4-21. Definitions.

As used in this article, the following words and terms shall have the meanings ascribed in this section, unless the context of their usage clearly indicates another meaning:

Direct call. A request for ambulance service made by telephone or other means directly to an ambulance service provider, his agents or employees.

Emergency circumstances. The existence of circumstances in which the element of time in expeditiously transporting a sick or injured person and in which rescue operations or competent out-of-hospital care, or both, at the place of emergency may be essential to the health or life of the person.

Emergency ambulance service. A trip made by an ambulance under emergency circumstances to the place of emergency, performance of any necessary rescue operations, rendering of any necessary out-of-hospital care, and, if required, a trip to the hospital or other place for medical attention. An ambulance shall be considered to be rendering emergency ambulance service when it is responding to a call for emergency assistance even though, upon arrival at the place of emergency, it is found that the call was falsely made or that no further emergency ambulance assistance is required or when it is responding to a call for routine ambulance service and during such trip emergency circumstances develop.

Sec. 4-22 Provision of emergency ambulance service.

(a) The operation of ambulances on the streets of the city for the furnishing of emergency ambulance service is hereby declared to be a governmental function of the city to be performed by the fire department in accordance with the terms of this article. It shall be unlawful for any person, other than a member of the fire department while driving emergency vehicles operated by the fire department, to furnish or to attempt to furnish emergency ambulance service or to operate or drive or cause to be operated or driven any ambulance on the streets of the city for the purpose of furnishing emergency ambulance service.

(b) The provisions of subsection (a) of this section are applicable only to emergency ambulance service, and nothing therein shall be construed to prohibit any person who operates an ambulance in compliance with state laws and regulations and the applicable provisions of this chapter from providing ambulance service under other than emergency circumstances, provided that the driver of the ambulance complies with all applicable traffic laws.

Sec. 4-23. Defenses.

It is an affirmative defense to prosecution under section 4-22 of this Code that any of the circumstances enumerated in items (1) through (8), below, existed and that the report required by subsection (b) of this section was timely filed, if applicable.

(1) The ambulance service provider upon receiving a direct call for emergency assistance within the city limits advised the fire department dispatcher of the pertinent details of the call, including the estimated time of arrival of the provider’s nearest appropriate ambulance and the respective medical capabilities of involved personnel and equipment.

(2) Ambulance service providers who respond to a direct call from service from a hospital, an acute care healthcare facility, or healthcare agency must notify the fire department dispatcher of the request. The ambulance service will include in the notification the nature of their response and the specialized service required or requested by the hospital, healthcare facility, or agency. This paragraph does not apply to nursing facilities or outpatient clinics unless a specific, specialized treatment or procedure is to be administered beyond the capabilities of the fire department.

(3) While operating the ambulance under other than emergency circumstances, the ambulance service provider’s personnel, in accordance with their training, medical protocols and operational policies, may determine that the medical condition of the patient was such that the patient required transportation with all practical speed for definitive medical attention and treatment at a medical facility appropriate to the patient’s needs.

(4) The emergency ambulance service was provided by an ambulance based outside the city when not in use and operated by an established place of business with a permanent address outside the city, provided:

a. The sick or injured person was picked up outside the corporate limits of the city; and

b. The ambulance performing the emergency ambulance service was, at the time, duly licensed and operated in accordance with applicable state laws and regulations; and

c. The driver of the ambulance complied with all speed and other traffic regulations of the city and the state.

(5) The emergency ambulance service was provided to a location outside of city limits but required the ambulance to pass through a portion of the city under emergency circumstances to either respond to the scene of the medical emergency or transport a patient with all practical speed to an appropriate medical facility for definitive treatment, provided:

a. The ambulance performing the emergency service was, at the time, duly licensed and operated in accordance with applicable state laws and regulations; and

b. The driver of the ambulance complied with all speed and other traffic regulations of the city and the state.

(6) The ambulance was stationed under contract of maintaining an ambulance at a particular location or event for the purpose of transporting sick or injured persons for medical or hospital treatment, and the ambulance service provider’s personnel determined that a sick or injured person at that location or event required immediate hospital or medical attention, provided:

a. The ambulance performing the emergency service was, at the time, duly licensed and operated in accordance with applicable state laws and regulations; and

b. The driver of the ambulance complied with all speed and other traffic regulations of the city and state.

(7) The emergency ambulance service was provided in accordance with the terms of an official mutual- aid contract or other written agreement with the city.

(8) The emergency ambulance service was provided at the direct request of the fire department dispatcher (i) because of the unavailability of a city ambulance to promptly respond, (ii) because of the existence of a large scale emergency, or (iii) because of a need to safeguard the continued availability of city ambulances for other emergencies where no medical assistance was the time being provided to the victim.

Sec. 4-24. Duties of private responder.

(a) It shall be unlawful for any private ambulance service provider who is given authorization by the fire department dispatcher to make a response or who accepts a call from the fire alarm dispatcher under the circumstances described in item (1) or (8) of subsection (a) of section 4-23 of this code then to fail or refuse to respond to the scene of the emergency, to refuse to render aid within the provider’s lawful capabilities or to refuse to transport the patient because of inability of the patient or other person responsible for the patient to provide advance payment or evidence of health insurance or other security for payment.

(b) It shall be unlawful for any person to provide false or misleading information to the fire department dispatcher or the health officer in any request or report made under section 4-23 of this code.

Sec. 4-25. Charges for city service.

(a) In order to partially defray the costs incurred by the city in providing ambulance service, the following fees are hereby established to be collected for the provision of emergency ambulance service by the city:

(1) A base fee of $365, plus the variable fees established in subsection (c), below, payable by the hospital from which the transportation originates, for the transportation of a person from one hospital to another hospital (inter-hospital transfer); and

(2) A base fee of $265, plus the variable fees established in subsection (c), below, payable by or on behalf of the person served, for the transportation of a person other than from on hospital to another hospital.

(b) The fee specified in subsection (a) for an inter-hospital transfer shall apply in each instance in which a person is transported from one hospital to another hospital. The fee for an inter-hospital transfer shall in each instance be payable by the hospital from which the transportation of the person originates, and the transportation of the person shall not commence until and unless:

(1) The physician in charge of the care of the person or another qualified medical person acting under proper authority of the hospital furnishes a written statement that the person’s condition is suitable for safe transportation, by ground ambulance to the intended destination hospital; and

(2) If requested to do so by the fire department personnel, the hospital furnishes a physician or other trained and qualified medical staff member to accompany them for the transport.

(3) The administrator of the hospital or another responsible person signs a statement promising on behalf of the hospital to pay for the transportation of the person and furnishes the necessary billing information.

The requirements specified above shall not be construed to authorize any unlawful inter-hospital transfer. Each inter-hospital transfer shall be subject to all applicable state and federal laws and regulations. To the extent that any applicable state or federal law or regulation prohibits the transfer or imposes more restrictive requirements for documentation or patient care, then the state or federal requirements shall control.

(c) In addition to the base fees imposed under subsection (a), above, the following variable fees shall be imposed, as applicable:

(1) For use of oxygen (any quantity)…… $55.60

(2) For use of an oxygen mask or a nasal canula, or both.....$12.60

(3) For use of an ECG (tracing only)….. $30.00

(4) For use of ECG electrode(s) (any quantity)….. $16.89

(5) For IV start equipment any quantity….. $6.00

(6) For IV administration set(s) (any quantity)…. $20.00

(7) For crystalloid solutions (any quantity)….. $15.15

(8) For D5W (any quantity)….. $6.60

(9) For miscellaneous medical supplies (any amount, type, or quantity….. $12.50

(10) For mileage (from pickup point to hospital), per mile or any portion of a mile……. $7.50

In lieu of actual computed miles, the fire chief may authorize the use of a zoned system or other procedure, provided that the mileage charged does not exceed the actual mileage.

(d) The fire department shall submit to the finance and administration director a record of each instance in which emergency ambulance service is provided. The finance and administration director shall be responsible for the billing and collection of the applicable fees. Except for the conditions expressly provided above in the instance of the transportation of a patient from one hospital to another hospital, no provision in this section shall be construed to authorize the fire department, under any circumstances, to refuse emergency ambulance service to any person upon the grounds that the person is indigent or unable to pay for the service.

Sec. 4-26. Uncollectible transport account.

There is herby created a list of ambulance accounts to be entitled ‘uncollectible transports.’ The finance and administration director shall have the power to place ambulance bills on the uncollectible transports list if he determines such ambulance bills to be uncollectible.

An ‘uncollectible transport’ shall be defined as any of the following:

(1) Emergency ambulance service provided a patient whose name or address, or both, is unknown, or for whom there is otherwise insufficient information to locate the patient, or a patient who is a minor and whose parents or next of kin are unknown, or for whom there is otherwise insufficient information to locate the parents or next of kin.

(2) Emergency ambulance service provided to a patient who is in the custody of a police officer of the city.

(3) Emergency ambulance service provided at least six months previously and upon which a diligent collection effort has been made.

Sec. 4-27-4-30. Reserved.

Article IV. Out-Of-Hospital/Emergency Medical Services

Division 1. General

Secs. 4-31. Definitions.

As used in this article, the following words and terms shall have the meanings ascribed in this section, unless the context of their usage clearly indicates another meaning:

Administrator means the natural person who is principally responsible for the day-to-day management of an ambulance service providers’ operations within the city.

Advanced life support means emergency out-of-hospital of interfacility care that uses invasive medical acts.

Advanced life support unit means an ambulance that is designed and intended for transportation of the sick or injured, meets the requirements of both a basic life support vehicle and advanced life support vehicle, and has sufficient equipment and supplies for providing intravenous therapy and endotracheal intubation.

Ambulance attendant means a person other than the driver who staffs an ambulance and whose primary responsibility is the provision of care to the patient.

Ambulance attendant’s permit means a current and valid ambulance attendant’s permit issued under division 4 of this article.

Ambulance decal means a current and valid decal affixed to an if ambulance by the health officer to verify that the ambulance has been inspected and certified for use under division 2 of this article.

Ambulance driver means the person who drives an ambulance on the streets and highways in addition to assisting with patient care while at scene of a medical incident.

Ambulance driver’s permit means a current and valid ambulance driver’s permit issued under division 4 of this article.

Ambulance service provider means a person who owns or operates or causes to be operated one or more ambulances within the city. The term includes the proprietor if a proprietorship, all partners if a partnership and each corporate officer, each corporate director and each person who owns ten percent or more of the outstanding shares of stock if a for-profit corporation.

Ambulance service provider’s permit means a current and valid permit issued under division 3 of this article.

Basic life support means emergency out-of-hospital or inter-facility care that uses non-invasive medical acts.

Basic life support unit means an ambulance that is designed and intended for transporting the sick or injured and that has sufficient equipment and supplies for providing basic life support and two-way communication.

Emergency medical technician means and individual who is currently certified as such by the Texas Department of Health.

Emergency medical technician-intermediate means an individual who is currently certified as such by the Texas Department of Health.

Emergency medical technician-paramedic means an individual who is currently certified or licensed as such by the Texas Department of Health.

In service means that an ambulance is being operated en route to pick up a patient, is attending a patient at the scene of an emergency or is carrying a patient to a medical facility.

Specialized unit means ground transport vehicle that is designed, stocked, and staffed as determined by the type and application of the vehicle and approved by the medical director to meet the needs of special situations or special needs of the patient.

Medical director means a physician licensed as such in Texas who supervises the medical care and medically related aspects of services rendered by emergency medical service or ambulance personnel under the terms of the Medical Practice Act. (Tex.Rev.Civ.Stat.art.4495b)

Mobile intensive care unit means an ambulance that is designed and intended for transportation of the sick or injured, meets the requirements of an advanced life support vehicle and has sufficient equipment and supplies to provide cardiac monitoring, defibrillation, cardio version, and drug therapy.

Person or personal means an individual, corporation, organization, government, governmental subdivision or agency, business, trust, partnership, association, or any other legal entity.

Secs. 4-32. General requirements.

(a) It shall be unlawful for any person to own or operate or cause to be operated any ambulance service unless they hold an ambulance service provider’s permit.

(b) It shall be unlawful for any person who does not have in his possession an ambulance driver’s permit to drive an ambulance.

(c) It shall be unlawful for any person to drive or operate or cause to be driven or operated any ambulance that does not have an ambulance decal properly affixed.

(d) It shall be unlawful for any person to drive or operate or cause to be driven or operated any ambulance that does not meet the applicable vehicle and equipment regulations established in sections 4-41, 4-42, and 4-43 of this code.

(e) It shall be unlawful for any person who does not hold and then have in his possession an ambulance attendant’s permit to function as an ambulance attendant within the city.

(f) It shall be unlawful for any ambulance service provider to suffer or permit the operation or use of any ambulance in violation of any of subsections (a) through (e), above.

(g) It is a defense to prosecution under this chapter that the ambulance was being operated in compliance with applicable state laws and regulations and was providing service to a patient who was picked up at a place not situated within the city at the time of the alleged offense. It is an affirmative defense to prosecution under this section that the ambulance was not in service at the time of the alleged offense.

Sec. 4-33. Transportation

No person shall cause or allow any patient to be transported in an ambulance other than while secured to the ambulance’s wheeled litter or secured to the squad bench of the ambulance. It is an affirmative defense to prosecution under this section that an extreme emergency existed that justified the transportation in another manner or that the patient’s size medical condition required alternative procedures.

Sec. 4-34. Sirens; lights; speed; etc.

(a) The use of emergency lights and sirens by ambulances within the city is unlawful unless while in service and providing emergency services under circumstances for which the use of flashing lights and sirens is authorized under state laws and this code. Where emergency operation is authorized, both lights and sirens shall be used simultaneously in order to provide both audible and visual warnings to pedestrian and vehicular traffic.

(b) Ambulances shall at all times be operated in full compliance with state and city traffic laws. Without limitation of the foregoing, each ambulance shall comply with traffic control devices and posted speed limits expect where authorized to operate in disobeyance, thereof by state laws and this code.

Sec. 4-35. Representation.

An ambulance service provider shall not advertise or represent that it provides any health care service(s) other than those it is permitted to provide. The words ‘paramedic,’ ‘mobile intensive care,’ ‘intensive care,’ ‘coronary care,’ ‘acute care,’ or ‘special care,’ or abbreviations of such words, shall only appear in advertisements when the provider is permitted to operate mobile intensive care units. The words ‘advanced life support,’ ‘advanced,’ ‘advanced care,’ ‘intermediate life support,’ ‘intermediate,’ or ‘intermediate care,’ or abbreviations of such words, shall only appear in advertisements when the provider is permitted to operate advanced life support vehicles or mobile intensive care units. All advertisements shall include the name under which provider is permitted by the city.

Sec. 4-36. Medical director

Each ambulance service provider shall at all times retain the services of a medical director who shall supervise and control the rendition of medical services rendered by the provider’s ambulances and personnel. The medical director shall be actively involved in emergency management of acutely ill or injured patients.

Secs. 4-37—4-40 Reserved.

DIVISION 2. VEHICLES, EQUIPMENT, INSPECTION, DECALS.

Sec. 4-41. Vehicle requirements.

The following requirements shall pertain to ambulances:

(1) Each ambulance shall comply with all applicable regulations, licensing and inspection requirements of state law and regulations, and proof thereof shall be maintained on the vehicle for inspection by any police officer or the health office.

(2) Each ambulance shall be free from structural defects and shall have no serious impairment of any safety function resulting from an accident or otherwise

(3) Each ambulance shall be covered by a public liability insurance policy meeting all requirements of chapter 601 of the Texas Transportation Code and having policy limits of not less than $1,000,000 combined single limit coverage because of bodily injury to or death of one or more persons and injury to or destruction of property of others in any one accident. The policy may not contain passenger liability exclusion. The foregoing policies must be written by a carrier that holds a valid certificate of authority from the state of Texas for the type of policy issued. Additionally, each policy must list the City of Houston as the certificate holder and contain an endorsement requiring 30 days’ written notice of termination or cancellation to the health officer. Proof of the required insurance policies shall be maintained in the vehicle for inspection by any police officer or the health officer.

(4) All ambulances must be adequately constructed, equipped, maintained, and operated to render patient care, comfort and transportation safely and efficiently. Ambulances must allow the proper and safe storage and use of all required equipment, supplies and medications and must allow all required procedures to be carried out in a safe and effective manner. Unless otherwise approved by the Texas Department of Health, Bureau of Emergency Management, ground vehicles must conform to one of the body types generally recognized as Type I, II, or III as specified by the General Services Administration KKK-A-1822 Specifications for Ambulances. Each ambulance shall meet the following standards:

a. There shall be no exhaust system defects, including leaking or loose joints, holes, split seams or patches, pinched components or damaged components. The ambulance’s exhaust system shall be maintained n accordance with Federal Motor Carrier Safety Regulations, Part 393 (49 C.F.R. 393.83). The exhaust shall discharge beyond the side(s) of the vehicle, away from the fuel tank filler pipe(s) and away from door(s) in order to minimize the amount of carbon monoxide and other toxic gases and fumes that could enter the vehicle. The vehicle’s exterior, doors, windows, and related seals shall be in good condition in order to limit the entrance of carbon monoxide and other toxic gases, fumes, and contaminants into the vehicle.

b. All emergency lighting and siren apparatus shall be in good operating condition. Warning lights shall provide 360 degree visibility an shall be installed in accordance with Society of Automotive Engineers, Inc., Standard J595 or comparable standards and shall function at levels defined as acceptable by the equipment manufacturer.

c. Headlights (bright and dim settings), parking lights, tail lights, brake lights, turn signals, backing lights, four-way flashers, floodlights, and the spotlight(s) shall be in good operating condition. Horn, windshield wipers, rear-view mirrors, and back-up alarm shall all be fully functional. Rear loading lights shall be mounted above the rear loading doors and shall automatically activate when the rear doors are opened, Exterior floodlights shall be located on both sides of the exterior of the ambulance and shall function when independently switched on at the driver’s console.

d. The electrical system shall be capable of supporting all emergency lights, driving lights and interior lights, the climate control system, the on-board suction device, and the two-way radio when used simultaneously for ten minutes while standing idle without a detectable dimming of any lights,

e. While the ambulance is parked and the engine is running, the steering wheel shall have less than 2 inches of free play before moving the front wheels in the direction of the turn.

f. The exterior shall be sufficiently clean to enable easy recognition of markings unless otherwise obscured by currently inclement weather or travel required for a recent trip.

g. The motor vehicle chassis, body, and components shall be standard commercial products that comply with all Federal Motor Vehicle Safety Standards and federal regulations applicable or specified for the year of manufacture.

h. Tires shall comply with Federal Motor Vehicle Safety Standard No. 120 (49 C.F.R. 571.120) and be rated for not less than the gross vehicle weight rating of the ambulance.

i. The braking system shall be properly maintained. The brake pedal, when depressed, shall hold the vehicle in place. The emergency brake shall hold the vehicle in place when employed.

j. The vehicle shall have a functional climate control system to provide heat or air conditioning, upon demand, to the driver’s compartment and patient compartment of the vehicle. Within 20 minutes after initial engine start-up, the heater shall provide an inside temperature of between 68 and 72 degrees Fahrenheit when the ambient temperature is below 65 degrees Fahrenheit. Within 45 minutes after initial engine start-up, the air conditioner shall provide an inside temperature of between 68 and 72 degrees Fahrenheit when the ambient temperature is between 75 and 85 degrees Fahrenheit, or at least 13 degrees below the outside temperature when the ambient temperature is over 85 degrees Fahrenheit.

k. The interior of the ambulance shall have no protruding edges, a ceiling finished with a padded material or a flat, even surface (excluding grab rails) and a floor with a flat, even surface; all patient compartment surfaces shall be covered with stain-resistant material that is impervious to blood, vomitus, grease, oil, and common cleaning materials, and each item of equipment shall be stored while not in use in a closeable cabinet or safely secure to the vehicle so as not to become a projectile in the event of a collision.

l. All interior areas, including storage areas, shall be kept clean and sanitary. A disinfectant shall be used on all surfaces routinely, provided that the ambulance shall be disinfected immediately following the transportation of any patient known or suspected to have a communicable disease other than the common cold.

m. Interior patient compartment lights shall be in operating condition and function as the manufacturer intended.

n. All seats shall comply with Federal Motor Vehicle Safety Standard No. 207 (40 C.F.R. 571.207). Safety belts and restraints and anchorages for seats shall comply with Federal Motor Vehicle Safety Standards Nos. 208, 209 and 210 (49 C.F.R. 571.208, 571.209 571.210) A safety belt restraint shall be provided for each person transported in the vehicle.

o. When response-ready or in-service, EMS vehicles shall have operational two-way communication capable of contacting appropriate medical resources, and shall be in compliance with all applicable state and or federal laws.

(5) In addition, ambulances constructed on chassis manufactured for model year 1994 or later shall comply with the following specifications:

a. The ambulance shall be constructed by a reputable ambulance manufacturer that has been endorsed by a national standards program as being capable of performing appropriate and safe vehicle modifications.

b. The ambulance manufacturer shall certify in writing that the completed/modified ambulance’s center of gravity is within the parameter recommended by the chassis manufacturer or that independent test results from a qualified automotive testing laboratory on a similar type or model from the same ambulance manufacturer have demonstrated that the vehicle meets the chassis manufacturer’s recommended center or gravity parameters for ambulances.

c. The ambulance manufacturer shall certify in writing or provide written independent test results from a qualified laboratory showing that the completed ambulance complies with the following standards of the Ambulance Manufacturers Division of the National Truck Equipment Association: AMD Standard 003 for oxygen bottle retention system, AMD Standard 004 for patient litter retention system and AMD Standard 006 for patient compartment exterior sound resistance.

d. The vehicle shall have a patient compartment that is separated from the driver’s seating area or driver’s compartment by a bulkhead or partition that may include a passageway with a closable door. It is required that verbal communication between the two compartments is possible.

e. The patient compartment shall have two exterior doorways, each at least 28 inches wide and at least 44 inches high and capable of being opened and used from inside or outside of the vehicle. One doorway shall be at the rear of the vehicle and the other at the passenger side of the vehicle. There shall be a window in each door of the patient compartment.

f. The attendant(s) shall be provided space and seating within the patient compartment at the head of the required litter. The seating shall face rearward, and there shall be a squad bench along side of the required litter with three sets of seat belts and of sufficient width to accommodate a second patient in a reclined position.

g. The patient compartment shall be at least 122 inches long, from the forward partition to the inside edge of the rear loading doors, as measured at the floor. A minimum distance of 10 inches shall be provided from the end of the required litter’s mattress to the rear loading doors to permit clearance for traction or long board splints.

h. The patient compartment shall be of sufficient width to provide at least 12 inches of clear aisle walkway between the required litter and the base of the squad bench, with the litter in the driver side or center position.

i. The patient compartment shall be at least 60 inches in height, as measured over the patient area from the floor to the ceiling panels.

(6) Any ambulance greater than five years old or has exceeded 150,000 miles shall have been inspected within the preceding period of six months by a mechanic who is certified by the National Institute for Automotive Service Excellence, who shall attest that the vehicle is in safe operating condition. The inspection shall be performed based upon a written report format that shall be promulgated by the director. Without exclusion of the inspection of any other safety-related components that may be subjected to deterioration with age, the inspection shall specifically include verification of the following:

a. The vehicle’s front wheel bearings, king pins, ball joints, tie rods, and steering gear show no signs of looseness or fatigue when the wheels are moved up and down and side to side.

b. The vehicle’s fuel tanks and fuel lines present no signs of cracks, leakage or deterioration and are securely mounted, and the manufacturer’s heat shields are intact.

c. The vehicle’s braking system hydraulic lines and cables, suspension system components, and drive train components present no readily apparent signs of fatigue, excessive wear, or structural stress that may endanger safety.

d. The vehicle’s exhaust system presents no disfigurations or loose clamps, hangers, or damaged heat protection shields, nor is there any exhaust soot present at seams or connections.

For purposes of this requirement an ambulance shall be considered to be greater than five years of age on the thirty-first day of January of the fifth year following the chassis manufacturer’s model year of the vehicle chassis, regardless of the date it was actually manufactured, purchased, equipped, modified or placed into service. Proof of the inspection required in this item shall be carried in the ambulance and be made available for inspection upon request of any police officer or health officer.

Sec. 4-42 Marking.

Each ambulance that is operated by any ambulance service provider under an ambulance service provider’s permit shall have the ambulance service provider’s name conspicuously displayed on both sides of the vehicle in letters at least 3 inches tall with a brush stroke width of at least 5/16 inch in width. Additionally, each ambulance shall have a fleet identification number (as assigned by the ambulance provider) displayed on both front quarter panels and the rear in numbers at least 3 inches tall with a brush stroke width of at least 5/6 inch in width.

Sec. 4-43. Equipment; supplies.

(a) The provider shall submit an equipment and supply list which is approved by the medical director and which is consistent with, and fully supportive of, the protocols. The list shall specify an adequate variety of sizes and types and shall specify quantities appropriate to the provider’s call volume, transport times and restocking capabilities. The equipment and supply list must include all items required by Chapter 773 of the Texas Health and Safety Code and regulations adopted there under. The need to replenish equipment and supplies shall not require that the ambulance be taken temporarily out of service. During unannounced inspections consideration will be given to equipment and supply deficiencies caused by recent or repeated EMS calls. All equipment shall be kept clean and in good working order and shall include all supplemental items, accessories, and attachments, as required for its proper use.

(b) In any inspection of an ambulance for compliance with this section by the health officer, it shall be the duty of the ambulance attendant to locate and demonstrate the availability of required equipment and supply items and test certificates. If the attendant cannot locate or produce any item or certificate, then it shall be presumed that the item or certificate is not on board the ambulance.

Sec. 4-44. Inspection

(a) Each ambulance service provider shall submit each ambulance to be used for service within the city to the health officer for inspection at the commencement of the annual permit term. Any ambulance added to the permit as an additional or replacement unit and any ambulance for which a change in status is made as provided in sections 4-52 (c)(3) and (4) of this code shall be inspected prior to its being placed into service.

(b) The health officer shall inspect the ambulance for compliance with this article and shall install an ambulance decal upon the ambulance if it is determined to be in compliance. Inspections shall be conducted at such place within the city as may be specified by the director. If the vehicle is found not to comply, then the ambulance service provider shall be given a written notice of the deficiencies found. Each ambulance decal shall be dated to show its expiration and shall be made of tamperproof materials.

(c) The health officer shall conduct spot inspections of ambulances. These inspections shall be conducted at the ambulance service provider’s base of operations, at hospitals or other places where the ambulance may be inspected without interfering with its use or operation. If any deficiencies are noted, the health officer shall provide a written list to the ambulance driver and shall remove the ambulance decal. Unless the health officer finds that the ambulance lacks any equipment that is required under subsection (f) of section 4-43 of this code or that the nature of the deficiencies is otherwise of such magnitude that the continued use of the ambulance constitutes a substantial threat to the health, safety or welfare or the public, the health officer shall issue a temporary certificate that may be utilized to operate the ambulance in place of an ambulance decal for a period of forty-eight hours from the time of the inspection or until 5:00p.m. on the next regular city work day following the inspection, whichever is later. A new ambulance decal shall be installed upon the ambulance upon its passing reinspection.

(d) The fee for the inspection and issuance of an ambulance decal shall be $50. The fee shall be payable for each ambulance at the commencement of the annual permit term. No fee shall be imposed for a spot inspection or for the inspection of any replacement ambulance, any ambulance for which a change in status is made or any ambulance for which the decal has been lost, stolen, or damaged. However, the $50 inspection fee shall be imposed for each ambulance added to a permit during the permit term. Following its initial inspection, each replacement ambulance, each ambulance for which a change in status is made and each added ambulance shall be subject to inspection at the regular inspection intervals.

The foregoing fee is intended to partially recover the city’s various regulatory costs under this article, rather than merely to recover the cost of inspection of the ambulance itself and the issuance of the ambulance decal. As a matter of administrative convenience, the fee is being assessed on a per-ambulance basis at the time of inspection and issuance of the ambulance decal.

(e) Replacements shall not be provided for lost, stolen, damaged ambulance decals. In that instance the ambulance shall be submitted again for inspection.

(f) If any ambulance fails to pass an inspection, then one free re-inspection shall be provided. The director shall impose a fee for additional re-inspections based upon the estimated cost of performing the re-inspection.

(g) The director may adopt regulation to carry out the terms of this section.

Secs. 4-45—4-50. Reserved.

DIVISION 3. AMBULANCE SERVICE PROVIDERS

Secs. 4-51. Application.

(a) Any person who desires to obtain an ambulance service provider’s permit shall make application to the health officer upon forms promulgated by the director. The application shall set forth and include the following:

(1) The name, date of birth, home street address (and home mailing address if different), business street address (and billing street address if different), home telephone number and business telephone number of both the administrator and the person who shall act as the alternate administrator and may be contacted in case the administrator is unavailable at any time.

(2) The name, date of birth, home street address (and home mailing address if different), and business address (and business mailing address if different), home telephone number and business telephone number of each person who is an ambulance service provider as that term is defined in section 4-31 of this code.

(3) The place or places where the ambulance service provider’s ambulance(s) will be based when not in service.

(4) Proof that the applicant holds all state licenses required for the proposed ambulance operations.

(5) The street address and telephone number of the place or places within the county at which requests for all records required to be made available for inspection by the health officer under this chapter shall be made.

(6) The number of ambulances to be operated and whether each will be operated as a basic life support ambulance, advanced life support ambulance, mobile intensive care unit, or specialized unit and the description by make, model, license plate and VIN number of each ambulance to be operated under the requested ambulance service provider’s permit.

(7) Evidence that the ambulance service provider has sufficient staff resources, or will be able to retain sufficient staff resources prior to the commencement of operation in order to comply with the staffing requirements of this chapter for the ambulances.

(8) The name, date of birth, home street address ( and home mailing address if different), business address (and business mailing address if different), of the medical director together with a pager number, answering service number or other reliable measure to allow the health officer to contact the medical director on a twenty-four hour per day basis. The applicant shall also provide evidence that the medical director is licensed as a physician in Texas and has the required experience and training to function in the capacity, which credential shall conform to current advisory recommendations of the committee.

(9) Copies of the medical director’s medical treatment protocols as applicable to the types of ambulance service to be provided, which protocols shall conform to current advisory recommendations of the committee.

(10) Evidence that the ambulance service provider has or will acquire prior to commencement of operations effective and reliable communications capabilities to permit vehicle-to-vehicle, vehicle-to-base, and direct or indirect vehicle-to-hospital communication and radio traffic recording capabilities as required by this article.

(11) Evidence that the ambulance service provider will maintain the supplies and equipment stores that are required by section 4-54 of this code.

(12) For first-time applicants, evidence that the ambulance service provider has sufficient financial revenues to sustain its operations for a period of at least three months from the start-up date in anticipation of the receipt of revenues from third party payers. This proof shall include all current financial statement of the ambulance service provider.

(13) For first-time applicant, evidence that the ambulance service is registered as a valid company. Copies of the Articles of Incorporation (if incorporated) or a document from Harris County showing business is registered in Harris County will meet this requirement.

(14) Evidence that the personnel attending the ambulance and the medical director for the ambulance service provider shall be covered by medical malpractice insurance and professional liability insurance in the amount of not less that $500,000 per occurrence and $1,000,000 aggregate for all medical aspects of the operation of the ambulance. The foregoing policies must be written by a carrier that holds a valid certificate of authority from the state of Texas for the type of policy issued. Additionally, each policy must list the City of Houston as the certificate holder and contain an endorsement requiring 30 days written notice of termination or cancellation to the health officer.

(15) Copies of the ambulance service provider’s policies and procedures which demonstrate the provider’s ability to satisfy the requirements of the code and all state and federal requirements.

(b) The director may adopt regulations to carry out the terms of this section.

(c) Each application shall be accompanied by a non-refundable fee of $500 for an initial ambulance provider’s permit and $200 for renewal of a current ambulance provider’s permit.

(d) When a complete application accompanied by the appropriate fee is received and reviewed to ensure compliance with all requirements of this code the department shall issue an Ambulance Service Permit will be issued. If the application is incomplete or not accompanied by the appropriate fee then the ambulance service provider shall be given a written notice of the deficiencies found. The ambulance service may submit additional information to correct the deficiencies. All deficiencies must be corrected within forty-five days of notice or the application will be rejected. Upon request, an appeal hearing shall be provided under section 4-4 of this code if an application is rejected.

(e) Each application shall be acted upon by the health officer within forty-five days of its filing in complete form. In the event that the application is for a new business or if for any other reason the health officer is unable to complete the inspection of the required equipment or make other required determinations that are requisite to the establishment of the businesses, then the permit may be referred to the EMS Advisory Committee for conditional approval of a ninety day provisional permit.

Sec. 4-52. Terms.

(a) An ambulance service provider’s permit shall be personal to the holder and may not be sold, transferred or assigned, including any assignment by operation of law.

(b) Unless sooner revoked as provided herein, an ambulance service provider’s permit shall be valid for one year from the date of its issuance. Renewal applications shall be valid for one year from the date of its issuance. Renewal applications shall be filed at least ninety days prior to expiration in order to ensure action before expiration of the applicant’s then existing permit.

(1) Within ten days of any change of medical director, providing the date specified in items (8) and (9) of subsection (a) of section 4-51 of this code

(2) Within ten days of any change of the administrator or alternate administrator, providing the date specified in item (1) of subsection (a) of section 4-51 of this code

(3) Prior to placement into service of any additional or replacement ambulance, providing for each one the individual data specified in item (6) of subsection (a) of section 4-51 of this code.

(4) Prior to its change in status, that any ambulance will be changed from its previously designated status as a basic life support vehicle advanced life support vehicle or mobile intensive care unit.

(5) Within ten days following any other change of information required to be provided under section 4-51 of this code.

If the change involves any personnel who are governed by section 1-10 of this code, then the health officer shall cause a determination to be made as soon as possible by the police department regarding compliance with section 1-10 of this code. If any additional person to be associated with the ambulance service provider has been convicted of an applicable offense within the time specified in section 1-10 of this code, then the health officer shall cause the ambulance service provider’s permit to be suspended upon written notice to permit holder, and the procedures established in section 1-9 of this code shall be applicable.

Sec. 4-53. Records; logs.

(a) Each ambulance service provider’s permit holder shall maintain the following logs and records, which shall be made available for inspection and/or copying by the health officer at the ambulance service provider’s designated office upon request by the administrator:

(1) Complete rosters demonstrating that the ambulance service provider has the personnel required under this chapter. The rosters shall include the personnel files of the ambulance service provider to the extent relevant to disclose that the personnel required by this chapter are employed.

(2) Documentation of compliance with applicable state and federal work place safety requirements, including inspection reports, if any, that are required under the federal Occupational Safety and Health Administration or any corresponding state law or regulation and proof that any noted report deficiencies have been cured.

(3) Repair and maintenance records of each ambulance operated under the ambulance service provider’s permit.

(4) Dispatch logs for the preceding period of ninety days, setting forth for each service call:

a. The patient’s name, age, gender, and home address.

b. The patient’s condition and the care given, if any.

c. If the patient was not transported, the reason.

d. The date, time and place of pickup and discharge, if applicable.

e. The ambulance number, crewmembers’ names and name and signature of the crewmember making the log entry.

f. Whether or not emergency warning devices were used enroute to the call scene or in transit.

g. Any required ambulance equipment that was left on or with the patient.

h. Audio-taped or digitally-recorded records of radio communications traffic if kept by the ambulance service, together with a written or electronic log that identifies each call or transmission, the persons involved and the date and time.

(5) The ambulance service provider’s current medical protocols and procedures for each level of service that is being provided, bearing the signature of its medical director.

(6) The current policies of any insurance required under this chapter, including any exclusions or limitations of drivers or other persons from coverage.

(7) An annual summary of numbers of patients served and transports made.

(b) Except as otherwise provided above, the information shall be maintained and made available within 96 hours or request for inspection and copying by the health officer for a period of two years. If the ambulance service provider ceases operation, then the health officer shall be notified in writing of the place where its records will be kept, and the obligation to make them available shall continue for a period or ninety days following the date of written notice to the health officer.

(c) To the extent permitted by state and federal law, all patient related information to be maintained under this section shall be kept confidential by the health officer.

Sec. 4-54. Operating requirements.

(a) Each ambulance service provider shall maintain one or more organized storage areas within the city or county, with back-up equipment and supplies in sufficient quantities at all times to fully restock one ambulance for each five ambulances or fraction thereof that is authorized under its ambulance service provider’s permit, provided that the back-up equipment and supply stock need not exceed a quantity sufficient to fully restock three ambulances, regardless of the number of ambulances authorized under the permit. The stock need not include any equipment or supply item valued at $1,000 or more, based upon its cost to the trade.

(b) Each ambulance service provider shall ensure that its personnel who are required to be licensed under this article maintain a current ambulance drivers and attendant permits to be issued by the health officer from time to time when applicable and valid state issued driver’s license.

Sec. 4-55. Staffing.

No ambulance service provider shall allow any of its ambulances to be utilized while in service without the following personnel on board:

(1) For basic life support ambulances, at least two emergency medical technicians (EMTs).

(2) For advanced life support ambulances, two emergency medical technicians (EMTs) at least one of the two required EMTs shall be an emergency medical technician-intermediate (EMT-I) who can provide advanced medical procedures while attending the patient under the direction of an authorized medical director.

(3) For mobile intensive care unit ambulances, two emergency medical technicians (EMTs) at least one of the two required EMTs shall be an emergency medical technician-paramedic (EMT-P) or licensed paramedic who can provide advanced medical procedures including electro-cardiography, defibrillation, cardio version, endotracheal intubation, intravenous therapy while attending the patient under the direction of an authorized medical director.

(4) For specialized ambulances two certified or licensed personnel, certification or licensure level determined by the type and application of the vehicle and approved by the medical director.

The driver of the ambulance may be counted among the foregoing personnel.

Sec. 4-56. Termination; suspension.

(a) The health officer may cause an ambulance service provider’s permit to be terminated or may refuse renewal as provided in this section.

(b) In the event that any personnel of the ambulance service provider to whom section 1-10 of this code is applicable is convicted of an offense covered thereunder, then the permit may be terminated or not renewed following notice and an opportunity for a hearing under the procedures specified in section 1-9 of this code.

(c) In the event that the ambulance service provider fails to comply with any other applicable requirement as set forth in this chapter or in the event that the permit was issued through error or on the basis of materially false or incomplete information, the health officer may give the ambulance service provider written notice of the grounds and may schedule a hearing regarding the termination of the permit or the refusal to renew the permit, as applicable. If the director has reason to believe that the grounds are such as to constitute a substantial and immediate threat to the health, safety and welfare of the public, then the permit may be suspended by the director pending the hearing. The ambulance service provider shall be given written notice of the date, time and place of the hearing and of his right to be present in person and/or through legal counsel, to present evidence and to cross-examine witnesses presented by the health officer. The hearing shall be conducted within five days if the ambulance service provider’s permit has been suspended pending the hearing, unless the permit holder requests an extension shall be upon the health officer. In any instance where it appears to the hearing officer that the violation was not intentional and that corrective action has been taken to prevent its recurrence, then the hearing officer may, if it appears that justice would be so served, suspend the permit for a period of time in lieu of terminating the permit.

Sec. 4-57-4-60. Reserved.

DIVISION 4. AMBULANCE DRIVERS AND ATTENDANTS

Sec. 4-61. Application

(a) Any person who desires to obtain an ambulance driver’s permit or an ambulance attendant’s permit shall make application to the health officer upon forms promulgated by the director. The application shall set forth and include the following information:

(1) The applicant’s home street address (and mailing address if different) and home telephone number. Including all previous addresses in the previous five years.

(2) Evidence that the applicant is at least 18 years of age and evidence of the applicant’s date of birth by birth certificate or other conclusive documentation.

(3) The name, street address (and mailing address if different) of the ambulance service provider who has employed or has agreed to employ the applicant. Including all previous employers in the previous five years.

(4) Proof that the applicant holds a current and valid certification issued by the Texas Department of Health as an emergency medical technician, emergency medical technician- intermediate, emergency medical technician- paramedic, or licensed paramedic.

(5) For an ambulance driver’s permit applicant, proof that the applicant holds a current and valid Texas driver’s license of a class that allows the operation of an ambulance.

(6) A signed statement indicating the applicant has not been convicted in the last five years of any disqualifying convictions as outlined in section 1-10 subsection (d) items a through h of this code.

(7) For an ambulance driver’s permit, a signed statement indicating the applicant has not been convicted in the last five years of any disqualifying convictions as outlined in section 1-10 subsection (d) items i through k of this code.

(8) A notarized statement verifying identity and truthfulness of the statements made on the application.

(b) The director may adopt regulations to carry out the terms of this section.

(c) Each application shall be accompanied by a non-refundable fee of $20 for an initial or renewal ambulance driver’s permit or ambulance attendant permit.

(d) When a complete application accompanied by the appropriate fee is received, the department will initiate a criminal background check and for ambulance driver’s permits a motor vehicle records check for the applicant.

(e) Upon completion of the background check the appropriate permit will be issued. If the applicant failed to meet the requirements imposed under section 1-10 of this code the application will be denied. If the applicant failed a requirement other than those imposed under section 1-10 of this code, then the application shall be denied, and the applicant shall be given notice of the grounds. Upon request, an appeal hearing shall provide under section 4-4 of this code.

(f) An applicant who meets all requirements other those set forth in item (6) or (7) of subsection (a) of this section may be issued a provisional permit valid for sixty days pending the completion of the background check and the motor vehicle records check. Only one provisional permit may be issued to any person within a period of two years.

Sec. 4-62. Terms.

(a) An ambulance driver’s permit or an ambulance attendant’s permit is personal to the person to whom it is issued and may not be transferred or assigned.

(b) Unless sooner revoked as provided herein, an ambulance driver’s permit or an ambulance attendant’s permit is valid for two years from the date of its issuance, except as provided in subsection (f) of section 4-61 of this code for provisional permits. Renewal applications should be filed at least ninety days prior to expiration of the applicant’s then existing permit.

(c) It shall be the duty of each ambulance driver’s permit holder to produce the permits upon request at all times while functioning as an ambulance driver or ambulance attendant within the city. In any prosecution under this subsection, it shall be presumed that the person did not hold an ambulance driver’s permit or ambulance attendant’s permit if the same was not in the person’s possession at the time of the alleged offense.

Sec. 4-63. Termination; suspension.

(a) The health officer may cause an ambulance driver’s permit or an ambulance attendant’s permit to be terminated or may refuse renewal as provided in this section.

(b) In the event that the permit holder is convicted of an offense covered under section 1-10 of this code, then the permit may be terminated or not renewed following notice and an opportunity for a hearing under the procedures specified in section 1-9 of this code.

(c) An ambulance driver’s permit or an attendant’s permit may also be terminated, refused for renewal or suspended in the same manner and upon the same grounds provided in subsection (c) of section 4-56 of this code.

Section 3. That section 1-10 of the Code of Ordinances, Houston, Texas, is hereby amended by redesigning the existing subsection (d) as subsection (e), and by adding a new subsection (d), which reads as follows:

“(d) The permits enumerated in this subsection shall be denied if the applicant has been convicted of any of the designated offenses within the five-year period immediately preceding the date of the filing of the application or has spent time in jail or prison during the five-year period immediately preceding the date of the filing of the application for such a conviction. Additionally the following permits shall be denied, revoked or refused for renewal, as applicable, if the permittee has within the past five years been convicted of any of the designated offenses or since the application was filed. Provided however, no such permit shall be denied, revoked or refused for renewal if the conviction was set aside as invalid or if it is found that the permit should not be denied, revoked or refused for renewal under Art. 6252-13c, Tex. Rev. Civ. Stat. Ann.:

All permits issued pursuant to division 4 or article IV of chapter 4 of this Code:

a. Any offense involving fraud or theft;

b. Any offense involving forgery;

c. Any offense involving the unauthorized use of a motor vehicle;

d. Any violation of state or federal laws regarding firearms;

e. Any offense involving violence to any person for conduct which is classified as no greater than a Class C misdemeanor under the laws of the state;

f. Any offense involving prostitution or the promotion of prostitution;

g. Any offense involving rape, sexual abuse, sexual assault, rape of a child, sexual abuse of a child or indecency with a child;

h. Any offense involving the possession, use of or sale of drugs.

In addition to the offenses listed above, the following shall apply to permits for ambulance drivers issued under division 4 or article IV of chapter 4:

i. Three or more moving violations of the traffic laws of this state or any other state if such violations occurred within the three years immediately preceding that application for a permit or of the notice of a hearing for revocation of a permit.

j. Any offense involving driving a motor vehicle while intoxicated, whether under the influence of alcohol or drugs, or both.

k. Any offense involving reckless driving, hit and run, or revocation or suspension of Driver License.

Conviction of above listed offenses within the last five years unless otherwise specified shall be grounds for denial, revocation or refusal for renewal of the permits issued pursuant to division 4 of article IV of chapter 4 as they allow persons to engage in the ambulance business and occupations relating thereto in which there is a high degree of personal contact with and danger to the public and a serious need to protect members of the public utilizing ambulance services from the type of criminal conduct represented by such offenses. The work also involves access to medical equipment and supplies that could be used unlawfully in connection with controlled substance law violations. Additionally, the offenses listed in items, i, j, and k specifically relate to operation of a motor vehicle and members of the public should be protected from unsafe operation of ambulances.

Section 4. The City Council hereby finds that each of the criteria that are added to Section 1-10 of the Code of Ordinances, Houston, Texas, in Section 3 of this Ordinance directly relates to the duties and responsibilities of persons who are licensed under Chapter 4 of the Code of Ordinances, Houston, Texas.

Section 5. Pursuant to Texas Revised Civil Statutes Annotated article 6252-13d, 4(b), the City Secretary is directed to cause a copy of Section 1-10 of the Code of Ordinances, Houston, Texas, as amended herein to be posted in the Courthouses of Harris, Fort Bend and Montgomery Counties.

Section 6. This Ordinance shall take effect upon the ninetieth day next following the date of its passage and approval by the Mayor. Ambulance driver’s permits, ambulance operator’s permits and ambulance decals issued under the provisions of Chapter 4 of this Ordinance prior to the effective date shall remain valid and be recognized for purposes of Chapter 4 of the Code of Ordinances, as amended herein for the reminder of their term or duration.

Section 7. If any provision, section, subsection, sentence, clause, or phrase, of this Ordinance, or the application of same to person or set of circumstances is for any reason held to be unconstitutional, void or invalid, the validity of the remaining portions of this Ordinance or their application to other persons or sets of circumstances shall not be affected thereby, if being the intent of the City Council in adopting this Ordinance that no portion hereof or provision or regulation contained herein shall become inoperative or fail by reason of any unconstitutionality, void ness or invalidity of any other portion hereof, and all provisions of this Ordinance are declared to be severable for that purpose.

Section 8. The provisions of Chapter 4 of the Code of Ordinances, Houston, Texas, as adopted in Section 2 of this Ordinance, make reference to publications of the Society of Automotive Engineers, Inc., and the Ambulance Manufacturers Division of the National Truck Equipment Association. The City Council finds that authentic copies of those publications have been placed on file in the City Secretary’s Office in connection with the adoption of this Ordinance.

Section 9. There exists a public emergency requiring that this Ordinance be passed finally on the date of its introduction as requested in writing by the Mayor; therefore, this Ordinance shall be passed finally on such date and shall take effect as provided in Section 6, above.

PASSED AND APPROVED this day of , 2004

Mayor of the City of Houston

Prepared by Legal Dept.Senior Counsel

PRB/ps/asw 06/25/96

Requested by Health & Human Services Director

L.D. No. 35-91047-01