Fiscal Note
No City appropriation required.
Title
Repealing and Recreating Section 9.34 of the Madison General Ordinances related to Licensing of Private Ambulance Service to Update Licensing Requirements.
Body
DRAFTER’S ANALYSIS: This ordinance amendment institutes a licensing protocol for private ambulance service providers who will provide ambulance services in the City of Madison that will be implemented and enforced by the Madison Fire Department. It requires minimum standards for ambulances used by such providers in the City of Madison and provides a penalty for non-compliance.
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The Common Council of the City of Madison do hereby ordain as follows:
1. Section 9.34 entitled “Licensing of Private Ambulance Service” of the Madison General Ordinances is repealed and recreated as follows:
“9.34 LICENSING OF PRIVATE AMBULANCE SERVICE
(1) Definitions.
(a) “Ambulance” means any emergency vehicle, whether privately or publicly owned, which is designed, constructed, or equipped to transport sick, disabled, or injured individuals.
(b) “Patient” means individual who may require assessment, treatment, or transport.
(c) “Person” means an individual, firm, partnership, association, corporation, trust, foundation, company, public agency, or a group of individuals, however named, concerned with the operation of an ambulance.
(d) “Private ambulance service provider” means a person engaged in the business of transporting sick, disabled, or injured individuals by ambulance to or from facilities or institutions providing health services.
(2) License Required.
(a) From July 1, 2025 on, no private ambulance service provider may act as or advertise for the provision of services as a private ambulance service provider within the City of Madison unless they hold a valid private ambulance service provider’s license pursuant to this chapter.
(b) No license shall be required for the operation of an ambulance which is:
1. Transporting patients from locations outside the limits of the City of Madison where the call for service originates from outside the City of Madison and the patient is received from outside the City of Madison;
2. Rendering assistance to licensed ambulance service in the case of a major catastrophe or emergency when so requested by the Madison Fire Department; or
3. Provided by any governmental entity.
(3) License Application.
(a) An application for a private ambulance service provider’s license shall be made upon such form as is prepared or prescribed by the Madison Fire Department. Such application form shall include a requirement that the applicant certify their compliance with Sections 6 and 7 of this Ordinance. The form shall indicate whether the application is an initial application or a timely renewal of an existing private ambulance service provider license.
(b) An application for a private ambulance service provider’s license must include a copy of a valid ambulance service provider license granted by the Wisconsin Department of Health Services as provided under Wis. Stats. Chapter 256 and DHS Chapter 110.
(c) An application for a private ambulance service provider’s license pursuant to this chapter shall only be considered upon payment of a license fee of six hundred dollars ($600).
(4) Change in License Application.
(a) Any change in the application provided to the Madison Fire Department pursuant to Subsection 3 shall be reported to the Madison Fire Department within five (5) working days.
(5) Issuance and Renewal of License.
(a) Within forty-five (45) calendar days after the receipt of an initial application for a private ambulance service provider license, the Madison Fire Department shall conduct an investigation of the private ambulance service provider, and it shall review the application and the attached State license above, to determine compliance with this Ordinance and other applicable laws. Within this time, the Madison Fire Department shall approve or deny the license, and the approval of such license shall not be unreasonably withheld.
(b) After such investigation and review, and upon approval by the Madison Fire Department, the City Clerk shall issue the private ambulance service provider license.
(c) A private ambulance service provider requesting the timely renewal of their license must provide to the Madison Fire Department an application form and provide payment of the same application fee as upon the initial license. The renewal application must include a copy of a valid state license. An application for timely renewal of a valid private ambulance service provider license issued under this Chapter must be received within 30 (thirty) calendar days of the expiration of the license. Timely renewals are not subject to the investigation referenced in subsections (a) and (b). The Madison Fire Department shall consider the timely renewal application by determining compliance with this Ordinance and other applicable laws before approving the renewal.
(d) After such consideration, and upon approval by approval by the Madison Fire Department, the City Clerk shall issue the renewal of the private ambulance service provider license.
(e) All licenses under this Chapter shall be valid upon issuance by the City Clerk, and remain so until expired, unless earlier suspended, revoked or terminated. Upon expiration or after revocation, a new private ambulance service provider license shall require compliance with all the requirements of this section, as are required upon an initial license.
(f) Licenses granted under this Ordinance shall be effective from July 1 to June 30 of the following year. License fees paid for partial years may be prorated quarterly.
(6) Standards, Staffing, and Inspections.
(a) A private ambulance service provider licensed under this Ordinance shall notify the Madison Fire Department within five (5) working days of any changes submitted to Wisconsin Department of Health Services affecting their operational plan.
(b) Every ambulance in service within the City of Madison operated by a private ambulance service provider licensed under this Chapter shall at all times contain equipment that meets the specifications of Trans. Chapter 309.
(c) Every ambulance used in the City of Madison by a private ambulance service provider licensed under this Chapter shall be inspected according to Trans. § 309.03.
(d) Every ambulance used in the City of Madison by a private ambulance service provider licensed under this Chapter shall maintain conformity with the requirements of Wis. Stat. Chapter 256 and DHS Chapter 110.
(7) Insurance Required.
(a) In addition to the insurance requirements of DHS § 110.35(2)(d), no private ambulance service provider license shall be issued unless the applicant shall first file with the Madison Fire Department evidence of a policy of insurance issued by an insurance company licensed to do business in the State of Wisconsin, which shall provide that the insurance company shall be liable for damages of up to three hundred thousand dollars ($300,000) for any accident due to the negligent operation of one of the service provider’s ambulances. The policy shall be approved by the Risk Manager of the City of Madison, and it shall contain a provision that the same may not be canceled before the expiration of its term, except upon thirty (30) days written notice to the Madison Fire Department. If at any time such policy shall be canceled or not in effect for any reason, the private ambulance service provider’s license shall be immediately suspended.
(8) Change of Ownership.
(a) No private ambulance service provider license issued pursuant to this chapter shall be transferable. A change of ownership of a private ambulance service provider license shall act as a termination of the license. The new owner must apply for and receive a new license prior to engaging in the business of a private ambulance service provider.
(9) Suspension or Revocation of License.
(a) The Madison Fire Department may suspend or revoke a license issued hereunder for failure of the licensee to comply with or violate any of the requirements of this chapter.
(b) The Madison Fire Department may suspend or revoke a license issued hereunder if the licensee’s ambulance service provider’s license has been suspended or denied by the Wisconsin Department of Health Services. The private ambulance service provider shall notify the Madison Fire Department within five (5) working days after receiving notice that the Wisconsin Department of Health Services has suspended their private ambulance service provider license.
(c) Upon suspension, revocation, or termination of a private ambulance service provider’s license, the provider shall cease ambulance operations entirely and immediately within the City of Madison.
(10) Hearing.
(a) Any licensee hereunder may, within fifteen (15) calendar days after a suspension or revocation, request in writing a hearing before the Building Code, Fire Code, Conveyance Code, and Licensing Appeals Board (the “Board”).
(b) After the Board’s receipt of the request for a hearing, the Board shall hold a hearing on such suspension or revocation.
(c) Within thirty (30) calendar days after conclusion of such hearing, issue a written decision (which shall include written findings) as to the suspension or revocation of said license. The written decision shall be promptly transmitted to the licensee.
(11) Penalty.
(a) Any person who shall violate any of the provisions of this chapter or fail to comply with any of its requirements or who shall neglect or refuse to comply with a lawful order of the Madison Fire Department issued pursuant to the provisions of this chapter, shall be subject to a forfeiture of not less than ten dollars ($10) nor more than one thousand dollars ($1,000) for each and every violation thereof. Each day or portion thereof such violation continues shall be considered a separate offense.
EDITOR’S NOTE:
Section 9.34 entitled “Licensing of Private Ambulance Service” of the Madison General Ordinances currently reads as follows:
“9.34 LICENSING OF PRIVATE AMBULANCE SERVICE
The purpose of this Ordinance is to protect the health and welfare of the residents of Madison by setting licensing standards for the operation of private ambulance services, providing for inspection of private ambulances and ambulance equipment, regulating the qualifications of persons employed as private ambulance attendants, providing for renewal and revocation of licenses, and requiring written reports.
(1) Definitions.
(a) Ambulance means any privately owned motor vehicle or aircraft that is specially designed or constructed, equipped, and intended to be used for and maintained or operated for the transportation of patients, except any such motor vehicle owned by, or operated under the direct control of, the United States or the State of Wisconsin.
(b) Attendant means a trained and licensed person responsible for the operation of an ambulance and for the care of the patients. An attendant must hold a valid Wisconsin motor vehicle operator's license.
(c) Patient means a person who is sick, injured, wounded, or otherwise incapacitated or helpless, and in need of transportation and/or medical treatment.
(d) Person means any individual, firm, partnership, association, corporation, company, group of individuals acting together for a common purpose or organization of any kind, including any governmental agency other than the United States or State of Wisconsin.
(e) Emergency Medical Technician-Basic means a person who has completed and maintains the prescribed training resulting in certification as Emergency Medical Technician-Ambulance or Emergency Medical Technician-Basic by the National Registry of Emergency Medical Technicians or the Wisconsin Division of Health. An Emergency Medical Technician-Basic must also be CPR-certified, that is, certified in cardio-pulmonary resuscitation according to standards set by the American Heart Association.
(f) Emergency Medical Technician-Paramedic means a person who is specially trained in the emergency cardiac, trauma and other lifesaving or emergency procedures in a training program or course of instruction resulting in certification as an Emergency Medical Technician-Advanced or Emergency Medical Technician-Paramedic by the National Registry of Emergency Medical Technicians or the Wisconsin Division of Health. An Emergency Medical Technician-Paramedic must also be CPR-certified, that is, certified in cardio-pulmonary resuscitation according to the standards set by the American Heart Association.
(g) Attendant-Trainee means a person engaged in training for the purpose of becoming an attendant as defined herein, and who holds a current provisional Emergency Medical Technician-Basic license.
(h) Ambulance Service Operator means a person engaged in the business of transporting patients by ambulance to or from facilities or institutions providing health services.
(2) Private Ambulance Service Operator's License.
(a) No person, either as owner, agent or otherwise, shall furnish, operate, conduct, maintain, advertise or otherwise be engaged in, or profess to be engaged in, the business or service of the transportation of patients within the City of Madison unless he or she holds a currently valid license as an Ambulance Service Operator, pursuant to this Ordinance. An ambulance operated by an agency of the United States or of the State of Wisconsin shall not be required to be licensed hereunder.
(b) No ambulance shall be operated for ambulance purposes, and no person shall drive, attend, or permit it to be operated for such purposes in the City of Madison, unless the owner or proprietor holds a currently valid Private Ambulance Service Operator's License issued by the City of Madison. Provided, however, that no license shall be required for the operation of an ambulance service which is:
1. Transporting patients from locations outside the limits of the City of Madison.
2. Rendering assistance to licensed ambulance service in the case of a major catastrophe or emergency with which the licensed ambulance services of the City of Madison are unable to cope.
3. Provided by the Police or Fire Department of the City of Madison.
(3) Application for Private Ambulance Service Operator's License.
Application for Private Ambulance Service Operator's Licenses shall be made upon such forms as may be prepared or prescribed by the Director of Public Health Madison and Dane County and shall contain:
(a) The name and address of the applicant.
(b) All trade or other corporate names, if any, under which the applicant does business and proposes to do business.
(c) A list of employees serving as attendants, along with the following:
1. The attendant's full name, current address and length of time he or she has resided at said address.
2. A copy of the attendant's current Wisconsin motor vehicle operator's license.
3. The attendant's training and experience in the transportation and care of patients, and whether he or she has previously been licensed as an emergency ambulance driver or attendant, and if so, when and where, and whether such license has ever been revoked or suspended in any jurisdiction and for what cause.
4. Two recent photographs of the attendant, of a size designated by the Director of Public Health Madison and Dane County.
5. Such other information as the Director of Public Health Madison and Dane County shall deem reasonably necessary to a fair determination of compliance with this Ordinance.
(d) The name and address of a responsible local agent who will be available at all times.
(e) A description of each ambulance, including the make, model, year of manufacture, motor and chassis number; current state license number; the length of time the ambulance has been in use; and the color scheme, insignia, name, monograph or other distinguishing characteristics to e used to designate applicant's ambulance or ambulances.
(f) A copy of the Certificate of Title, as provided by Wis. Stat. ch. 342, for each of applicant's ambulances.
(g) The location and description of the place or places from which ambulances will operate.
(h) A schedule of rates being charged, accompanied by a description as to how these rates are calculated. Any changes or revisions in these rates and/or the method of calculation shall be immediately filed with the City Clerk.
(i) Such other information as the Director of Public Health Madison and Dane County shall deem reasonably necessary to a fair determination of compliance with this Ordinance.
(j) An accompanying license fee of one hundred dollars ($100) per vehicle.
(4) Standards for Issuance of Private Ambulance Service Operator's License.
(a) Each ambulance proposed to be used by a private ambulance service operator, shall, at all times when in use as such:
1. Be suitable for the transportation of patients from the standpoint of health, sanitation and safety, and be maintained in suitable premises; that is, each ambulance shall be kept in a heated garage from October 15 through April 15 when not in service, and each ambulance operator shall make provisions for adequate off-street parking facilities for his/her vehicles.
2. Contain equipment conforming to the standards, requirements, and regulations provided by the Director of Public Health Madison and Dane County, which equipment shall be in proper and good condition for such use.
3. Be equipped with such lights, sirens and special markings to designate it as an ambulance as may be prescribed in reasonable regulations promulgated by the Director of Public Health Madison and Dane County.
4. Be equipped with approved safety belts for the driver and for the passenger in the front seat, if such seat is provided.
5. The inside height of the patient compartment shall be a minimum dimension of fifty-four (54) inches, floor to ceiling. A height of sixty (60) inches is preferable.
6. When responding to a call, be staffed by no less than two (2) attendants licensed as an Emergency Medical Technician-Basic as defined in Subsection (1)(g) of this Ordinance. Provided, however, that for the first two (2) years after the effective date of this Ordinance, one of the two attendants may be an Attendant-Trainee, who holds a current provisional Emergency Medical Technician-Basic License. Every attendant must hold a valid Wisconsin motor vehicle operator's license. Every attendant while on duty shall wear the identification badge issued by the Director of Public Health Madison and Dane County pursuant to Subsection (5)(f) of this Ordinance.
7. Be equipped with radio, as follows:
a. Each ambulance shall be equipped with at least one portable radio capable of transmitting on the Federal Communications Commission assigned emergency medical frequency and shall be capable of transmitting from any patient location within the City of Madison to all Madison hospitals.
b. Ambulance radio operation shall comply with procedures approved by the Federal Communications Commission and the Chief of Communications, Madison Fire Department.
8. Be driven by a person who has demonstrated knowledge of ambulance driving techniques and of traffic laws relative to ambulance driving. The Director of Public Health Madison and Dane County shall provide a suitable test for the demonstration of such knowledge.
(b) Any change of ownership of an ambulance used by an operator licensed pursuant to this Ordinance, shall terminate that license, and shall require a new application and a new license and conformance with all the requirements of this Ordinance as upon the original licensing.
(c) Application for transfer of any Private Ambulance Service Operator's License to another or substitute operator shall require conformance with all the requirements of this Ordinance as upon original licensing. No ambulance license may be sold, assigned, mortgaged or otherwise transferred without the approval of the Director of Public Health Madison and Dane County, and a finding of compliance with all the requirements of this Ordinance as upon original licensing.
(d) The ambulance or ambulances, equipment and premises designated in the application for an ambulance service operator's license and all records relating to maintenance and operation of said ambulance shall be open to inspection at any time by the Director of Public Health Madison and Dane County or her/his designated representative.
(e) No official entry made upon a license may be defaced, removed or obliterated.
(f) Any change in the application information provided to the Director of Public Health Madison and Dane County pursuant to Subsection (3) of this Ordinance, shall be reported to the Director within five (5) working days.
(g) Each ambulance operator shall provide service twenty-four (24) hours a day, every day, for the entire calendar year. Operators unable to provide service because a vehicle or vehicles are involved in rendering care and/or undergoing maintenance or repair are not to be construed to be in violation of this section. Operators unable to provide service because attendants are unavailable or because a vehicle or vehicles are undergoing maintenance or repair, are required to report this fact to the Chief of Communications of the Madison Fire Department. Unless unusual or exigent circumstances make it impossible, this report must be made at least twenty-four (24) hours in advance. The Chief of Communications of the Madison Fire Department shall keep the Director of Public Health Madison and Dane County informed as to the times and dates that licensed operators are unable to provide service. If the Director of Public Health Madison and Dane County reasonably believes these periods to be excessive, or caused by inadequate equipment or insufficient staff, she or he shall issue a warning to the operator. If no improvement is shown within a reasonable time, the operator's license shall be suspended.
(h) No private ambulance operator's license shall be issued unless the applicant shall first file with the Director of Public Health Madison and Dane County a sufficient policy of insurance issued by an insurance company licensed to do business in the State of Wisconsin, which shall provide that the insurance company shall be liable for damages of up to three hundred thousand dollars ($300,000) for any accident due to the negligent operation of one of the service operator's ambulances. The policy shall be approved by the Risk Manager, and shall contain a provision that the same may not be cancelled before the expiration of its term, except upon thirty (30) days written notice to the Director of Public Health Madison and Dane County. If at any time such policy shall be cancelled or not in effect for any reason, the ambulance service operator's license shall be immediately suspended.
(5) Licensing.
(a) The Director of Public Health Madison and Dane County shall, within forty-five (45) days after receipt of an application for a license as provided for herein, cause an investigation he or she deems necessary to be made of the applicant and of his/her proposed operation, and grant or deny the license.
(b) Upon authorization by the Director of Public Health Madison and Dane County, the City Clerk shall issue a license hereunder, when he or she finds:
1. That each ambulance proposed to be operated by the applicant, its required equipment, ad the premises designated in the application, have been approved by the Fire Department as provided for herein.
2. That all other requirements of this Ordinance and all other applicable laws and ordinances have been met.
Such license shall be valid for a period of one (1) year unless earlier suspended, revoked, or terminated.
(c) Prior to the issuance of any Private Ambulance Operator's License hereunder, the Director of Public Health Madison and Dane County shall cause to be inspected the vehicles, equipment and premises designated in each application hereunder, and shall certify his/her approval in a written report when he or she finds compliance with the standards prescribed in Subsections (4)(a), (6) and (7) of this Ordinance, and with the regulations promulgated thereunder.
(d) Subsequent to issuance of a Private Ambulance Operator's License hereunder, the Director of Public Health Madison and Dane County shall cause to be inspected each such licensed vehicle, and its equipment and premises, whenever he or she deems such inspection to be necessary, but in any event no less frequently than twice each year, and shall promptly report his/her findings in a written report. The periodic inspection required hereunder shall be in addition to any other safety or motor vehicle inspection required to be made for ambulances or other motor vehicles, or other inspections required to be made under general law or ordinances, and shall not excuse compliance with any requirement of law or ordinance to display any official certificate of motor vehicle inspection and approval, nor excuse compliance with the requirements of any other applicable general law or ordinance.
(e) A copy of each initial, semi-annual or other ambulance, equipment, and premises inspection report submitted by the Director of Public Health Madison and Dane County under the provisions of this subsection shall be promptly transmitted to the applicant or licensee to whom it refers and to the Board of Health.
(f) The Director of Public Health Madison and Dane County shall issue to each attendant a numbered identification badge containing the photograph of said attendant.
(6) Standards for Ambulance Equipment. Each licensee shall comply with such reasonable regulations as may be promulgated hereunder by the Board of Health and the Director of Public Health Madison and Dane County, and shall maintain in each ambulance, at all times when it is in service, all such equipment as may be prescribed hereunder.
(7) Renewal of Licenses. Renewal of any license hereunder, upon expiration for any reason or after revocation, shall require compliance with all the requirements of this Ordinance as upon original licensing. All licenses issued hereunder shall expire December 31 annually. License fees shall be pro-rated quarterly.
(8) Revocation of Licenses.
(a) The Director of Public Health Madison and Dane County may suspend or revoke a license issued hereunder for failure of a licensee to comply and to maintain compliance with, and/or for violation of, any applicable provisions, standards or requirements of this Ordinance, and/or of regulations promulgated thereunder. Within fifteen (15) days after a suspension or revocation, the licensee shall be afforded a hearing, after reasonable notice, before the Board of Health. The Board shall, within thirty (30) days after conclusion of such hearing, issue a written decision (which shall include written findings) as to the suspension, revocation, or continuation of said license. Such written decision shall be promptly transmitted to the licensee to whom it refers.
(b) The initial, semi-annual or other ambulance equipment and premises inspection reports of the Director of Public Health Madison and Dane County herein provided for shall be prima facia evidence of compliance or noncompliance with, or violation of, the provisions, standards and requirements provided herein, and of the regulations promulgated hereunder, for the licensing of private ambulance service operators.
(c) Upon suspension, revocation or termination of a Private Ambulance Service Operator's License hereunder such operator shall cease all operations entirely.
(9) Reports. At the conclusion of each run, a report shall be completed by an attendant, upon such report forms as the Director of Public Health Madison and Dane County may provide or prescribe. This applies to any patient picked up within the City of Madison. Copies of said reports shall be available for inspection at the request of the Director of Public Health Madison and Dane County or the Board of Health.
(10) Obedience to Traffic Laws, Ordinances and Regulations.
(a) The driver of an ambulance shall be covered by traffic laws relating to the operation of emergency vehicles, as provided by Wis. Stat. § 346.03.
(b) No siren shall be used when transporting a stabilized patient, unless a known additional emergency response situation exists.
(11) Severability. The provisions of this Ordinance shall be severable and if any of the provisions shall be held in contravention of the Constitution and laws of the State of Wisconsin, or the United States, the validity of the rest of the ordinance shall not be affected. It is hereby declared to be the intent of this Ordinance that the same would have been adopted had such unconstitutional or unlawful provisions, if any, not been included herein.
(12) Assistance - Advice. Appropriate assistance and/or technical advice in the administration and enforcement of this Ordinance shall be provided by the Madison Fire Department, Madison Police Department or other applicable City agencies pursuant to requests of the Director of Public Health Madison and Dane County.
(13) Effective Date. To permit the City to develop updated procedures and forms related to the application process, this section shall not be in effect until July 1, 2025 unless reinstated earlier by action of the Common Council.”