Minnesota Session Laws - 1989, Regular Session

  

                         Laws of Minnesota 1989 

                        CHAPTER 134-H.F.No. 1429 
           An act relating to licensure of ambulance services; 
          establishing new standards; amending Minnesota 
          Statutes 1988, sections 144.801, subdivision 7; 
          144.802, subdivisions 3, 3a, 4, and by adding a 
          subdivision; 144.804; 144.806; 144.807, subdivision 1; 
          144.808; 144.809; and 144.8091; repealing Minnesota 
          Statutes 1988, sections 144.805; 144.807, subdivision 
          3; and 144.8092. 
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: 
    Section 1.  Minnesota Statutes 1988, section 144.801, 
subdivision 7, is amended to read: 
    Subd. 7.  [BASE OF OPERATION OPERATIONS.] "Base 
of operation operations" means the address at which the physical 
plant housing ambulances, related equipment and personnel is 
located.  
    Sec. 2.  Minnesota Statutes 1988, section 144.802, 
subdivision 3, is amended to read: 
    Subd. 3.  [APPLICATIONS; NOTICE OF APPLICATION; 
RECOMMENDATIONS.] (a) Each prospective licensee and each present 
licensee wishing to offer a new type or types of ambulance 
service, to establish a new base of operation, or to expand a 
primary service area, shall make written application for a 
license to the commissioner on a form provided by the 
commissioner.  
    (b) For applications for the provision of ambulance 
services in a service area located within a county, the 
commissioner shall promptly send notice of the completed 
application to the county board and to each community health 
service board, regional emergency medical services system 
designated under section 144.8093, ambulance service, and 
municipality in the area in which ambulance service would be 
provided by the applicant.  The commissioner shall publish the 
notice, at the applicant's expense, in the State Register and in 
a newspaper in the municipality in which the base of operation 
will be located, or if no newspaper is published in the 
municipality or if the service would be provided in more than 
one municipality, in a newspaper published at the county seat of 
the county in which the service would be provided.  
    (c) For applications for the provision of life support 
transportation ambulance services in a service area larger than 
a county, the commissioner shall promptly send notice of the 
completed application to the municipality in which the service's 
base of operation will be located and to each community health 
board, county board, regional emergency medical services system 
designated under section 144.8093, and ambulance service located 
within the counties in which any part of the service area 
described by the applicant is located, and any contiguous 
counties.  The commissioner shall publish this notice, at the 
applicant's expense, in the State Register and in a newspaper 
with statewide circulation.  
    (d) The commissioner shall request that the chief 
administrative law judge appoint an administrative law judge to 
hold a public hearing in the municipality in which the service's 
base of operation will be located.  The public hearing shall be 
conducted as contested case hearing under chapter 14. 
    (e) Each municipality, county, community health service, 
regional emergency medical services system, ambulance service, 
and other person wishing to make recommendations concerning the 
disposition of the application shall make written 
recommendations to the administrative law judge within 30 days 
of the publication of notice of the application in the State 
Register.  
    (f) The administrative law judge shall:  
    (1) hold a public hearing in the municipality in which the 
service's base of operations is or will be located; 
    (2) provide notice of the public hearing in the newspaper 
or newspapers in which notice was published under part 
paragraph (b) or (c) for two successive weeks at least ten days 
before the date of the hearing; 
    (3) allow any interested person the opportunity to be 
heard, to be represented by counsel, and to present oral and 
written evidence at the public hearing; 
    (4) provide a transcript of the hearing at the expense of 
any individual requesting it. 
    (g) The administrative law judge shall review and comment 
upon the application and shall make written recommendations as 
to its disposition to the commissioner within 90 days of 
receiving notice of the application.  In making the 
recommendations, the administrative law judge shall consider and 
make written comments as to whether the proposed service, change 
in base of operations, or expansion in primary service area is 
needed, based on consideration of the following factors:  
    (1) the relationship of the proposed service, change in 
base of operations or expansion in primary service area to the 
current community health plan as approved by the commissioner 
under section 145.918; 
    (2) the recommendations or comments of the governing bodies 
of the counties and municipalities in which the service would be 
provided; 
    (3) the deleterious effects on the public health from 
duplication, if any, of life support transportation ambulance 
services that would result from granting the license; 
     (4) the estimated effect of the proposed service, change in 
base of operation or expansion in primary service area on the 
public health; 
     (5) whether any benefit accruing to the public health would 
outweigh the costs associated with the proposed service, change 
in base of operations, or expansion in primary service area.  
     The administrative law judge shall recommend that the 
commissioner either grant or deny a license or recommend that a 
modified license be granted.  The reasons for the recommendation 
shall be set forth in detail.  The administrative law judge 
shall make the recommendations and reasons available to any 
individual requesting them.  
    Sec. 3.  Minnesota Statutes 1988, section 144.802, 
subdivision 3a, is amended to read: 
    Subd. 3a.  [LICENSURE OF SCHEDULED FIXED-WING AIR AMBULANCE 
SERVICES.] Except for submission of a written application to the 
commissioner on a form provided by the commissioner, an 
application to provide scheduled air ambulance service by 
fixed-wing aircraft only, shall be exempt from the provisions of 
subdivisions 3 and 4.  
    A license issued pursuant to this subdivision need not 
designate a primary service area.  
    No license shall be issued under this subdivision unless 
the commissioner of health determines that the applicant 
complies with the requirements of section 144.804, and the rules 
promulgated under that section applicable federal and state 
statutes and rules governing aviation operations within the 
state. 
    Sec. 4.  Minnesota Statutes 1988, section 144.802, 
subdivision 4, is amended to read: 
    Subd. 4.  [COMMISSIONER'S DECISION.] Within 30 days after 
receiving the administrative law judge's report, the 
commissioner shall grant or deny a license to the applicant.  In 
granting or denying a license, the commissioner shall consider 
the administrative law judge's report, the evidence contained in 
the application, and any hearing record and other applicable 
evidence.  The commissioner's decision shall be based on a 
consideration of the factors contained in subdivision 3, clause 
(f) (g).  If the commissioner's decision is different from the 
administrative law judge's recommendations, the commissioner 
shall set forth in detail the reasons for differing from the 
recommendations.  
    Sec. 5.  Minnesota Statutes 1988, section 144.802, is 
amended by adding a subdivision to read: 
    Subd. 6.  [TEMPORARY LICENSE.] Notwithstanding other 
provisions herein, the commissioner may issue a temporary 
license for instances in which a primary service area would be 
deprived of ambulance service.  The temporary license shall 
expire when an applicant has been issued a regular license under 
this section.  The temporary license shall be valid no more than 
six months from date of issuance.  A temporary licensee must 
provide evidence that the licensee will meet the requirements of 
section 144.804 and the rules adopted under this section.  
    Sec. 6.  Minnesota Statutes 1988, section 144.804, is 
amended to read: 
    144.804 [STANDARDS.] 
    Subdivision 1.  [FIRST AID CERTIFICATE DRIVERS AND 
ATTENDANTS.] No publicly or privately owned basic ambulance 
service shall be operated in the state unless its drivers and 
attendants possess a current advanced American Red Cross first 
aid certificate or other first aid or emergency medical care 
certificate authorized by rules adopted by the state 
commissioner of health pursuant according to chapter 14 or 
issued by the commissioner pursuant to section 214.13.  Until 
August 1, 1994, a licensee may substitute a person currently 
certified by the American Red Cross in advanced first aid and 
emergency care or a person who has successfully completed the 
United States Department of Transportation first responder 
curriculum, and who has also been trained to use all of the 
equipment carried in the ambulance, for one of the persons on a 
basic ambulance, provided that person will function as the 
driver while transporting a patient.  The commissioner may grant 
a variance to allow a licensed ambulance service to use 
attendants certified by the American Red Cross in advanced first 
aid and emergency care in order to ensure 24-hour emergency 
ambulance coverage.  The variance must expire no later than 
August 1, 1990.  The commissioner shall study the roles and 
responsibilities of first responder units and report the 
findings by January 1, 1991.  This study shall address at a 
minimum:  (1) education and training; (2) appropriate equipment 
and its use; (3) medical direction and supervision; and (4) 
supervisory and regulatory requirements. 
    Subd. 2.  [EQUIPMENT AND STAFF.] (a) Every ambulance 
offering ambulance service shall be equipped with a stretcher 
and after August 1, 1979, a two-way radio communications system 
which is in accordance with the commissioner's statewide radio 
communications plan as promulgated in rule as required by the 
commissioner and carry at least the minimal equipment necessary 
for the type of service to be provided as determined by 
standards adopted by the commissioner pursuant to subdivision 
3 and chapter 14.  
    (b) Each ambulance service shall offer service 24 hours per 
day every day of the year, unless otherwise authorized by the 
commissioner, and each vehicle.  
    (c) Each ambulance while in operation transporting a 
patient shall be staffed by at least a driver and an attendant.  
Drivers and attendants are authorized to use only equipment for 
which they are qualified by training, according to subdivision 
1.  An ambulance service may substitute for the attendant a 
physician, osteopath or, registered nurse for the attendant, or 
physician's assistant who is qualified by training to use 
appropriate equipment in an the ambulance.  Whenever an 
ambulance service finds it impossible to arrange for an 
attendant to accompany the driver, the driver may proceed to 
answer an emergency call without an accompanying attendant, 
provided that the service shall make all reasonable efforts to 
arrange for an attendant to be present at the site of the 
emergency and enroute to a health care facility.  Advanced life 
support procedures including, but not limited to, intravenous 
fluid administration, drug administration, endotracheal 
intubation, cardioversion, defibrillation, and intravenous 
access may be performed by the physician, osteopath, registered 
nurse, or physician's assistant who has appropriate training and 
authorization, and who provides all of the equipment and 
supplies not normally carried on basic ambulances. 
    (d) An operator ambulance service shall not deny life 
support transportation services emergency ambulance service to a 
any person needing life support care emergency ambulance service 
because of ability inability to pay or due to source of payment 
for services if this need develops in within the licensee's 
primary service area.  Transport for such a patient may be 
limited to the closest appropriate emergency medical facility.  
    Subd. 3.  [TYPES OF SERVICES TO BE REGULATED.] The 
commissioner, in consultation with the appropriate standing 
committees of the legislature, shall promulgate as may adopt 
rules standards for the operation of needed to carry out 
sections 144.801 to 144.8091, including the following types of 
ambulance service: 
    (a) basic life support ambulance service, which shall have 
that has appropriate personnel, vehicles, and equipment, and be 
is maintained in a sanitary condition according to rules adopted 
by the commissioner according to chapter 14, and that provides a 
level of care so as to ensure that life-threatening situations 
and potentially serious injuries can be recognized, patients 
will be protected from additional hazards, basic treatment to 
reduce the seriousness of emergency situations will be 
administered and patients will be transported to an appropriate 
medical facility for treatment; 
    (b) intermediate ambulance service that has appropriate 
personnel, vehicles, and equipment, and is maintained according 
to standards the commissioner adopts according to chapter 14, 
and that provides basic ambulance service and intravenous 
infusions or defibrillation or both.  Standards adopted by the 
commissioner shall include, but not be limited to, equipment, 
training, procedures, and medical control; 
    (b) (c) advanced life support ambulance service which 
shall have that has appropriate personnel, vehicles, and 
equipment, and be is maintained in a sanitary condition so as to 
provide medical care beyond the according to standards the 
commissioner adopts according to chapter 14, and that provides 
basic life support level, including, but not limited to, 
intubation, ambulance service, and in addition, advanced airway 
management, defibrillation, and administration of intravenous 
fluids and certain pharmaceuticals;.  Vehicles of advanced 
ambulance service licensees not equipped or staffed at the 
advanced ambulance service level shall not be identified to the 
public as capable of providing advanced ambulance service. 
    (c) scheduled (d) specialized ambulance service; that 
provides basic, intermediate, or advanced service as designated 
by the commissioner, and is restricted by the commissioner to 
(1) less than 24 hours of every day, (2) designated segments of 
the population, or (3) certain types of medical conditions; and 
    (d) ambulance service provided by an employer for the 
benefit of its employees; 
    (e) ambulance service operated by a nonprofit entity and 
limited exclusively to providing service by contract for 
specific events and meetings; 
    (f) (e) air ambulance scheduled - fixed-wing; service, that 
includes fixed-wing and helicopter, and is specialized ambulance 
service. 
    (g) air ambulance scheduled - helicopter. 
    An advanced life support ambulance may be used as a basic 
life support ambulance provided that its operation fulfills the 
standards promulgated pursuant to clause (a).  
    Until standards have been developed under clauses (f) (b), 
(d), and (g) (e), the current provisions of Minnesota Rules 
shall govern these services. 
    Subd. 4.  [POLICE, PUBLIC SAFETY EXCEPTIONS.] Nothing in 
sections 144.801 to 144.806 shall prevent operation of a police 
emergency vehicle by one person nor affect any statute or 
regulatory authority vested in the department of public safety 
concerning automotive equipment and safety requirements.  
    Subd. 5.  [LOCAL GOVERNMENT'S POWERS.] Local units of 
government may, with the approval of the commissioner, establish 
standards for ambulance services which impose additional 
requirements upon such services.  Local units of government 
intending to impose additional requirements shall consider 
whether any benefit accruing to the public health would outweigh 
the costs associated with the additional requirements.  Local 
units of government which desire to impose such additional 
requirements shall, prior to promulgation of relevant 
ordinances, rules or regulations, furnish the commissioner with 
a copy of such proposed ordinances, rules or regulations, along 
with information which affirmatively substantiates that the 
proposed ordinances, rules or regulations:  will in no way 
conflict with the relevant rules of the department of health; 
will establish additional requirements tending to protect the 
public health; will not diminish public access to life support 
transportation ambulance services of acceptable quality; and 
will not interfere with the orderly development of regional 
systems of emergency medical care.  The commissioner shall base 
any decision to approve or disapprove such standards upon 
whether or not the local unit of government in question has 
affirmatively substantiated that the proposed ordinances, rules 
or regulations meet these criteria.  
    Subd. 6.  [RULES ON PRIMARY SERVICE AREAS.] The 
commissioner shall promulgate as rules standards particularizing 
the definition of defining primary service area areas under 
section 144.801, subdivision 9 8, under which the commissioner 
shall designate each licensed ambulance service as serving a 
primary service area or areas.  
    Subd. 7.  [DRIVERS OF AMBULANCE SERVICE VEHICLES.] An 
ambulance service vehicle may shall be staffed by a driver 
possessing a (1) current first responder certificate issued 
under United States Department of Transportation standards, or 
(2) a valid class C driver's license provided a siren and 
flashing lights are not used and the vehicle is driven within 
legal speed limits, if, in either case, the ambulance service 
vehicle is also staffed by two or more attendants meeting the 
following qualifications:  (a) attendants staffing a basic 
ambulance service vehicle shall meet the qualifications 
contained in subdivision 1; and (b) attendants staffing an 
advanced ambulance service vehicle shall possess a current 
certification as an emergency medical technician or an emergency 
medical technician-paramedic, provided that at least one 
attendant is an emergency medical technician-paramedic. 
Minnesota driver's license or equivalent and whose driving 
privileges are not under suspension or revocation by any state.  
If red lights and siren are used, the driver must also have 
completed training approved by the commissioner in emergency 
driving techniques.  An ambulance transporting patients must be 
staffed by at least two persons who are trained according to 
this section, one of whom may be the driver.  
    Sec. 7.  Minnesota Statutes 1988, section 144.806, is 
amended to read: 
    144.806 [PENALTIES.] 
    Any person who violates a provision of sections 144.801 to 
144.806 is guilty of a misdemeanor.  The commissioner may issue 
fines to assure compliance with sections 144.801 to 144.806 and 
rules adopted under those sections.  The commissioner shall 
adopt rules to implement a schedule of fines by January 1, 1991. 
    Sec. 8.  Minnesota Statutes 1988, section 144.807, 
subdivision 1, is amended to read: 
    Subdivision 1.  [REPORTING OF INFORMATION.] Operators of 
ambulance services licensed pursuant to sections 144.801 to 
144.806 shall report information about ambulance service to the 
commissioner as the commissioner may require, excluding data 
relative to patient identification.  All information shall be 
reported on forms prescribed by the commissioner for that 
purpose.  The reports shall be classified as "private data on 
individuals" under the Minnesota government data practices act, 
chapter 13.  
    Sec. 9.  Minnesota Statutes 1988, section 144.808, is 
amended to read: 
    144.808 [INSPECTIONS.] 
    The commissioner may inspect life support transportation 
ambulance services as frequently as deemed necessary.  These 
inspections shall be for the purpose of determining whether the 
ambulance and equipment is clean and in proper working order and 
whether the operator is in compliance with sections 144.801 to 
144.804 and any rules that the commissioner adopts related to 
sections 144.801 to 144.804. 
    Sec. 10.  Minnesota Statutes 1988, section 144.809, is 
amended to read: 
    144.809 [RENEWAL OF EMERGENCY MEDICAL TECHNICIAN'S 
CERTIFICATE, FEE.] 
    No fee set by the commissioner for biennial renewal of an 
emergency medical technician's certificate by a volunteer member 
of a volunteer an ambulance service or volunteer, fire 
department, or police department shall exceed $2.  
    Sec. 11.  Minnesota Statutes 1988, section 144.8091, is 
amended to read: 
    144.8091 [REIMBURSEMENT TO NONPROFIT AMBULANCE SERVICES.] 
    Subdivision 1.  [REPAYMENT FOR VOLUNTEER TRAINING.] Any 
political subdivision, or nonprofit hospital or nonprofit 
corporation operating a licensed ambulance service shall be 
reimbursed by the commissioner for the necessary expense of the 
initial training of a volunteer ambulance attendant upon 
successful completion by the attendant of a basic 
emergency medical care course, or a continuing education course 
for basic emergency medical care, or both, which has been 
approved by the commissioner, pursuant to section 
144.804.  Reimbursable expense Reimbursement may include 
tuition, transportation, food, lodging, hourly payment for the 
time spent in the training course, and other necessary 
expenditures, except that in no instance shall a volunteer 
ambulance attendant be reimbursed more than $210 for successful 
completion of a basic course, and $70 for successful completion 
of a continuing education course.  
    Subd. 2.  [VOLUNTEER ATTENDANT DEFINED.] For purposes of 
this section, "volunteer ambulance attendant" means a person who 
provides emergency medical services for a Minnesota licensed 
ambulance service without the expectation of remuneration and 
who does not depend in any way upon the provision of these 
services for the person's livelihood.  An individual may be 
considered a volunteer ambulance attendant even though that 
individual receives an hourly stipend for each hour of actual 
service provision provided, except for hours on standby alert, 
even though this hourly stipend is regarded as taxable income 
for purposes of state or federal law, provided that this hourly 
stipend does not exceed $500 in the year in which the individual 
received training within one year of the final certification 
examination.  Reimbursement will be paid under provisions of 
this section when documentation is provided the department of 
health that the individual has served for one year from the date 
of the final certification exam as an active member of a 
Minnesota licensed ambulance service.  
    Subd. 3.  [STARTING DATE.] Reimbursements authorized by 
subdivision 1 shall only be paid for volunteer ambulance 
attendants commencing and completing training after July 1, 1977.
    Sec. 12.  [REPEALER.] 
    Minnesota Statutes 1988, sections 144.804, subdivision 4; 
144.805; 144.807, subdivision 3; and 144.8092, are repealed. 
    Presented to the governor May 12, 1989 
    Signed by the governor May 15, 1989, 5:55 p.m.