vate consultants on a contract basis or otherwise, for the rendering of professional or technical services and advice;

(e) enter into contracts, leases, and subleases and to execute all instruments necessary or convenient for the conduct of its business, including contracts with the commissioner and any state agency or municipal entity; and contracts with hospitals and physicians for the purposes of carrying out its powers under this article;

(f) undertake or cause to be undertaken plans, surveys, analyses and studies necessary, convenient or desirable for the effectuation of its purposes and powers, and to prepare recommendations and reports in regard thereto; (8) fix and collect reasonable fees, rents, and other charges for the use of its equipment and the provision of its services;

(h) contract for and to accept any gifts or grants, subsidies, or loans of funds or property, or financial or other aid in any form from the federal or state government or any agency or instrumentality thereof; or from any other source, public or private, and to comply, subject to the provisions of this article, with the terms and conditions thereof; provided, however, that the councils may contract for payment of debt evidenced by bonds or notes or other evidence of indebtedness, either directly or through a lease purchase agreement;

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(i) recommend to the department approval of training course sponsors within its region, and to develop, promulgate and implement annually EMS training plan which addresses the needs of its region;

(j) enter into contracts or memoranda of agreement with other regional councils to provide services in a joint or cooperative manner; and to enter into contracts or memoranda of agreement with an EMS program agency to carry out one or more of its responsibilities under this article;

(k) procure insurance against any loss or liability in connection with the use, management, maintenance, and operation of its equipment and facilities, in such amounts and from such insurers as it reasonably

deems necessary;

(1) approve regional medical advisory committee nominees;

ser

be

(m) provide focused technical assistance and support to those voluntary ambulance services operating under exemptions, to assist such vices in progressing toward the uniform standards established pursuant to this section. Such assistance and support shall include, but not limited to, volunteer recruitment and management training; and (n) do all things necessary, convenient and desirable to carry out its purposes and for the exercise of the powers granted in this article. § 7. Section 3003 of the public health law is amended by adding a new subdivision 5-a to read as follows:

5-a. The regional emergency medical services council is authorized to grant an exemption from the staffing standards set forth in section three thousand five-a of this article to a voluntary ambulance service operating solely with enrolled members or paid emergency medical technicians which has demonstrated a good faith effort to meet the standards and is unable to meet such standards because of factors deemed appropriate by the regional council. An exemption shall be for a period not to exceed two years and shall be conditioned on the participation by the voluntary service in a program to achieve compliance which shall include technical assistance and support from the regional council tailored to the needs and resources at the local level, as provided by paragraph (m) of subdivision three of this section, to be funded by the New York state emergency medical services training account established pursuant to section ninety-seven-q of the state finance law, such account as funded by a chapter of the laws of nineteen hundred ninety-three. Nothing shall prevent the regional council from issuing subsequent exemptions. Such exemptions shall have no effect whatsoever on the insurability of the organization receiving such exemption and such exemption shall not be used as a basis for increasing insurance rates or premiums related thereto, notwithstanding any other provision of law, rule, regulation, or commissioner's ruling or advisory to the contrary. Prior to issuing an exemption, the regional council shall provide written notice by certified mail to the chief executive officers of all general hospitals and municipalities in the county or counties within which the service requesting an exemption operates. Such notice shall provide opportunity for comment on the issuance of the exemption. Notice of the determinaEXPLANATION-Matter in italics is new; matter in brackets [ ] is old law

tion of the regional council shall be provided within ten days of the determination to the applicant, the department, and any party receiving notification of the application who requests notice of the determination. The applicant, the department, or any concerned party may appeal the determination of the regional council to the state council within thirty days after the regional council makes its determination.

§ 8. Paragraph (a) of subdivision 10 of section 3003 of the public health law, as added by chapter 1016 of the laws of 1981, is amended read as follows:

to

(a) The department shall provide each regional council with the funds necessary to enable such regional council to carry out its responsibilities as mandated under this section[; provided, however, that on an annual basis no such council shall receive an amount in excess of five thousand dollars ($5,000) for approved operating expenses] within amounts appropriated therefor.

§ 9. Section 3004 of the public health law is repealed.

§ 10. The public health law is amended by adding two new sections 3003-a and 3004-a to read as follows:

§ 3003-a. EMS program agencies. 1. As provided by agreement with the commissioner or regional councils based on needs identified by the regional emergency medical services councils, an EMS program agency may be responsible for facilitating quality improvement of emergency medical care within its region, staffing the regional emergency medical advisory committees provided for in section three thousand four-a of this article, providing prehospital education programs approved by the department, and other activities to support and facilitate regional emergency medical services systems.

2. The programs developed by the agencies established by subdivision one of this section shall be implemented beginning in nineteen hundred ninety-three using funds collected by the New York state emergency medical services training account, established within the miscellaneous special revenue fund 339 by section ninety-seven-q of the state finance law.

3. The portion of the funds collected by the emergency medical services training New York state account, established and allocated within the miscellaneous special revenue fund - 339 by section ninety-seven-q of the state finance law, shall be adequate to support the costs incurred in implementing the programs described in subdivision one of this

section.

§ 3004-a. Regional emergency medical advisory committees. 1. Regional emergency medical advisory committees shall develop policies, procedures, and triage, treatment, and transportation protocols which are consistent with the standards of the state emergency medical advisory committee and which address specific local conditions. Regional emergency medical advisory committees may also approve physicians to provide on line medical control, coordinate the development of regional medical control systems, and participate in quality improvement activities addressing system-wide concerns. Hospitals and prehospital medical care services shall be authorized to release patient outcome information to regional emergency medical advisory committees for purposes of assessing prehospital care concerns. Regional quality improvement programs shall be presumed to be an extension of the quality improvement program set forth in section three thousand six of this article, and the provisions of subdivisions two and three of such section three thousand six shall apply to such programs.

2. The committee shall nominate to the commissioner a physician with demonstrated knowledge and experience in emergency medical services to serve on the state emergency medical advisory committee.

3. No civil action shall be brought in any court against any member, officer or employee of the committee for any act done, failure to act, or statement or opinion made, while discharging his or her duties as a member, officer, or employee of the committee, without leave from a justice of the supreme court, first had and obtained. In no event shall such member, officer, or employee be liable for damages in any such action if he or she shall have acted in good faith, with reasonable care and upon probable cause.

§ 11. Section 3005 of the public health law, as added by chapter 1053 of the laws of 1974, subdivisions 1 and 6 as amended by chapter 1054 of the laws of 1974, is amended to read as follows:

§ 3005. Ambulance service certificates[; services operating for profit, hospital ambulance services, municipal ambulance services of a city of over one million population]. 1. No ambulance service operating for

profit, hospital ambulance service or municipal ambulance service of a city of over one million population shall operate on or after September first, nineteen hundred seventy-five unless it possesses a valid ambulance service certificate issued pursuant to this article. Effective January first, nineteen hundred ninety-seven, no ambulance service shall be operated unless it possesses a valid ambulance service operating certificate issued pursuant to this article or has been issued a statement of registration. No advanced life support first response service shall operate unless it possesses a valid advanced life support first responder service operating certificate. Effective January first, two thousand, no ambulance service shall be operated unless it possesses a valid operating certificate.

2. The department shall issue an initial certificate to an ambulance service [operating for profit] certified prior to the effective date of this section upon submission of proof that it is the holder of a valid ambulance service [permit] certificate and is otherwise in compliance with provisions of section three thousand nine of this article.

2-a. Prior to January first, two thousand, the department shall issue an initial certificate to a registered ambulance service in possession of a valid registration provided that such service has been issued an exemption issued by a regional council pursuant to subdivision five-a of section three thousand three of this article. 3.

The department shall issue an initial certificate to [a hospital ambulance service or to a municipal ambulance service of a city of over one million population] an advanced life support first response service upon submission of proof that such [ambulance services are] advanced life support first response service is staffed and equipped in accordance with rules and regulations promulgated pursuant to this article and is otherwise in compliance with provisions of section three thousand nine of this article.

5.

4. A certificate issued to an ambulance service [operating for profit, or to a hospital ambulance service or to a municipal ambulance service of a city of over one million population] or advanced life support first response service shall be valid for two years. The initial certification fee shall be one hundred dollars. Thereafter the biennial fee shall be in accordance with the schedule of fees established by the commissioner pursuant to this article. However, there shall be no initial or renewal certification fee required of a [municipal ambulance service of a city of over one million population] voluntary ambulance service or voluntary advanced life support first response service. No initial or renewal certificate (except initial certificates issued pursuant to subdivision two of this section) shall be issued unless the commissioner finds that the proposed operator or operators are competent and fit to operate the service and that the ambulance service or advanced life support first response service is staffed and equipped in accordance with rules and regulations promulgated pursuant to this article. For purposes of this subdivision, competent means that any proposed operator or actual operator of any ambulance service or advanced life support first response service who is already or had been within the last ten years an incorporator, director, sponsor, principal stockholder, or operator of any ambulance service, hospital, private proprietary home for adults, residence for adults, or non-profit home for the aged or blind which has been issued an operating certificate by the state department of social services, or a halfway house, hostel, other residential facility or institution for the care, custody, or treatment of the mentally disabled subject to the approval by the department of mental hygiene, or any invalid coach service subject to approval by the department of transportation, is rendering or did render a substantially consistent high level of care. For purposes of this subdivision, the state emergency medical services council shall adopt rules and regulations, subject to the approval of the commissioner, to establish the criteria to be used to define substantially consistent high level of care with respect to ambulance services, advanced life support first response services, and invalid coaches, except that the commissioner may not find that a consistently high level of care has been rendered where there have been violations of the state EMS code, or other applicable rules and regulations, that (i) threatened to directly affect the health, safety, or welfare of any patient, and (ii) were recurrent or were not promptly corrected. For purposes of this subdiviEXPLANATION-Matter in italics is new; matter in brackets [ ] is old law

or

coun

sion, the rules adopted by the state hospital review and planning cil with respect to subdivision three of section twenty-eight hundred one-a of this chapter shall apply to other types of operators. Fit means that the operator or proposed operator (a) has not been convicted of a crime or pleaded nolo contendere to a felony charge involving murder, manslaughter, assault, sexual abuse, theft, robbery, fraud, embezzlement, drug abuse, or sale of drugs and (b) is not or was not subject to a state or federal administrative order relating to fraud or embezzlement, unless the commissioner finds that such conviction or order does not demonstrate a present risk or danger to patients or the public.

6. No ambulance service [operating for profit, or hospital ambulance service or municipal ambulance service of a city of over one million population which commences operation after April first, nineteen hundred seventy-five shall be certified] or advanced life support first response service shall begin operation without prior approval of the appropriate regional council, or if there is no appropriate regional council established such ambulance service or advanced life support first response service shall apply for approval from the state council as to the public need for the establishment of additional [emergency medical] ambulance service or advanced life support first response service, pursuant to section three thousand eight of this article.

7. Applications for a certificate shall be made by the owner of an ambulance service or advanced life support first response service operating for profit, or by the responsible official of a hospital ambulance service or by the responsible official of a municipal ambulance service of a city of over one million population] or the responsible official of a voluntary ambulance service or advanced life support first response service upon forms provided by the department. The application shall

state the name and address of the owner and such other information the department may require pursuant to rules and regulations.

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§ 12. The public health law is amended by adding a new section 3005-a to read as follows:

§ 3005-a. Staffing standards; ambulance services and advanced life support first response services. The following staffing standards

1.

shall be in effect unless otherwise provided by this section:

(a) effective January first, nineteen hundred ninety-seven the minimum staffing standard for a registered ambulance service shall be a certified first responder with the patient;

(b) effective January first, two thousand, the minimum staffing standard for a voluntary ambulance service shall be an emergency medical technician with the patient;

(c) the minimum staffing standard for all other ambulance services shall be an emergency medical technician with the patient; and

(d) the minimum staffing standard for an advanced life support first response service shall be an advanced emergency medical technician with the patient.

2. Any service granted an exemption by the regional council pursuant

to subdivision five-a of section three thousand three of this article shall be subject to the standards and terms of the exemption.

3. Notwithstanding any other provision of this article, the effective date of the standards established by this section shall be delayed by one year for each fiscal year, prior to January first, two thousand, in which the amounts appropriated are less than that which would have been expended pursuant to the provisions of section ninety-seven-q of the state finance law.

§ 13. Section 3006 of the public health law is repealed and a new section 3006 is added to read as follows:

§ 3006. Quality improvement program. 1. By January first, nineteen hundred ninety-seven, every ambulance service shall establish or participate in a quality improvement program, which shall be an ongoing system to monitor and evaluate the quality and appropriateness of the medical care provided by the ambulance service, and which shall pursue opportunities to improve patient care and to resolve identified problems. The quality improvement program may be conducted independently or in collaboration with other services, with the appropriate regional council, with EMS program agency, with a hospital, or with another appropriate organization approved by the department. Such program shall include a committee of at least five members, at least three of whom do not participate in the provision of care by the ambulance service. At least one

an

member shall be a physician, and the others shall be nurses, or emergency medical technicians, or advanced emergency medical technicians, or other appropriately qualified allied health personnel. The quality improvement committee shall have the following responsibilities: (a) to review the care rendered by the ambulance service, as documented in prehospital care reports and other materials. The committee shall have the authority to use such information to review and to recommend to the governing body changes in administrative policies and procedures, as may be necessary, and shall notify the governing body of significant deficiencies;

ice to periodically review

(b) to periodically review the credentials and performance of all persons providing emergency medical care on behalf of the ambulance ser(c) information concerning compliance with standard of care procedures and protocols, grievances filed with the ambulance service by patients or their families, and the occurrence of incidents injurious or potentially injurious to patients. A quality improvement program shall also include participation in the department's prehospital care reporting system and the provision of continuing education programs to address areas in which compliance with procedures and protocols is most deficient and to inform personnel of changes in procedures and protocols. Continuing education programs may be provided by the ambulance service itself or by other organizations; and (d) to present data to the regional medical advisory committee and to participate in system-wide evaluation. 2. The information required to be collected and maintained, including information from the prehospital care reporting system whịch identifies individual, shall be kept confidential and shall not be released except to the department or pursuant to section three thousand four-a of this article.

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3. Notwithstanding any other provisions of law, none of the records, documentation, or committee actions or records required pursuant to this section shall be subject to disclosure under article six of the public officers law or article thirty-one of the civil practice law and rules, except as hereinafter provided or as provided in any other provision of law. No person in attendance at a meeting of any such committee shall be required to testify as to what transpired thereat. The prohibition related to disclosure of testimony shall not apply to the statements made by any person in attendance at such a meeting who is a party to an action or proceeding the subject of which was reviewed at the meeting. The prohibition of disclosure of information from the prehospital care reporting system shall not apply to information which does not identify a particular ambulance service or individual.

§ 14. Subdivisions 1 and 2 of section 3008 of the public health law, subdivision 1 as added by chapter 1053 of the laws of 1974 and subdivision 2 as amended by chapter 252 of the laws of 1981, are amended to read as follows:

1. [Application] Every application for a determination of public need shall be made in writing to the appropriate regional council, shall specify the primary territory within which the applicant requests to operate, be verified under oath, and shall be in such form and contain such information as required by the rules and regulations promulgated

pursuant to this article.

2.

Notice of the application shall be forwarded by registered or certified mail by the appropriate regional council to the chief executive officers of all [existing] general hospitals, ambulance services, and municipalities operating within the same [region and to each municipality proposed to be served in the region and each adjoining municipality by forwarding a copy of such notice to the person, officer, agent, clerk or employee designated by law as the person to whom a summons in any action in the supreme court issued against such party may be delivered, or if there be no regional council established, the state council shall forward such notice to all ambulance services operating within the county or counties of the proposed operation of the applicant and to each municipality proposed to be served in the county and each adjoining municipality by forwarding a copy of such notice to the person, officer, agent, clerk or employee designated by law as the person to whom a mons in any action in the supreme court issued against such party may be EXPLANATION-Matter in italics is new; matter in brackets [ ] is old law

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