COMMITTEE SUBSTITUTE FOR ORDINANCE NO. 030376

Amending section 34-362, code of ordinances, entitled Prehospital emergency medical services system definitions by defining the metropolitan ambulance services trust to include any successor not-for-profit corporation to MAST; and authorizing the termination of the MAST trust indenture dated September 11, 1979, for the purpose of allowing MAST to change its form from a trust to a not-for-profit corporation; and approving the substitution of the Metropolitan Ambulance Services Trust Corporation for the Metropolitan Ambulance Services Trust in all contracts, grants, or agreements between the City and the Metropolitan Ambulance Services Trust.

WHEREAS, the Metropolitan Ambulance Services Trust was established through a Trust Indenture dated September 11, 1979, for the purpose of providing prehospital emergency medical services to Kansas City, and the metropolitan area; and

WHEREAS, the legal character of MAST is unique in Missouri local government; and

WHEREAS, the Metropolitan Ambulance Services Trust Indenture provides that MAST was established to exist for the term of duration of the beneficiary and until such time as its purpose shall have been fulfilled or until it shall be terminated as hereinafter provided; and

WHEREAS, opportunities for funding and support from agencies and groups outside the City are available for ambulance services, but that the unique character of MAST as a trust has precluded participation in those funding sources; and

WHEREAS, MAST and the City have learned that no source of support for the ambulance system should be ignored; and

WHEREAS, the legal character of MAST as a trust or as a not-for-profit corporation does not alter the mission or functionality of MAST as an integral part of the prehospital emergency medical services system; NOW, THEREFORE

BE IT ORDAINED BY THE COUNCIL OF KANSAS CITY:

Section 1. MAST defined to include a successor not-for-profit corporation. That section 34-362, code of ordinances, is amended to read as follows:

Sec. 34-362. Definitions.

The following words, terms and phrases, when used in this article, shall have the meanings ascribed to them in this section, except where the context clearly indicates a different meaning:

Ambulance means any motor vehicle equipped with facilities to convey infirm or injured persons in a reclining position.

Ambulance control center means a single facility designated by MAST as the central communications center from which all ambulances operating in the city subject to regulations pursuant to this article shall be dispatched and controlled at all times.

Ambulance dispatcher means a paramedic certified to dispatch ambulances, and is also known as a system status controller.

Ambulance operations contractor means the entity secured by MAST to provide prehospital

emergency medical services and transport of patients by ambulance.

Attendant means a person assigned to provide prehospital emergency medical services to patients, and includes a first responder, EMT, paramedic, or other authorized person such as a mobile emergency nurse.

Base station physician means a physician licensed to practice medicine in the state, knowledgeable in the medical protocols, radio procedure and general operating policies of the city emergency medical services system, and a person from whom attendants may take medical direction.

Emergency medical services advisory committee means the committee authorized to serve as an advisory committee to the director of health on all issues affecting the prehospital emergency medical services system.

Emergency medical technician (EMT) means a person licensed by the state as an emergency medical technician, and licensed by the director of health. There may be multiple levels of EMT licensure.

Emergency physician advisory board (EPAB) means the board empowered to recommend various standards, rules and regulations for the operation of the emergency medical system, and to perform medical audits.

Emergency physicians foundation (EPF) means a professional and charitable organization composed of and controlled by full-time emergency physicians presently serving in an advisory capacity to the director of health.

First responder means any person or unit capable of providing the appropriate emergency care, as evidenced by current licensure as designated by regulation of the director of health.

Helicopter rescue unit means any rotary wing aircraft providing basic or advanced emergency medical service and transportation.

KCFD EMT first responder means an employee of the fire department licensed by the director of health as an EMT first responder to provide prehospital emergency medical services to patients.

KCFD first responder means an employee of the fire department licensed by the director of health as a first responder to provide prehospital emergency medical services to patients.

Life-threatening emergency means a situation posing immediate threat to human life or of long-term disability, including but not limited to acute respiratory distress, shock, airway blockage, bleeding beyond control, acute poisoning, acute cardiovascular distress or central nervous system injury.

Medical audit means an official inquiry into the circumstances involving an ambulance or first responder incident or request for service, usually conducted by the EPAB or an EPAB subcommittee.

Medical control means direction given prehospital EMS personnel by a base station physician through direct voice contact, with or without vital sign telemetry, as required by applicable medical protocols approved by the director of health.

Medical protocol means any diagnosis-specific or problem-oriented written statement of standard procedure, or algorithm, approved by the director of health as the normal standard of pre-hospital care for a given clinical condition.

Metropolitan ambulance services trust (MAST) means the entity established to oversee and manage the operation of the ambulance transport service system, including any successor not-for-profit corporation established for the same purposes with the consent of the city.

Mobile emergency nurse means a registered nurse licensed by the state, knowledgeable of advanced life support ambulance care and certified by the director of health as a mobile emergency nurse.

Mutual aid call means a request for emergency ambulance service issued by an ambulance dispatcher in one political jurisdiction to an ambulance dispatcher or ambulance crew normally operating in a neighboring jurisdiction with a licensed ambulance system.

Paramedic means a person licensed by the state as a paramedic and licensed by the director of health as knowledgeable of and competent to perform advanced life support procedures and the medical protocols established by the director of health. There may be multiple levels of paramedic licensure.

Patient means any person who is ill, injured or otherwise incapacitated, bedridden or helpless and who requires or requests ambulance services.

Public utility model means that strategy for the organization, financing, management and regulation of ambulance transport service operation which employs the use of a single level of advanced life support capability for the conduct of all emergency and nonemergency service within a geographical area, including mechanisms of payment which neutralize the "fee-for-service incentive" to overserve or underserve any given patient or geographic area, optimum economics of scale to spread fixed costs of sophisticated ambulance service operations over a wider range of production, competitive procurement of facilities management services from a qualified private firm, financing strategies which minimize or allow minimization of local tax subsidy, ownership or direct control of all major systems hardware by the public sector, and other features intended to promote clinical excellence, reliable response time performance, disaster readiness, long range stability of service and cost containment.

Response time means the actual elapsed time between receipt of notification at the dispatch point that an ambulance or first responder unit is needed at a location and the arrival of that ambulance or first responder unit at the location.

Senior EMS provider in charge means that individual responding to an incident holding the highest level of city licensure, as designated by regulation of the director of health.

Special use permit means a permit issued by the director of health to hospitals, and other institutions serving the public, for the provision of specialized mobile intensive care services.

Specialized mobile intensive care services means services provided to patients, as defined in regulations promulgated by the director of health, being transported between hospitals and other health care institutions, whose critical conditions necessitate the use of specially equipped mobile intensive care units crewed by specialized teams of health care personnel, whose clinical capabilities exceed the capabilities of advanced life support ambulance crews.

Section 2. Finding that purposes of MAST have been fulfilled. That MAST has served as the seminal element of the ambulance system since its inception, but that MAST has the potential to secure alternative sources of funding and support only if it is not organized as a trust. Termination of the trust under the terms of Article IX of the Trust Indenture is not appropriate since the work of MAST, and its obligations and rights are not intended to be ended, but MAST is intended to continue its role in the prehospital emergency medical services system as a not-for-profit corporation. Therefore, the Council finds that the purpose of MAST has been fulfilled since it has reached the end of its potential for continuing to participate in the provision of prehospital emergency medical services with new and alternative sources of funding, since those sources of funds are available only to not-for-profit institutions.

Section 3. Approval of establishment of a not-for-profit corporation. The important factor in the prehospital emergency medical services system is that high quality service is provided to all citizens at the best cost possible. The organization of MAST as a trust does not provide benefits to the public that are not available if MAST is organized as a not-for-profit corporation. The organization of MAST as a not-for-profit corporation provides benefits to the public that are not available to MAST if it is organized as a trust. Therefore, the Council approves of the establishment of the Metropolitan Ambulance Services Trust Corporation to assume all rights, responsibilities and liabilities of the current Metropolitan Ambulance Services Trust.

Section 4. Approval contingent on specific elements of a corporate structure. The approval for the transformation of MAST from a trust to a not-for-profit corporation is contingent on the corporation retaining the following basic elements:

A. The corporation shall be a not-for-profit corporation which is tax exempt under the terms of section 501(c)(3) of the Internal Revenue Code.

B. Upon dissolution of the corporation all available assets will be transferred pursuant to a plan of distribution to the City of Kansas City, Missouri.

C. No agreement with any jurisdiction outside the City of Kansas City, Missouri, will reduce or otherwise adversely affect the level of services provided to the people of Kansas City, Missouri.

D. At least seven directors will constitute the Board of Directors. These seven directors will be appointed by the Mayor of Kansas City, Missouri.

E. Directors appointed by the Mayor of Kansas City, Missouri will hold these minimum qualifications:

1. Two elected members of the Kansas City, Missouri, City Council.

2. Two licensed physicians, clinically experienced and currently involved in the full-time practice of emergency medicine.

3. One person experienced in health care administration or public administration.

4. One person with a background in finance and banking.

5. One licensed attorney with a background in legal aspects of the health care industry.

F. The Kansas City, Missouri, director of health and director of finance are ex officio members of the Board of Directors.

G. The number of directors will not be expanded by the board beyond nine voting members without the approval of the Mayor of Kansas City, Missouri.

Section 5. Substitution of MAST Corporation for MAST. Effective upon the incorporation of the Metropolitan Ambulance Services Trust Corporation and the acceptance by the Corporation of all rights, responsibilities and liabilities held by the Metropolitan Ambulance Services Trust, the City authorizes and approves the continuance of all contracts, grants, agreements or other legal obligations between the City and MAST by the Metropolitan Ambulance Services Trust Corporation without further approval or action of the City Council or any officer, official, employee or department.

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Approved as to form and legality:

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Assistant City Attorney