# COMAR Title 30 — Maryland Institute for Emergency Medical Services Systems (MIEMSS) ## Subtitle 09 — Commercial Ambulance Services ### Chapter 09 — Enforcement **Authority:** Education Article, §§13-508 and 13-515, Annotated Code of Maryland **Administrative History:** Effective date: October 12, 1992 (19:20 Md. R. 1816) **Administrative History:** Chapter recodified from COMAR 14.22.09 to COMAR 30.09.09, August, 1997 **Administrative History:** Regulations .01—.05, BLS Service, repealed effective January 10, 2000 (26:27 Md. R. 2017) **Administrative History:** Regulations .01—.10, Enforcement, adopted effective January 10, 2000 (26:27 Md. R. 2017) **Administrative History:** Regulation .03J, K amended and L adopted effective October 15, 2004 (31:20 Md. R. 1486) #### Regulation .01 Scope. *COMAR 30.09.09.01* This chapter governs the enforcement of commercial ambulance statutes and regulations. #### Regulation .02 Sanctions. *COMAR 30.09.09.02* A. If a licensee or applicant violates Education Article, §13-515, Annotated Code of Maryland, or this subtitle, SOCALR may: (1) Deny the applicant's application; or (2) Suspend or revoke the licensee's license. B. If a person granted a waiver of the requirements of Education Article, §13-515, Annotated Code of Maryland, by MIEMSS violates the provisions of this subtitle, MIEMSS may rescind the waiver. #### Regulation .03 Prohibited Conduct. *COMAR 30.09.09.03* The following conduct is prohibited: A. Obtaining, attempting to obtain, or maintaining a waiver by fraud or deceit; B. Making a material omission or misrepresentation of fact on an application for a license or a waiver; C. Making a material omission or misrepresentation of fact in response to an inquiry or investigation by SOCALR for the purposes of determining compliance or investigating a complaint; D. Defacing, altering, removing, or obliterating any portion of or any official entry on a license, licensing decal, or waiver issued by SOCALR; E. Interfering with SOCALR in the performance of its duties; F. Failing to pay applicable licensing fees; G. Failing to pay the cost of services and materials provided to the commercial ambulance service by MIEMSS; H. Failing to comply with the requirements of a noncompliance notice or remedial action; I. Receiving multiple noncompliance notices which in SOCALR's judgment are of sufficient quantity, severity, or frequency to require more severe action to ensure the health, safety, and welfare of those persons utilizing the services of a particular commercial ambulance service; J. Violating Education Article, §13-515, Annotated Code of Maryland; K. Violating this subtitle; or L. Under the laws of the United States or of any state, conviction of any owner, Maryland based principal, or individual with substantial control over the finances, operations, or both of the service, for a felony or a misdemeanor that is directly related to the fitness and qualification of the applicant or licensee to provide commercial ambulance services. #### Regulation .04 Complaints. *COMAR 30.09.09.04* A. A commercial ambulance service licensed by SOCALR shall: (1) Have a written procedure for responding to complaints about service; (2) Provide a copy of its complaint procedure to any person upon request; and (3) Notify each complainant of the right to file a complaint with SOCALR if not satisfied with the response of the commercial ambulance service. B. Any person may file a complaint about a commercial ambulance service with SOCALR. C. SOCALR may ask a commercial ambulance service to explain a complaint before SOCALR takes further action on it. D. A complaint not covered by this subtitle may be referred by SOCALR to other appropriate parties for investigation and action. E. A commercial ambulance service shall: (1) Send SOCALR any written complaint made to the commercial ambulance service alleging a potential violation of the Maryland Medical Protocols for Emergency Medical Providers within 5 days of receipt by the commercial ambulance service; (2) Send SOCALR within 14 days a written report of the investigation by the commercial ambulance medical director; (3) Notify SOCALR within 72 hours of receiving a written complaint alleging a potential violation of Education Article, §13-515, Annotated Code of Maryland, or this subtitle; (4) Forward applicable complaints within 5 days of receipt; (5) Attach a written explanation of the ambulance service's position on the complaint; and (6) Explain the current status of the complaint. F. A commercial ambulance service may not retaliate against an employee because the employee: (1) Makes a complaint under this subtitle; or (2) Participates in a proceeding under this subtitle. G. SOCALR does not have jurisdiction over and may not take action on complaints that relate solely to billing matters. #### Regulation .05 Inspections and Investigations. *COMAR 30.09.09.05* A. SOCALR may inspect a commercial ambulance service or commercial ambulance and investigate compliance by a commercial ambulance crew member to: (1) Decide whether to issue a license; (2) Ensure the health, safety, or welfare of the persons who utilize commercial ambulance services; or (3) Respond to a complaint. B. SOCALR may inspect the following to verify eligibility or continued compliance with this subtitle: (1) All premises designated on the application; (2) All commercial ambulances; (3) All required equipment and supplies; (4) The manner of use of required equipment; (5) The manner of operation of the commercial ambulance service; (6) The driver's licenses and health care certification or license issued by MIEMSS for each crew member; and (7) All records regarding the operation of the commercial ambulance service relating to this subtitle, including patient medical records when appropriate. C. SOCALR may conduct confidential conferences with staff or patients during any inspection or investigation. D. Upon request by SOCALR, a commercial ambulance service, and its owners, management, employees, or agents, shall, at reasonable times and without delay, allow SOCALR to enter all premises designated on the application or used in the operation of a commercial ambulance service, and all commercial ambulances used by the commercial ambulance service, for the purpose of an inspection or investigation necessary to ensure compliance with this subtitle. E. Inspections to evaluate eligibility of a commercial ambulance service or a commercial ambulance for a license shall be scheduled with the management of the commercial ambulance service at least 24 hours before the inspection unless otherwise mutually agreed. F. Inspections to ensure continued compliance with this subtitle do not require advance notice. G. Inspection Procedure. SOCALR shall: (1) Identify itself at the inspection site; (2) Inform the commercial ambulance service representative of the purpose for the inspection; and (3) Inform the commercial ambulance service representative when the inspection has been completed. H. SOCALR may inspect a commercial ambulance vehicle at any reasonable time, including whenever it is present at a health care facility or other place of medical care or when picking up, transporting, or discharging any patient. I. Inspections shall be conducted without impeding patient care or unreasonably delaying patient transport unless, in the judgment of SOCALR, the patient care being rendered is detrimental or is reasonably likely to be detrimental to the patient's health, safety, or welfare. J. No one may impede SOCALR in conducting lawful inspections necessary to evaluate compliance with this subtitle. K. SOCALR may, with written permission from a commercial ambulance service's owner, which may include a hold harmless clause, ride on commercial ambulance service calls for the purpose of evaluating compliance with this subtitle. L. SOCALR may conduct surveys of patients served by a commercial ambulance service to evaluate compliance with this subtitle. M. SOCALR may take photographs or videos during an inspection or investigation under this subtitle. N. After the initial investigation, SOCALR may dismiss a complaint or terminate an investigation if it finds the complaint or alleged violation to be: (1) Frivolous; (2) Made in bad faith; (3) Legally or factually insufficient; or (4) Fully resolved to the satisfaction of the SOCALR. #### Regulation .06 Noncompliance Notices. *COMAR 30.09.09.06* A. If SOCALR finds that a commercial ambulance service, a commercial ambulance, or an individual to whom MIEMSS has issued a certification card or license is believed to have violated this subtitle or an order issued by SOCALR, SOCALR may issue a noncompliance notice. B. Each noncompliance notice shall: (1) Be in writing; (2) Describe the alleged violation; (3) Reference the provision of this subtitle that the commercial ambulance service or individual is alleged to have violated; (4) State the proposed remedy or corrective action required; (5) Set a reasonable time for abatement and correction of the alleged violation, if applicable; (6) Specify the reporting mechanism that will be required to confirm the remedy, abatement, or correction of the alleged violation; and (7) Specify any proposed disciplinary action to be taken by SOCALR. C. The noncompliance notice is the final agency action if a party does not timely request a hearing under Regulation .09 of this chapter to contest the noncompliance notice. #### Regulation .07 Summary Suspension of License. *COMAR 30.09.09.07* A. SOCALR may summarily suspend a license for prohibited conduct under this chapter if the public health, safety, or welfare imperatively requires the emergency action. B. If a license is summarily suspended under §A of this regulation, SOCALR shall furnish, within 3 business days, to the licensee whose license is temporarily suspended: (1) Written notice of the temporary suspension, including the finding that a temporary suspension was required; (2) The reasons supporting the finding and the temporary suspension; and (3) An opportunity to be heard. C. The written notice under §B of this regulation shall be: (1) Served personally; or (2) Sent by certified mail to the last known address of the commercial ambulance service. D. For a hearing on a summary suspension under Regulation .09 of this chapter, certain time periods shall be shortened, as specified in Regulation .09 of this chapter. E. The summary suspension is the final action if a party does not timely request a hearing under Regulation .09 of this chapter to contest the summary suspension. #### Regulation .08 Suspension, Revocation, or Remedial Action. *COMAR 30.09.09.08* A. SOCALR may suspend or revoke a license for acts that violate this chapter. B. SOCALR may require appropriate remedial action instead of suspension or revocation of a license. The requirements for the remedial action shall: (1) Be written; (2) Set a reasonable time for abatement; and (3) Specify any proposed disciplinary action to be taken by SOCALR for failure to satisfy the requirements of the remedial action. C. The action taken by SOCALR is the final agency action if a party does not timely request a hearing under Regulation .09 of this chapter to contest the action. D. Upon the suspension or revocation of a commercial ambulance service license the commercial ambulance service shall immediately: (1) Cease operations with all commercial ambulance vehicles; (2) Make a reasonable effort to cease all recallable advertising; and (3) Surrender to SOCALR all commercial ambulance licenses issued to the commercial ambulance service; and (4) Make all licensed commercial ambulances available to SOCALR for removal of the licensing decal by or under the supervision of SOCALR. E. Upon the suspension or revocation of a commercial ambulance license, the commercial ambulance service shall immediately: (1) Cease operations with that specific commercial ambulance; and (2) Surrender the commercial ambulance license to SOCALR; and (3) Make the commercial ambulance available to SOCALR for removal of the licensing decal by or under the supervision of SOCALR. #### Regulation .09 Hearings. *COMAR 30.09.09.09* A. Initiation of a Hearing. (1) If an applicant or licensee has a license denied, suspended, or revoked, or wishes to contest a noncompliance notice or remedial action, the applicant or licensee may request a hearing before an administrative law judge by filing a request for a hearing with SOCALR. The request for a hearing must be received by SOCALR not later than 7 calendar days after the applicant or licensee receives the written denial, suspension, revocation, or noncompliance notice. (2) Within 7 calendar days of receiving a request for a hearing, SOCALR shall forward the request to the Office of Administrative Hearings. (3) A hearing shall be scheduled as soon as practical for all parties and the Office of Administrative Hearings but shall be within the following time periods after receipt of the hearing request by SOCALR: (a) For summary suspensions under Regulation .07 of this chapter, 21 calendar days; or (b) For all other hearings, 60 calendar days. (4) Failure of a party to make a timely request to contest a noncompliance notice, remedial action, or denial, suspension, or revocation of a license shall render the action taken the final agency action. B. Hearing Procedures. (1) A hearing is governed by COMAR Title 28, except as modified in this regulation. (2) For denial of a license, the applicant has the burden of proving, by a preponderance of the evidence, full satisfaction of all requirements and entitlement to the license. (3) For suspensions, revocations, and contested noncompliance or violation notices, SOCALR has the burden of proving, by a preponderance of the evidence, the violation or violations alleged. (4) In a proceeding before an administrative law judge or a court, SOCALR may disclose information that contains or might reveal confidential business information if: (a) The information is relevant to the case at hand; and (b) Before disclosure, the administrative law judge or court that is conducting the proceeding enters an appropriate order to protect confidential business information. C. Final Decision. (1) The decision of the administrative law judge is final as to all factual matters submitted at the hearing. (2) The Executive Director retains the final decision-making authority on all penalties including denial, suspension, or revocation of a license or required remedial action. (3) The administrative law judge shall render a proposed decision on all factual and legal matters and on the recommended penalty within the following time periods after conclusion of the hearing or after receipt of written closing statements or proposed findings of fact, whichever is later: (a) For summary suspensions under Regulation .07 of this chapter, 21 calendar days; or (b) For all other hearings, 60 calendar days. D. Exceptions. (1) Any party dissatisfied with the proposed decision of the administrative law judge may file written exceptions with the Executive Director or the Executive Director's designee as provided in this section: (2) Exceptions shall be received by the Executive Director or the Executive Director's designee within 10 calendar days after receipt of the proposed decision by the excepting party, or within 14 calendar days after the date of the proposed decision, whichever is earlier, and copies shall be promptly served on all other parties to the hearing. (3) If exceptions are timely filed, any other party may file opposing or reply comments with the Executive Director or the Executive Director's designee within 10 calendar days of the date of filing of the original exceptions. The party shall promptly serve copies on all other parties to the hearing. (4) If exceptions are timely filed, the Executive Director or the Executive Director's designee shall consider the proposed decision, the exceptions, and any responses to the exception, and the portions of the administrative record as cited by the parties and as considered necessary. The Executive Director or the Executive Director's designee shall render a final written decision without the receipt of any new evidence, but after the opportunity for oral arguments before the Executive Director or the Executive Director's designee. (5) If exceptions are not timely filed, the Executive Director or the Executive Director's designee shall issue a final decision as soon as possible which shall include adoption or modification of the penalty recommended by the administrative law judge. (6) Unless the Executive Director or the Executive Director's designee orders a summary suspension under Regulation .07 of this chapter, any suspension or revocation of a license shall be stayed during the pendency of timely filed and pursued administrative proceedings, but not after a final agency decision. E. Judicial Review. Final contested case decisions of the Executive Director are subject to judicial review as provided by law. MIEMSS shall be a party to any review. #### Regulation .10 Criminal Penalties. *COMAR 30.09.09.10* A. In addition to the civil remedies provided under this subtitle, a person who violates any provision of this subtitle may be prosecuted criminally for commission of a misdemeanor. B. Upon conviction, a person found guilty of violating any provision of this subtitle is subject to a fine not exceeding $1,000 per violation.