Resolution 2013-04RESOLUTION NO. 2013-04
A RESOLUTION OF THE CITY COUNCIL OF THE CITY
OF GILROY SETTING FEES FOR AMBULANCE
SERVICES
WHEREAS, State law and Gilroy City Code Chapter 7 requires the City to ascertain and
recover costs reasonably borne through fees and charges levied in providing the regulation,
products or services, and allows the City to charge fees for services so long as the amount of
those fees and charges does not exceed the estimated cost required to provide the services for
which the fees or charges are levied; and
WHEREAS, Gilroy City Code Chapter 15, Article XI "Ambulance Permits ", Section
15.130 "Ambulance services; permits and regulation" requires the City to adhere to Chapter XVI
of Division A18 of the Santa Clara County Ordinance relating to permits and regulation of
ground and air ambulance services; and
WHEREAS, 911 ambulance transport and related services provided in accordance with
the Santa Clara County Emergency Medical Services Agreement [approved July 1, 2012] must
comply with the current fee structure approved by the County Board of Supervisors, and
concurrent with Santa Clara County Ordinance; and
WHEREAS, after review and analysis Staff has prepared and recommends the included
Fee for Ambulance Services approved by the Santa Clara County Board of Supervisors, and
concurrent with Santa Clara County Ordinance, as authorized by the City Code; and
WHEREAS, this Resolution is exempt from environmental review pursuant to Section
15273 of the State Guidelines implementing the California Environmental Quality Act of 1970,
as amended.
NOW, THEREFORE, BE IT RESOLVED that the City Council of the City of Gilroy
approves the attached Fees for Ambulance Services attached hereto as "Exhibit A ".
RESOLUTION NO. 2013 -04
\JH \861867.2
102811-04706083
BE IT FURTHER RESOLVED that these fees and charges shall take effect immediately
upon adoption
PASSED AND ADOPTED this 4th day of March, 2013, by the following roll call vote:
AYES: COUNCILMEMBERS: ARELLANO, AULMAN, BRACCO,
LEROE- MUNOZ, TUCKER,
WOODWARD and GAGE
NOES: COUNCILMEMBERS: NONE
ABSENT: COUNCILMEMBERS: NONE
APPROVED:
sJ `
Donald Gage, Mayor
ATTEST:
n �1
411
Shawna Freels, ity Clerk
2 RESOLUTION NO. 2013 -04
WH1861867.2
102811 - 04706083
EXHIBIT "A"
AMBULANCE BILLING AND USER FEES
Table 1. User Fees
Service Levels
Price
ALS -1
1,080.00
ALS -Z
1,080.00
Mileage
35.00
Hourly Ambulance Standby
150.00
Hourly Paramedic - Individual
75.00
Hourly EMT - Individual
50.00
Emergency Medical Services Agreement
03 / 13 / 12 - Exhibit M Page 1 of 3
Table 2. User Fee Schedule for Disposable Supplies and Medications
Equipment/ Su lies
ACTIVATED CHARCOAL
$20.32
AIRWAY NASAL
$22.00
AIRWAY ORAL
$12.00
ALBUTEROL NEBULIZER
$47.00
BAG VALVE MASK
$73.00
BANDAGES TRIANGULAR
$10.00
BED PAN
$10.00
BLANKET, DISPOSABLE
$24.00
BLOOD GLUCOSE TEST
$10.00
BURN PACK
$33.00
BURN SHEET
$37.00
CERVICAL COLLAR
$72.00
COLD HOT PACK
$15.00
CPAP PROCEDURE
$310.00
DEFIB PADS
$44.00
DRESSING - MAJOR
$10.00
DRESSING - MINOR
$10.00
EKG ELECTRODES
$19.00
EKG MONITOR 12 LEAD
$95.00
ENDOTRACHEAL TUBE INTRODUCER GUM ELASTIC BOUGIE
$66.80
GLUCOMETER TEST SUPP
$20.00
HEADBED IMMOBILIZER
$17.00
HEPA MASK, MED LARGE
$25.00
HEPA MASK, SMALL
$25.00
INFUSION SET MICRO
$89.00
INFUSION SET W 3WAY STOPCOCK
$27.00
INTRAVENOUS SALINE LOCK
$52.65
INTRAVENOUS START KIT
$39.97
INTUBATION SUPPLIES
$45.00
IO SUPPLIES
$298.00
KING AIRWAY LTS -D Sizes 3,4,5
$34.19
NON - REBREATHER MASK
$11.00
02MASK CANNULA
$23.00
OB PACK
$80.00
PULSE OXIMETRY
$42.00
RESUSCITATOR VALVE
$31.00
SPLINT ARM
$15.00
Emergency Medical Services Agreement
03/13/12 - Exhibit M Page 2 of 3
SPLINT LEG
$15.00
SPLINTING EXTREM
$72.00
SUCTION TUBE
$31.00
SUCTIONING
$63.00
UNIVERSAL PRECAUTIONS
$28.00
URINAL
$10.00
Medications
ADENOCARD
$55.00
ADENOSINE
$58.00
ALBURETROL
$24.00
ASPRIN
$6.00
ATROPHINE
$17.00
BENADRYL
$17.00
CALCIUM CHLORIDE
$17.00
DEXTROSE 10%
$1.60
DEXTROSE 25%
$28.00
DEXTROSE 50%
$2.50
DOPAMINE
$52.00
DOPAMINE DRIP
$54.00
DUODOTE AUTOINJECTOR
$50.25
EPI 1:1,000 1MG 1CC
$28.00
EPI 1:10,000
$28.00
GLUCAGON
$285.00
GLUCOSE PASTE
$8.71
GLUCOSE TABS
$1.68
LASIX FUROSEMIDE
$40.00
LIDOCAINE DRIP
$22.00
MIDAZOLEM
$1.59
MORPHINE
$17.00
NARCAN
$32.00
NITROPASTE
$7.79
NITROSPRAY
$122.00
NORMAL SALINE FLUSH PLS 10cc
$14.95
NORMAL SALINE 1000cc
$97.00
ONDANSETRON
$34.80
SODIUM BICARB
$30.00
SODIUM THIOSULFATE
$19.83
STERILE WATER
$24.00
Emergency Medical Services Agreement
03 / 13 / 12 - Exhibit M Page 3 of 3
I, SHAWNA FREELS, City Clerk of the City of Gilroy, do hereby certify that the
attached Resolution No. 2013 -04 is an original resolution, or true and correct copy of a city
resolution, duly adopted by the Council of the City of Gilroy at a regular meeting of said Council
held on the 4th day of March, 2013, at which meeting a quorum was present.
IN WITNESS WHEREOF, I have hereunto set my hand and affixed the Official Seal of
the City of Gilroy this 5th day of March, 2013.
Ana Freels,
Clerk of the C4fy of Gilroy
(Seal)