| (5: THEA oo
¥N P.O. Box 994 @ Saranac Lake, NY 12983 @ (618) SobB6Hrext- 27
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howe
ey ec, 1993 KG J- bg 3
Cory!
Mr. Peter Repos, Legislative Director
Office of Senator Ronald Stafford
State Capitol, Room SOeC Ly
Albany, NY 12247 y
Dear Peter:
Please accept my belated thanks For attending the Eleanor
Roosevelt Community Service Awards presentation last month.
Michael 2emany and I also appreciated the time you took to
speak with us. It was great to Finally meet you.
At your request, please find enclosed LIFE FLIGHT’s proposed
1993-S4% operating budget. It’s hard to believe that we are
beginning our Fourth year of service. Many changes have occur-
red during this time and 1992, especially, will be remembered
os a year oF growth.
During 1992, we experienced a 17% increase in the number of:
transports, including more on-scene calls. This increase
initiated a discussion that ultimately resulted in relocating
LIFE FLIGHT offices to a building near the hangor, where the
New York State Police helicopter is stationed.
Also during 1992, we added a Chief Flight Nurse/Clinical Coor-
dinator to the staff. This position was primarily created to
provide a continuity of patient care. The combination of the new
location and another staff member have been additional expenses,
but they have also proven to be essential.
As I write this letter, our Chief Flight Nurse and a volunteer
aqir crew member are in the process of transporting LIFE FLIGHT’s
e9S3th patient. A woman in premature labor is being flown From
Massena Memorial Hospital to the Medical Center Hospital of
Vermont in Burlington. She has gone into labor 10 weeks before
the pregnancy reaches its term. This type of patient greatly
benefits From air medical transport becuuse not only is the
mother at risk, but also the unborn child.
In crder to address the added financial responsibility of our
recent expansion, a Program Developer has been hired to research
and identify further means of support. This support will be
especially necessary as LIFE FLIGHT responds to the increasing
Health care needs of the region. And as historically evidenced,
LIFF FLIGHT will be called upon more Frequently to assist in
caring For criticolly ill or seriously injured patients.
CO pel ay
Mc. Peter Repas Page 2
January 20, 1993
Even with the addition of a Chief Flight Nurse, we continue to
experience difficulty in providing our level of service on a
voluntary basis. While the core of the LIFE FLIGHT program will
Qlways be our volunteer medical professionals, we can no longer
rely solely on volunteers to be on-call 24 hours a day, seven
Gays a week. It is the goal of our Board of Directors to hire
another Flight Nurse/Medic by January 1, 195854.
As LIFE FLIGHT strives to maintain its High level of care, it
will be necessary to continue to rely on present funding sources
to meet our current operating budget. We must, therefore, again
agppeal to Senator Stafford for Financial assistance. I would
like to take this opportunity to request that consideration be
given to awarding LIFE FLIGHT a $50,000 member item appropriation
in the 1993-34 budget to be applied towards Operating expenses.
LIFE FLIGHT, and the residents and visitors of the North Country,
Owe a tremendous debt of gratitude to Senator Stafford. His
commitment to the medevac concept has truly meant a difference
between life and death for many people. We are all very grate-
Ful, and are hopeful that the Senator will be able to extend his
continued support.
We also owe a lot to you and Tom Grant for everything you have
both done to keep LIFE FLIGHT a regional reality. I hope to hear
from you soon regarding the ideas we discussed at our meeting,
specifically creating an air ambulance tox district and/or
obtaining funding through the Department of Health. I will also
be eager to hear about the status of our 1992-93 Grant funding as
the cre-appropriation process begins.
Thanks again for your time and assistance, Peter. Please do not
hesitate to contact me if you have aqny questions or require
additional information. I look forward to talking with you in
the near future.
gum Vii Jed [Maer (LS
ebb Cf 7,
Deborah D. Mueller (7 A (AWM p* « he
Program Coordinator
/ddm
enclosure
cc: Tom Grant, Legislative Coordinator
Michael Zemany, President, North Country LIFE FLIGHT
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| 1988 REGULAR SESSION
Ch. 24
PERSONS SUBPOENAED—FEES AND TRAVEL EXPENSES
CHAPTER 23
A. 7268
Memorandum relating to this chapter, see Judiciary Memoranda, post
Approved March 28, 1988, effective Jan. 1, 1989
AN ACT to amend the civil practice law and rules, in relation to fees of persons subpoenaed
The People of the State of New York, represented in Senate and Assembly, do enact
as follows:
1. Subdivision (a) of section eight thousand one of the civil practice law and rules, is
amended to read as follows:
subpoena, whet
ance two fifteen dollars for attendance fees and eight twenty-three cents as travel
expenses for each mile to the place of attendance from the place where he or she was
served, and return. There shall be no mileage fee for travel wholly within a city.
9. This act shall take effect on the first day of January next succeeding the date on
which it shall have become a law.
VOLUNTEER AMBULANCE WORKERS’ BENEFIT LAW
CHAPTER 24
A. 8515-B
Memorandum relating to this chapter, see Legislative Memoranda, post
Approved March 28, 1988, effective Jan. 1, 1989
AN ACT to amend the town law, the education law, the election law, the estates, powers and
trusts law, the executive law, the general municipal law, the insurance law, the municipal
home rule law, the village law, the New York state defense emergency act and the workers’
compensation law, in relation to the establishment of ambulance districts and to enact
chapter sixty-four-B of the consolidated laws, to be the volunteer ambulance workers’ benefit
law, in relation to volunteer ambulance workers
The People of the State of New York, represented in Senate and Assembly, do enact
as follows:
§ 1. Section one hundred ninety of the town law, as amended by chapter six hundred
twenty-two of the laws of nineteen hundred eighty-four, is amended to read as follows:
parking, lighting, snow removal, water supply, sidewalk, a fallout shelter district or
refuse and garbage district, aquatic plant growth control district, ambulance district, and
in any town bordering upon or containing within its boundaries any navigable waters of
this state, a harbor improvement district, a public dock district, or beach erosion control
district, and provide improvements or services, or both, in any such district, wholly at the
expense_of the district; but no water supply district shall be established or extended to
include lands situate within the boundaries of a water district. No such district shall be
established or extended in a city or in an incorporated village provided, however, that suc
; oe , ‘ er Rene eR SY NC NEE TR
Additions in text are indicated by underline; deletions by strikeouts 65
mitmntn
Ch. 24 LAWS OF NEW YORK
a_district may be established or ly or partly within an incorporated village
on consent of the village expressed in a local law, ordmance OF Tesolution, su Hee a
Ser akan De amt Reais , pepe ep pene xd ax liciiiesntthamteademietens sadar“dhe pw, ve yt
referendum on petition under section twenty-four of the Municipal home.rule law or a
permissive-referéndtim under article nine.of..the..villagelaw,!as. the. case may be, and
except, in the case of a water quality treatment district, on consent of a village expressed
in a local law or by resolution of the board of trustees and not subject to any referendum.
‘Village Law § 9-900 et seq.
§ 2. Section one hundred ninety-three of such law, as amended by chapter six hundred
twenty-two of the laws of nineteen hundred eighty-four, is amended to read as follows:
§ 193. Notice of hearing on petition
Wheneyer a.petition shall be presented to the town board pursuant to this article, for
the establishment or extension of a sewer wastewater disposal drainage, water, water
quality treatment, park, public parking, lighting, snow removal, water supply, sidewalk,
refuse and garbage, aquatic plant growth contro] district, ambulance district, harbor
improvement district, public dock district, beach erosion control district, or a fallout
shelter district, the board shall adopt an order and enter the same in the minutes. of its
proceedings, saciid In Ms the tiling of such petition, the boundaries of the
ee - PARE St ES BES = PP eae F Pehae 86 SU Avg) SEA NITEM NG WF ME ieeidiie
proposéd™district; the improvements proposed, the maximum amount proposed to be
7 ie Samet HS 6 Qn aytea . marr 7 ~ estes ins Sreenniieies ania tmidtalig
e ment as Stated in thé petition or the Maxiniinramiount’ tobe
a 2 RED AB PDS : ORV EBay SRyeee
expende ormancé ing of services if 4a maximum amount is stated in
ion, and speci Time the ime when and place“wheré Said board will meet’ to
consider the petition and to hear all persons interested in the subject thereof, concerning
‘the same. The board shall cause a Copy of “Such Order, Certified bY the town clerk tobe"
published at least once in the official paper, the first publication thereof to be not less
than ten nor more than twenty days before the day set therein for the hearing as
aforesaid, and shall also cause a copy thereof to be posted on the signboard of the town
maintained pursuant to subdivision six of section thirty of this chapter, not less than ten
nor more than twenty days before the day designated for the hearing as aforesaid.
§ 3. Section one hundred ninety-eight of such law is amended by adding a new
subdivision ten-f to read as follows:
10-f. Ambulance districts. After an ambulance district has been established, includ-
ing ambulance districts established | prior to the effective date of this subdivision pursuant
to this article and article twelve-A of this chapter ! or any other provision of law, the town
board may:
(a) provide an emergency medical service, a general ambulance service, or a combina-
tion of such services for the purpose of providing prehospital emergency medical
treatment or transporting sick or injured persons found within the boundaries of the
district_to_a hospital, clinic, sanitorium, or other place for treatment of such illness or
injury, and to that end may: stat ONTO aOn estan
(i) Acquire by gift or purchage one or more motor vehicles Suitable for such purpose
and supply and equip the same with such materials and facilities as it may consider
necessary for prehospital emergency treatment, and may operate, maintain, repair and
replace such vehicles and such supplies and equipment;
(ii) Contract with one or more individuals, municipal corporations, associations, or other
organizations having sufficient trained and experienced personnel except an emergency
rescue and first aid squad of a fire department or fire company which is subject to the
provisions of section two hundred nine-b of the general municipal law for operation,
maintenance and repair of such emergency medical service or ambulance vehicles and for
the furnishing of prehospital emergency treatment;
(ii) Contract with one or more individuals, municipal corporations, associations, or other
organizations except an emergency rescue and first aid squad of a fire department or fire
company which is subject to the provisions of section two hundred nine-b of the general
municipal law to supply, staff and equip emergency medical service or ambulance vehicles
66 Additions in text are indicated by underline; deletions by strikeouts
1988 REC
suitable f
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1Town Lav
2Town Law |
§ 4. Su
one thousa
as follows.
3. The
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1988 REGULAR SESSION Ch. 24
suitable for such purposes and operate such vehicles for the furnishing of prehospital
emergency treatment;
(iv) Employ any combination of the methods authorized in subparagraphs (i), (ii) and (iii)
of this paragraph;
(b) formulate rules and regulations relating to the use of such apparatus and equip-
ment in the provision of emergency medical services or ambulance service, fix a schedule
of fees or charges to be paid by persons requesting the use of such facilities, provide for
the collection of such fees and charges, or formulate rules and regulations for the
collection thereof by the individuals, municipal corporations, associations, or other orga-
nizations furnishing service under contract as provided in subparagraph (ii) of paragraph
(a) of this subdivision;
(c) purchase or provide insurance indemnifying against liability for the negligent
operation of such emergency medical service or ambulance service and the negligent use
of other equipment or supplies incidental to the furnishing of such emergency medical
service or ambulance service;
(d) provide for the administration and coordination of such emergency medical service
or ambulance service including but not limited to operation of an emergency medical
communications system and medical control; and
(e) establish by local law a district board of ambulance commissioners, and delegate
ministerial functions related to the operation of the ambulance district to the commission-
ers. The district board of ambulance commissioners shall act in an advisory capacity to
the town board with regard to other functions related to the operation of the district.
The town board may appoint members to the district board of ambulance commissioners
or may provide that the commissioners be elected pursuant to the procedures in article
thirteen of this chapter” for the election of improvement district commissioners. If
appointed by the town board, the town board shall appoint the members to terms so fixed
that at least one will expire at the end of each calendar year. No term shall exceed three
years.
1Town Law § 209 et seq.
2Town Law § 210 et seq.
§ 4. Subdivision three of section two hundred two of such law, as amended by chapter
one thousand ninety-one of the laws of nineteen hundred seventy-one, is amended to read
as follows:
3. The expense of the establishment of a park, public parking, water, lighting, snow
removal, water supply, water, water storage and distribution, sidewalk, refuse and
garbage, aquatic plant growth control district, ambulance district, harbor improvement
district, public dock district, fallout shelter district, or beach erosion control district, and
providing improvements or services, or both, therefor, and of constructing lateral water
mains pursuant to paragraph (b) of subdivision one of section one hundred ninety-nine,
shall be assessed, levied and collected from the several lots and parcels of land within the
district for each purpose in the same manner and at the same time as other town charges,
except as otherwise provided by law. In the event that any order adopted pursuant to
section two hundred nine-d of this chapter for the establishment of a water district,
sidewalk district, a public parking district, a refuse and garbage district, an aquatic plant
growth control district, or beach erosion and control district or that any petition for the
establishment of a water district, sidewalk district, a public parking district, a refuse and
garbage district, an aquatic plant growth control district, or beach erosion control district,
shall contain a statement that the cost of constructing the water system, sidewalks, or
acquiring and improving lands for public parking or for refuse and garbage purposes or
for beach erosion control, or for aquatic plant growth control, shall be assessed by the
town board in proportion as nearly as may be to the benefit which each lot or parcel will
derive therefrom, the amount to be raised for the payment of the principal and interest of
the bonds issued for the construction of the water system, sidewalks, or acquiring and
improving lands for public parking or for refuse and garbage purposes or for beach
erosion control, or for aquatic plant growth control, pursuant to such petition or order,
Additions in text are indicated by underline; deletions by strikeouts 67
Ch. 24 LAWS OF NEW YORK
shall be assessed on the lands within such district in the same manner as provided in the
case of trunk sewers. The expense of constructing lateral water mains pursuant to
paragraph (c) of subdivision one of section one hundred and ninety-nine shall be assessed,
levied and collected from the several lots and parcels of land within the district in
proportion to the area of such lot or parcel of land to the total area of the district.
§ 5. Section two hundred nine-a of such law, as amended by chapter three hundred
eighty-eight of the laws of nineteen hundred eighty, is amended to read as follows:
§ 209-a. Definition
For the purposes of this article the term “improvement district” shall include only a
sewer, wastewater disposal, drainage, water, park, public parking, lighting, snow remov-
al, water supply, sidewalk, refuse and garbage or, aquatic plant growth control or
ambulance district in any town, and, in any town bordering upon or containing within its
boundaries any navigable water of this state a public dock or beach erosion control
district.
§ 6. Paragraph (d) of subdivision one of section four hundred fourteen of the edu-
cation law, as amended by chapter two hundred fifty-seven of the laws of nineteen
hundred seventy-six, is amended to read as follows:
(d) For meetings, entertainments and occasions where admission fees are charged,
| when the proceeds thereof are to be expended for an educational or charitable purpose;
but such use shall not be permitted if such meetings, entertainments and occasions are
under the exclusive control, and the said proceeds are to be applied for the benefit of a
society, association or organization of a religious sect or denomination, or of a fraternal,
secret or exclusive society or organization other than organizations of veterans of the
military, naval and marine service of the United States and organizations of volunteer
firemen firefighters or volunteer ambulance workers.
| § 7. Section 3-224 of the election law is amended to read as follows:
§ 3-224. Voting machines; use of by other than the board of elections
The board of elections or the local legislative body of a city or town, may permit towns,
villages, school districts, fire, ambulance, water, sanitation, police and other special
districts within the county to use voting machines and other equipment owned by it and
used for the conduct of elections or for educational and instructional purposes, upon such
rental and other terms and conditions as shall be fixed by it. Such board or body may
similarly permit the use of such machines by associations and organizations for the
conduct of elections where it judges the use of such machines for elections conducted by
such associations and organizations will be in the public interest.
§ 8. Subdivision two of section 3-500 of such law is amended to read as follows:
2. The board of elections of such county shall have and exercise the powers and duties
under this chapter, not inconsistent with this section, of all other officers, boards or
bodies in the county of Monroe who are charged with the conduct of elections and matters
preliminary or relating thereto, except village, school, fire, ambulance and other special
district elections. Such board of elections shall direct the purchase or lease of voting
machines, of a kind authorized by law, which shall be selected by such board. All voting
machines and all appliances and equipment relating to or used in the conduct of elections
shall be in the care, custody and control of the board of elections. Such board may cause
all necessary repairs and alterations to be made and employ such help as may be
necessary in making such repairs and in moving, setting up and caring for all election
materials, equipment and appliances, including voting machines, in its custody. All
supplies, equipment or election appliances to be used or furnished by such board shall be
purchased by the county purchasing agent. All expenses of such board of elections shall
be certified, audited and paid as are other claims against the county, and all expenses
connected with elections and matters preliminary or relating thereto, except compensation
of inspectors and clerks of election and the rental of town polling places and except
expenses or parts thereof to be apportioned pursuant to this chapter to a city or town and
borne by it shall be a county charge. However, any city, town or village in such county,
68 Additions in text are indicated by underline; deletions by strikeouts
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1988 REGULAR SESSION
by its common council, town board or village trustees, may assume the payment of the
cost of purchasing voting machines.
§ 9. Subdivision three of section 3-502 of such law is amended to read as follows:
3. The board of elections of such county shall have and exercise the powers and duties
under this chapter, not inconsistent with this section, of all other officers, boards or
bodies in the county of Nassau charged with the conduct of elections and matters relating
thereto, except village, school, fire, ambulance and other special district elections. Such
board of elections shall direct the purchase or lease of voting machines of a kind
authorized by law and all appliances and equipment relating to or used in the conduct of
elections which shall be selected by such board. All voting machines and all appliances
and equipment relating to or used in the conduct of elections shall be in the care, custody
and control of the board of elections. Such board may cause al] necessary repairs and
alterations to be made and employ such help as may be necessary in making such repairs
and in moving, setting up and caring for all election materials, equipment and appliances,
including voting machines. All supplies, equipment or election appliances to be used or
furnished by such board shall be purchased by such board unless otherwise provided by
ordinance of the local legislative body. All expenses of such board of elections shall be
certified, audited and paid as are other claims against the county, and all expenses
connected with elections and matters preliminary or relating thereto, including compensa-
tion of inspectors and clerks of election, shall be a county charge.
§ 10. Paragraph (b) of section 8-1.4 of the estates, powers and trusts law, as amended
by chapter two hundred nine of the laws of nineteen hundred eighty-three, is amended to
read as follows:
(b) The registration and reporting provisions of this section do not apply to (1) the
United States, any state, territory or possession of the United States, the District of
Columbia, the Commonwealth of Puerto Rico or to any of their agencies or governmental
subdivisions, (2) any trustee which is required by any other provision of law to render a
full, complete and itemized annual report to the congress of the United States or to the
legislature of this state, (3) corporations organized under the religious corporations law
and other religious agencies and organizations, and charities, agencies and organizations
operated, supervised or controlled by or in connection with a religious organization, (4)
educational institutions incorporated under the education law or by special act, (5) any
hospital, (6) fraternal, patriotic, veterans, volunteer firemen firefighters, volunteer ambu-
lance workers, social, student or alumni organizations and historical societies chartered by
the New York state board of regents, (7) a trust for which there is a corporate trustee
acting as sole trustee or co-trustee under the terms of a will of a decedent who died
domiciled in a state other than New York or a trust instrument executed by a non-resident
of the state of New York, (8) any trust in which and so long as the charitable interest is
deferred or contingent, (9) any person who, in his capacity as an officer, director or
trustee of any corporation or organization mentioned in this paragraph, holds property for
the religious, educational or charitable purposes of such corporation or organization, (10)
any cemetery corporation subject to the provisions of section one thousand four hundred
two of the not-for-profit corporation law.
§ 11. Subdivision four of section four hundred thirty-two of the executive law, as
amended by chapter four hundred thirty-seven of the laws of nineteen hundred sixty-two,
is amended to read as follows:
4. “Authorized organization” shall mean any bona fide religious or charitable orga-
nization or bona fide educational, fraternal, civic or service organization or bona fide
organization of veterans er, volunteer firemen firefighters, or volunteer ambulance
workers, which by its charter, certificate of incorporation, constitution, or act of the
legislature, shall have as its dominant purpose or purposes one or more of the lawful
purposes as defined in the bingo licensing law, provided that each shall operate without
profit to its members, and provided that each such organization has engaged in serving
one or more of the lawful purposes as defined in the bingo licensing law, article
fourteen-h fourteen-H of the general municipal law,! for a period of one year immediately
prior to applying for a license under the licensing law.
! General Municipal Law § 475 et seq.
Additions in text are indicated by underline; deletions by strikeouts
1N.Y.Laws '88—3 —
Ch. 24
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Ch. 24 LAWS OF NEW YORK
to read as follows:
8. Inapplicability of section. This section shall not apply to claims arising under the
provisions of the werkmen’s workers’ compensation law, er the volunteer firemen’s
firefighters’ benefit law, or the volunteer ambulance workers’ benefit law or to claims
against public corporations by their own infant wards.
§ 13. Subdivision one of section fifty-h of such law, as amended by chapter twenty-
two of the laws of nineteen hundred seventy-six, is amended to read as follows:
1. Wherever a notice of claim is filed against a city, county, town, village, fire district,
provided in this section shall in no way affect the right of a city, county, town, village, fire
district, ambulance district or school district in a subsequent action brought upon the
claim to demand a physical examination of the plaintiff pursuant to statute or court rule.
§ 14. Subdivision four of section four hundred seventy-six of such law, as amended by
chapter four hundred thirty-eight of the laws of nineteen hundred sixty-two, is amended
to read as follows:
4. “Authorized organization” shall mean and include any bona fide religious or
members, and provided that each such organization has engaged in serving one or more
§ 15. Paragraph seven of subsection (b) of section four thousand two hundred sixteen
of the insurance law, as amended by chapter nine hundred twenty-three of the laws of
nineteen hundred eighty-six, is amended to read as follows:
(7) A policy insuring the members of one or more troops or units of the state troopers
or state police of any state, issued to the commanding officer of the state troopers or
70 Additions in text are indicated by underline: deletions by strikeouts
198&
som:
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1988 REGULAR SESSION Ch. 24
some beneficiary or beneficiaries, other than such commanding officer or such association
or any of its officials, as such, and shall also provide for the issuance of a certificate to
the policyholder for delivery to the person insured or to such beneficiary, as evidence of
such insurance. For the purposes of this paragraph any association currently holding
premium dividends as a result of policies issued under this section shall be permitted to
maintain said dividends for the general purposes of the entire membership. For the
purposes of this paragraph the term “eligible members of an association of volunteer
firefighters or volunteer ambulance workers’? means members who perform services in
fire-fighting duties or members of a volunteer exempt fire benevolent association who are
entitled to benefits from the expenditures of foreign fire insurance tax moneys, including,
inactive exempt volunteer firefighters as defined by section two hundred of the general
municipal law or in ambulance-related duties, respectively. The amounts of insurance
may be based upon a plan which permits a limited number of selections by the members if
the selections offered utilize a consistent pattern of grading the amounts of insurance for
individual group members so that the resulting pattern of coverage is reasonable.
§ 16. Paragraph g of subdivision three of section thirty-four of the municipal home
rule law is amended to read as follows:
g. In this chapter or in the civil service law, condemnation eminent domain procedure
law, environmental conservation law, election law, executive law, judiciary law, labor law,
local finance law, multiple dwelling law, multiple residence law, public authorities law,
public housing law, public service law, railroad law, retirement and social security law,
state finance law, volunteer firemen’s firefighters’ benefit law, volunteer ambulance
workers’ benefit law, or werkmen’s workers’ compensation law.
§ 17. Subdivision one of section 3-308 of the village law is amended to read as follows:
1. The board of trustees may establish or abolish a board or boards of fire, ambulance,
water, light, sewer, park or cemetery commissioners or a single municipal board having
the powers, duties and responsibilities of two or more such separate boards.
§ 18. Subdivision two of section one hundred thirteen of chapter seven hundred
eighty-four of the laws of nineteen hundred fifty-one, constituting the New York state
defense emergency act, as amended by chapter two hundred thirty-one of the laws of
nineteen hundred sixty-one, is amended to read as follows:
2. The provisions of this section shall not affect the right of any person to receive
benefits to which he may be entitled under the werkmen’s workers’ compensation law,
volunteer firemen’s firefighters’ benefit law, volunteer ambulance workers’ benefit law,
any pension law or the general municipal law, nor the right of any person to receive any
benefits or compensation under any act of congress or under any law of this state.
§ 19. Subdivision nine of section two of the workers’ compensation law, as amended
by chapter eight hundred twenty-seven of the laws of nineteen hundred eighty-seven, is
amended to read as follows:
9. “Wages” means the money rate at which the service rendered is recompensed
under the contract of hiring in force at the time of the accident, including the reasonable
value of board, rent, housing, lodging or similar advantage received from the employer, or
in the case of (a) a civil defense volunteer, (b) a volunteer worker in a state department as
provided in group sixteen of subdivision one of section three of this chapter, (c) a
volunteer worker for a social services district as provided in group seventeen of subdivi-
sion one of section three of this chapter, (d) a county fire coordinator, a deputy county fire
coordinator or a comparable county official to whom the provisions of group fifteen-a of
subdivision one of section three of this chapter are applicable, who is also a volunteer
firefighter or ambulance worker, (e) a fire district officer whether elective or appointive
and whether or not he is compensated for his services or a paid fire or ambulance district
employee, (f) an
Additions in text are indicated by underline; deletions by strikeouts 71
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Ch. 24 LAWS OF NEW YORK
performing services for a public or not-for-profit corporation, association, institution or
agency organized as an unincorporated association or duly incorporated under the laws of
this state in fulfillment of a sentence of probation or of conditional discharge, or persons
performing such services pursuant to the provisions of section 170.55 or 170.56 of the
criminal procedure law, §) (i) an auxiliary policeman in a municipal corporation which
elected to include such persons within the definition of “employee” as authorized by
subdivision four of this section, or &) (j) a duly appointed member of a regional hazardous
materials incidents team recognized under section two hundred nine-y of the general
municipal law, such money rate applying in his regular vocation or the amount of the
regular earnings of such volunteer, coordinator, instructor, or comparable officer, fire or
ambulance district officer or employee or call fireman, or team member as the case may
be, in his regular vocation, plus any amount earned as such a coordinator, instructor or
comparable officer, or as such a fire or ambulance district officer or employee or call
fireman or team member, provided, however, that in no event shall the average weekly
wage be fixed at less than thirty dollars regardless of whether or not such volunteer,
coordinator, instructor or comparable officer or fire or ambulance district officer or
employee or call fireman or team member had gainful employment elsewhere at the time
of the injury.
§ 20. Group nineteen of subdivision one of section three of such law, as amended by
chapter four hundred eighty-nine of the laws of nineteen hundred eighty-four, the third
unnumbered paragraph as amended by chapter seven hundred sixty of the laws of
nineteen hundred eighty-six, is amended to read as follows:
Group 19. An employer may bring an employment that is not listed in this section
within the coverage of this chapter by securing compensation to his employee or
employees engaged in such employment in accordance with section fifty of this chapter.
Any municipal corporation or other political subdivision of the state may bring its
employees or officers, elective or appointed or otherwise, not enumerated in groups one to
seventeen of subdivision one of this section inclusive, of this chapter within the coverage
of this chapter by appropriate action of the legislative or governmental body of the
municipal corporation or political subdivision, notwithstanding the definitions of the terms
“employment,” “employer” or “employee” in subdivisions three, four and five of section
two of this chapter; and by separate and distinct action of said legislative or governmen-
tal body may bring within the coverage of this chapter any group, as defined by order of
the New York state civil defense commission, of civil defense volunteers not enumerated
in group seventeen of subdivision one of this section, who are personnel of a volunteer
agency of the local office of such municipal corporation or other political subdivision, as
defined in the state defense emergency act, as to their authorized civil defense services to
the extent not covered under article ten of this chapter.' Where one or more groups of
such civil defense volunteers of a county office of civil defense are not brought within the
coverage of this chapter by the county, a town or a village in such county or a city
participating in the consolidated county office of civil defense of such county may, by
separate and distinct action of its legislative or governmental body, bring the members of
such group or groups of duly enrolled civil defense volunteers who are residents of and
are enrolled from such town, village or city within the coverage of this chapter during any
period when the county has not so provided; however, whenever a county brings one or
more groups of its civil defense volunteers within the coverage of this chapter, such other
coverage of members of such group or groups by the town, village or city shall be deemed
terminated to the extent and as of the date coverage is afforded by the county. A village
may not provide such coverage during any period coverage is provided by a town in which
the village is located, except where there is a deputy director of civil defense for a village
not wholly within one town.
i2 Additions in text are indicated by underline; deletions by strikeouts
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1988 REGULAR SESSION
A public or not-for-profit corporation, association, institution or agency organized as ai
unincorporated association or duly incorporated under the laws of this state shall be
deemed to be an employer of persons who are performing services for it pursuant to
paragraphs (h) and (i) of subdivision two of section 65.10 of the penal law in fulfillment of
a sentence of probation or of conditional discharge and of persons performing such
services pursuant to the provisions of section 170.55 or 170.56 of the criminal procedure
law, and such persons shall for the purposes of this chapter be deemed to be employees
for the public or not-for-profit corporation, association, institution or agency. Said
employer may elect to bring such employees within the coverage of this chapter by
securing compensation in accordance with the terms of section fifty of this chapter.
1 Worker's Compensation Law § 300 et seq.
§ 21. Paragraph d of subdivision four of section fifty of such law, as amended by
chapter three hundred seventy-three of the laws of nineteen hundred sixty-two, is
amended to read as follows:
d. A contract of insurance issued to a county or a town in accordance with subdivision
one or two of this section and in force on or after the first day of March, nineteen
hundred sixty-three, in relation to fire districts and on or after the first day of January, in
the year in which this paragraph as hereby amended becomes effective in relation to
ambulance districts shall contain a provision reading as follows: “This contract does not
provide (1) any coverage under the Workmen's Workers’ Compensation Law or the
Volunteer Firemen’s Firefighters’ Benefit Law or the Volunteer Ambulance Workers’
Benefit Law for which any fire district or ambulance district would be liable under such
laws, (2) any werkmen’s workers’ compensation benefits for fire or ambulance district
officers and employees for which any fire district or ambulance district would be liable
under the Workmen's Workers’ Compensation Law, or (3) any volunteer firemen’s
firefighters’ or ambulance workers’ benefits for any volunteer firemen firefighters or
volunteer ambulance workers under the Volunteer Firemen’s Firefighters’ Benefit Law or
the Volunteer Ambulance Workers’ Benefit Law”.
§ 22. Subdivision six-a of section fifty-four of such law, as added by chapter seven
hundred eighty-eight of the laws of nineteen hundred sixty, is amended to read as follows:
6-a. Insurance contracts with fire or ambulance districts. Notwithstanding any other
provision of this section or of this chapter, any insurance contract to secure W _
workers’ compensation for a fire or ambulance district pursuant to subdivision one or
subdivision two of section fifty of this chapter issued to take effect on or after July first,
nineteen hundred sixty, in relation to a fire district and January first, in the year next
succeeding the year in which this Subdivision as hereby amended becomes effective, in
relation to an ambulance district or any such contract renewed to continue in effect on or
after such date dates, shall provide werkmen's workers’ compensation coverage for all
fire or ambulance district officers, whether elective or appointive, and all fire or ambu-
lance district employees, whether or not they are compensated for their services, unless
the board of fire or ambulance commissioners of the fire district or ambulance district by
resolution elects not to provide such coverage for any one or more of such officers or
employees, or class thereof. Such election not to provide such coverage shall be effective
with respect to all such insurance contracts thereafter issued to such fire or ambulance
district by any insurance carrier until revoked in whole or in part by resolution of the
board of fire or ambulance commissioners of the fire or ambulance district. Such election
not to provide such coverage shall not become effective until thirty days after a copy of
such resolution has been filed with the chairman of the workmen's workers’ compensation
board and with the insurance carrier and a copy thereof is furnished to each officer and
employee as to whom such revocation is applicable. The chairman of the workmen's
workers’ compensation board shall prescribe the form of such resolution. The provisions
of this subdivision shall not be applicable in cases where the injury arises out of and in the
course of duty as a volunteer fireman firefighter or a volunteer ambulance worker or as a
Additions in text are indicated by underline; deletions by strikeouts 73
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Ch. 24 LAWS OF NEW YORK
civil defense volunteer and where the computation of benefits would be made under the
provisions of the volunteer firemen’s firefighters’ benefit law or the volunteer ambulance
workers’ benefit law or under article ten of this chapter.!
1 Worker’s Compensation Law § 300 et seq.
§ 23. Subdivision seven of section sixty of such law, as amended by chapter nine
hundred seventy-six of the laws of nineteen hundred fifty-eight, is amended to read as
follows:
firemen’s benefit law, and the volunteer ambulance workers’ benefit law except as
otherwise provided in section sixty-one of this chapter.
§ 24. Subdivision five of section sixty-one of such law, as amended by chapter seven
hundred fifty-five of the laws of nineteen hundred sixty-five, is amended to read as
follows:
5. Ifa local law has been adopted pursuant to either subdivision three or subdivision
four of this section, the board of Supervisors may, notwithstanding the provisions of
paragraph f of subdivision one of section eleven of the municipal home rule law, adopt a
provisions of subdivision three of section sixty-three of this chapter shall be applicable in
relation to such plan, after the thirty-first day of December in such year, and, further, the
provisions of section sixty-seven of this chapter shall be applicable on and after the first
day of August in such year in relation to such plan.
§ 25. Subdivision eight of section sixty-three of such law, as added by chapter one
hundred eighty-one of the laws of nineteen hundred sixty, is amended and a new
subdivision nine is added to read as follows:
9. Where a town participates in a plan, in addition to payments with respect to the
liability of the town, the county shall make payments with respect to that portion of the
town outside cities, villages, ambulance districts, arising out of the death of or injury to
volunteer ambulance workers; provided, however, that the county shall not be obligated
towns in which such village or ambulance district is located are not participants in the
plan. The term “injury”, as used in this subdivision, means “injury” as defined in
subdivision four of section three of the volunteer ambulance workers’ benefit law, as
amended from time to time.
the laws of nineteen hundred fifty-six, subdivision two as amended by chapter seven
74 Additions in text are indicated by underline; deletions by strikeouts
1988 |
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1988 REGULAR SESSION Ch. 24
hundred fifty-one of the laws of nineteen hundred fifty-seven, is amended to read as
follows:
§ 100. Insurance against liability to volunteer firemen firefighters and ambulance
workers
Insurance contracts issued by the state insurance fund to insure political subdivisions
against liability in relation to volunteer firemen firefighters or volunteer ambulance
workers under the volunteer firemen’s firefighters’ benefit law or the volunteer ambu-
lance workers’ benefit law shall be designated “volunteer firemen’s firefighters’ benefit
insurance” or ‘“‘volunteer ambulance workers’ benefit insurance’’. The provisions of this
article which are not inconsistent with such law laws shall be applicable in relation to such
insurance. The following terms used in this article, unless inconsistent with the volunteer
firemen’s firefighters’ benefit law or the volunteer ambulance workers’ benefit law, are
hereby enlarged as follows:
1. “Employer” includes any political subdivision liable for benefits pursuant to the
volunteer firemen’s firefighters’ benefit law or the volunteer ambulance workers’ benefit
law.
2. “Employee” includes a volunteer fireman firefighter or volunteer ambulance work-
er who has been or might be injured in line of duty or who dies or might die from such an
injury. When a political subdivision or a district or area thereof is responsible for the
payment of benefits pursuant to the volunteer fireman’s firefighters’ benefit law or the
volunteer ambulance workers’ benefit law, it shall be deemed the “employer” of such
“employee.”
3. ‘Workmen's Workers’ compensation” and “compensation” include the benefits in
relation to volunteer fremen firefighters or volunteer ambulance workers pursuant to the
volunteer firemen’s firefighters’ benefit law or the volunteer ambulance workers’ benefit
law.
4. “This chapter” includes the volunteer firemen’s firefighters’ benefit law and the
volunteer ambulance workers’ benefit law, except when such a meaning is inconsistent
with this article.
§ 27. The last two unnumbered paragraphs of section one hundred six of such law, as
amended by chapter thirty-four of the laws of nineteen hundred eighty-seven, are
amended to read as follows:
“Workers’ compensation” and “compensation” include the benefits in relation to vol-
unteer firemen firefighters and volunteer ambulance workers pursuant to the volunteer
firefighters’ benefit law and the volunteer ambulance workers’ benefit law and benefits in
relation to longshore and harbor workers pursuant to the longshore and harbor workers’
compensation act, United States Code, Title 33, Sections 901 through 950.
“This chapter” includes the volunteer firefighters’ benefit law and the volunteer
ambulance workers’ benefit law; and the longshore and harbor workers’ compensation
act, United States Code, Title 33, Sections 901 through 950; except when such a meaning
is inconsistent with this article.
§ 28. Section one hundred fifty-seven of such law, as amended by chapter seven
hundred two of the laws of nineteen hundred fifty-six, subdivision two as amended by
chapter seven hundred fifty-one of the laws of nineteen hundred fifty-seven, is amended
to read as follows:
§ 157. Application of article to volunteer firemen’s firefighters’ benefit law or the
volunteer ambulance workers’ benefit law
The following terms used in this article, unless inconsistent with the volunteer fire-
men's firefighters’ benefit law or the volunteer ambulance workers’ benefit law, are
hereby enlarged as follows:
1. “Employer” includes any political subdivision liable for benefits pursuant to the
volunteer firemen’s firefighters’ benefit law or the volunteer ambulance workers’ benefit
law.
Additions in text are indicated by underline; deletions by strikeouts 15
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Ch. 24
LAWS OF NEW YORK
2. “Employee” includes a volunteer fireman firefighter or volunteer ambulance work-
er who has been or might be injured in line of duty or who dies or might die from such an
injury. When a political subdivision or a district or area thereof is responsible for the
payment of benefits pursuant to the volunteer fireman’s firefighters’ benefit law or the
volunteer ambulance workers’ benefit law, it shall be deemed the “employer” of such
“employee.”
3. “Workmen's Workers’ compensation” and “compensation” include the benefits in
relation to volunteer firemen firefighters or volunteer ambulance workers pursuant to the
volunteer firemen’s firefighters’ benefit law or the volunteer ambulance workers’ benefit
law.
4. “This chapter” includes the volunteer firemen’s firefighters’ benefit law and the
volunteer ambulance workers’ benefit law, except when such a meaning is inconsistent
with this article.
0. _“‘Subdivisions one and two of section fifty”, as used in section one hundred fifty-one
of this chapter, includes subdivision nine of section thirty of the volunteer firefighters’
benefit law and subdivision nine of section thirty of the volunteer ambulance workers’
benefit law.
§ 29. Subdivision two of section two hundred six of such law, as amended by chapter
six hundred forty-four of the laws of nineteen hundred fifty-nine, is amended to read as
follows:
2. If an employee who is eligible for benefits under section two hundred three or two
hundred seven is disabled and has claimed or subsequently claims werkmen’s workers’
compensation benefits under this chapter or benefits under the volunteer fremen’s
firefighters’ benefit law or the volunteer ambulance workers’ benefit law, and such claim
is controverted on the ground that the employee’s disability was not caused by an accident
that arose out of and in the course of his employment or by an occupational disease, or by
an injury in line of duty as a volunteer fireman firefighter or volunteer ambulance
worker, the employee shall be entitled in the first instance to receive benefits under this
article for his disability. If benefits have been paid under this article in respect to a
disability alleged to have arisen out of and in the course of the employment or by reason
of an occupational disease, or in line of duty as a volunteer fireman firefighter or a
volunteer ambulance worker, the employer or carrier or the chairman making such
payment may, at any time before award of workmen's workers’ compensation benefits, or
volunteer firemen’s firefighters’ benefits or volunteer ambulance workers’ benefits, is
made, file with the board a claim for reimbursement out of the proceeds of such award to
the employee for the period for which disability benefits were paid to the employee under
this article, and shall have a lien against the award for reimbursement, notwithstanding
the provisions of section thirty-three of this chapter or section twenty-three of the
volunteer firemen’s firefighters’ benefit law or section twenty-three of the volunteer
ambulance workers’ benefit law provided the insurance carrier liable for payment of the
award receives, before such award is made, a copy of the claim for reimbursement from
the employer, carrier or chairman who paid disability benefits, or provided the board’s
decision and award directs such reimbursement therefrom.
§ 30. Section three hundred nine of such law, as amended by chapter six hundred
ninety-nine of the laws of nineteen hundred fifty-six, is amended to read as follows:
§ 309. Non-duplication
No compensation under the provisions of this article shall be payable to any civil
defense volunteer or to the dependents of a deceased civil defense volunteer otherwise
entitled to receive werkmen’s workers’ compensation under the provisions of this chapter
or of any other law, or volunteer firemen’s firefighters’ benefits or volunteer ambulance
workers’ benefits under the provisions of the volunteer firemen’s firefighters’ benefit law
or the volunteer ambulance workers’ benefit law or of any other law, or if the disabled
civil defense volunteer or the dependents of a deceased civil defense volunteer are entitled
to receive benefits under the disability benefits law or similar statute of any state or
under any disability or retirement or insurance program of an employer who has
76 Additions in text are indicated by underline; deletions by strikeouts
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1988 REGULAR SESSION Ch. 24
contributed to the cost thereof or under any provision of benefits by or under laws of the
federal government or a state or political subdivision thereof, except only as herein
provided. Compensation payable under this article shall in such event, or any of them, be
reduced to an amount which, together with such other compensation or benefits, shall not
exceed in aggregate the amount of compensation to which the claimant, or his depend-
ents, would be entitled under this article but for such other provision.
§ 31. Chapter sixty-four-B of the consolidated laws, constituting the volunteer ambu-
lance workers’ benefit law, is enacted to read as follows:
CHAPTER 64-B OF THE CONSOLIDATED LAWS
VOLUNTEER AMBULANCE WORKERS’ BENEFIT LAW
Article. I. SHORT TITLE; PURPOSE; DEFINITIONS 6 oii.¢ ¢ oii ssiice sss sacwus 1-3
IL, COVERAGE AND BENE YTD esc «sess emawre 645s paws eas eames s 5-25
HL. LIABILATY POR BENEPTIS, INSURANCE wc. 5.6 s cscrenne oy exw 30-32
IV. PROCEDURE............. 0. ccc ccc cece eee nee ees 40-61
My, SON CMTE sctectcnin 0 0 reehinsindee GREG cad EA BR 8 BB RRR 90-91
ARTICLE I
SHORT TITLE; PURPOSE; DEFINITIONS
Section 1. Short title.
2. Purpose.
3. Definitions.
§ 1. Short title
This chapter shall be known and may be cited as the “volunteer ambulance workers’
benefit law”.
§ 2. Purpose
In recognition of the unselfish service given to the people of New York state by these
volunteer ambulance workers, government has undertaken to provide for them and their
families some measure of protection against loss from death or injuries in the line of duty.
This law establishes a system of benefits for volunteer ambulance workers and provides
for the administration of such system by the workers’ compensation board and the
chairman of such board.
It is hereby declared that this chapter is intended to effectuate the objects and purposes
of section eighteen of article one of the state constitution and that the relationship
between the political subdivision liable for benefits under this chapter and a volunteer
ambulance worker entitled to such benefits is that of employer and employee within the
meaning of such provision of the state constitution.
§ 3. Definitions
As used in this chapter:
1. ‘Volunteer ambulance worker’ means an active volunteer member of an ambulance
company as specified on a list regularly maintained by that company for the purpose of
this chapter.
2. “Ambulance company” means any voluntary or municipal ambulance service reg-
istered or certified pursuant to article thirty of the public health law,’ except an
ambulance service subject to the provisions of section two hundred nine-b of the general
municipal law.
3. “Line of duty’? means the performance by a volunteer ambulance worker as a
volunteer ambulance worker of the duties and activities described in subdivision one of
Additions in text are indicated by underline; deletions by strikeouts 7
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Ch. 24 LAWS OF NEW YORK
section five of this chapter for which the volunteer ambulance worker does not receive
any remuneration or a gratuity and shall be deemed to include any date of injury as
determined by the workers’ compensation board pursuant to the provisions of section
forty-one of this chapter. The following shall not be deemed to be remuneration or a
gratuity: reimbursement of expenses for meals, lodging and actual and necessary travel;
the receipt of a mileage allowance in lieu of travel expense; and the acceptance of
transportation, food, drink, shelter, clothing and similar items while on duty or engaged in
such activities.
4. “Injury” means any disablement of a volunteer ambulance worker that results from
services performed in line of duty and such disease or infection as may naturally and
unavoidably result from an injury.
5. “Child” includes a posthumous child, a child legally adopted prior to the injury of
the volunteer ambulance worker; and a step-child or acknowledged child born out of
wedlock dependent upon the deceased volunteer ambulance worker.
6. “Surviving spouse” means the legal wife of a deceased male volunteer ambulance
worker or the legal husband of a deceased female volunteer ambulance worker, as the
case may be, but shall not include a spouse who has abandoned the deceased. The term
“abandoned”, as used in this subdivision, means such an abandonment as would be
sufficient under section two hundred of the domestic relations law to sustain a judgment
of separation on that ground.
7. “Dependent” means a surviving spouse entitled to receive benefits under this
chapter, whether or not actually dependent upon a volunteer ambulance worker, unless a
contrary meaning is clearly intended.
8. “Earning capacity”, except as herein provided, means:
a. The ability of a volunteer ambulance worker to perform on a five day or six day
basis either the work usually and ordinarily performed by him in his remunerated
employment or other work which for any such worker would be a reasonable substitute
for the remunerated employment in which he was employed at the time of his injury, or
b. The ability of a volunteer ambulance worker to perform on a five day or six day
basis either the work usually and ordinarily performed by him in the practice of his
profession or in the conduct of his trade or business, including farming, and from which
he could derive earned income or other work which for any such person would be a
reasonable substitute for the profession, trade or business in which he was engaged at
the time of his injury.
Every volunteer ambulance worker shall be considered to have earning capacity and, if
the provisions of paragraphs a and b of this subdivision are not applicable in any given
case, the workers’ compensation board, in the interest of justice, shall determine the
reasonable earning capacity of the volunteer ambulance worker with due regard to the
provisions of such paragraphs and the work he reasonably could be expected to obtain
and for which he is qualified by age, education, training and experience. The ability of a
volunteer ambulance worker to perform the duties of a volunteer ambulance worker, or to
engage in activities incidental thereto, may be considered in determining loss of earning
capacity, but the inability of a volunteer ambulance worker to perform such duties or to
engage in such activities shall not be a basis of determining loss of earning capacity.
9. “State” means all territory within the boundaries of the state of New York,
including territory which has been or may hereafter be ceded to the federal government
or to the United Nations and territory within the boundaries of Indian reservations.
10. “Political subdivision” means a county, city, town, village or fire or ambulance
district.
11. “State fund” means the state insurance fund provided for in article six of the
workers’ compensation law.
12. “County plan of self-insurance” means a county plan of self-insurance under
article five of the workers’ compensation law.2
78 Additions in text are indicated by underline; deletions by strikeouts
1988 I
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1988 REGULAR SESSION Ch. 24
13. “Insurance carrier” means the state fund, the stock corporations, mutual corpora-
tions or reciprocal insurers described in subdivision nine of section thirty of this chapter, a
county plan of self-insurance, or a self-insuring political subdivision.
14. “Fund raising activity” means a fund raising activity described in subdivision one
of section two hundred four-a of the general municipal law, except that for the purposes
of paragraph k of subdivision one of section five of this chapter it shall not include
competitive events in which volunteer ambulance workers are competitors, such as
baseball, basketball, football, bowling, tugs of war, donkey baseball, donkey basketball,
boxing, wrestling, contests between bands or drum corps, or other competitive events in
which volunteer ambulance workers are competitors and which involve physical exertion
on the part of the competitors. Such term “fund raising activity” shall not include drills,
parades, inspections, reviews, competitive tournaments, contests or public exhibitions,
described in paragraphs e and h of subdivision one of section five of this chapter, even
though prizes are awarded at such events.
1 Public Health Law § 3000 et seq.
2 Worker’s Compensation Law § 60 et seq.
ARTICLE II
COVERAGE AND BENEFITS
Section 5. Coverage.
6. Volunteer ambulance workers’ benefits; general.
7. Death benefits.
7-a. Date of death benefits.
8. Permanent total disability benefits.
S Temporary total disability benefits.
10. Permanent partial disability benefits.
13. Temporary partial disability benefits.
ll-a. Repair or replacement of prosthetic devices.
11-b. Hazardous exposures.
12. Nonschedule adjustments.
13. Reclassification of disabilities.
14. Previous disability.
15. Expense for rehabilitating injured volunteer ambulance workers.
16. Treatment and care.
17. Aliens.
18. Disposition of accrued benefits upon death.
19. Exclusiveness of remedy.
20. Other remedies of volunteer ambulance workers; subrogation.
Bln Assistance to other states, the Dominion of Canada, property ceded to
the federal government and to Indian reservations.
22. Revenues and benefits from sources other than this chapter.
23. Assignments, exemptions.
24. Waiver agreements void.
25. Limitation of time.
§ 5. Coverage
1. The duties and activities in relation to which benefits shall be paid and provided
pursuant to this chapter are:
a. Necessary travel to, working at, and necessary travel returning from an accident,
alarm of accident, or other duty to which his ambulance department, ambulance company,
or any unit thereof, either has responded or would be required or authorized to respond,
including necessary travel during such work or incidental thereto.
b. While, within the state, personally assisting another ambulance department, ambu-
lance company, or any unit thereof, including, after his services have been duly accepted,
Additions in text are indicated by underline; deletions by strikeouts 79
DENA Tire Henn cents Eger at lt ae a ne
necessary travel to and returning from such work and necessary travel during such work
or incidental thereto,
1. While, pursuant to orders or authorization, engaged in the inspection of ambulance
es and a ]
k. While, within the state and pursuant to orders or authorization, working in
bowling, tugs of war, donkey baseball, donkey basketball, boxing, wrestling, contests
between bands or drum corps, or other competitive events in which volunteer ambulance
2. Benefits shall not be paid and provided pursuant to this chapter in the following
instances:
198
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1988 REGULAR SESSION Ch. 24
b. Practice for and participation in any recreational, social, or fund raising activity
other than a fund raising activity for which coverage is provided under paragraph k of
subdivision one of this section.
c. Work or service rendered by a volunteer ambulance worker while suspended from
duty pursuant to any general, special or local law, charter or ordinance or pursuant to the
constitution, by-laws, rules or regulations applicable to the ambulance company or
ambulance department of which he is a member.
d. Work or service not rendered as a volunteer ambulance worker, but rendered as an
officer, official or employee of a public corporation or any special district thereof, whether
with or without remuneration, even though by law a requirement for such office, position
or employment shall be that such officer, official or employee shall have been or must be
a volunteer ambulance worker.
e. Work or service not rendered as a volunteer ambulance worker, but rendered in the
course of his employment for a private employer.
f. Work, service or activities in which the volunteer ambulance worker has been
ordered not to participate.
This subdivision shall not be deemed to enumerate all of the activities engaged in by
volunteer ambulance workers for which mandatory coverage is not provided by this
chapter, or to prohibit any of the activities described in this subdivision, or to prevent the
securing of insurance pursuant to section four thousand two hundred thirty-seven of the
insurance law to cover volunteer ambulance workers when engaged in activities other
than those for which mandatory coverage is provided by this chapter.
§ 6. Volunteer ambulance workers’ benefits; general
If a volunteer ambulance worker dies from the effects of injury in the line of duty, or if
such an ambulance worker shall be injured in line of duty, benefits shall be paid and
provided pursuant to this chapter, except that there shall be no liability for such benefits
when the injury has been solely occasioned by intoxication of the volunteer ambulance
worker while acting in line of duty or by the wilful intention of the volunteer ambulance
worker to bring about the injury or death of himself or another.
§ 7. Death benefits
In the event of death the benefit shall be known as a death benefit and shall be paid as
follows:
1. The reasonable funeral expenses of the deceased volunteer ambulance worker shall
be paid in an amount not exceeding two thousand dollars. If such funeral expenses shall
have been paid by a person entitled to benefits under this section or by others, the funeral
expenses awarded shall be made payable to such beneficiary or others; otherwise they
shall be payable to the undertaker who provided the burial. Funeral expenses shall be
awarded in all death cases.
2. If there be a surviving spouse, to such spouse the lump sum of five thousand
dollars, but if there be no surviving spouse, then to the executor or administrator of the
estate of the volunteer ambulance worker, the lump sum of five thousand dollars. Such
sum shall be in addition to any other benefits provided in this chapter and shall not be
diminished by benefits paid to the volunteer ambulance worker during his lifetime. Any
money paid to an executor or administrator pursuant to the provisions of this subdivision
shall be distributed in the manner provided by the laws of this state for the distribution of
the personal property of an intestate decedent.
3. If there be a surviving spouse and no surviving child of the deceased under the age
of eighteen years or under the age of twenty-five years who is enrolled as a full time
student in any accredited educational institution and no surviving child of any age
dependent blind or physically disabled, te such spouse three hundred dollars for each
week until remarried, and upon such remarriage the lump sum of thirty-one thousand two
hundred dollars.
Additions in text are indicated by underline; deletions by strikeouts 81
A i reker :
Mine ois het, shen on SEED AE bs. eka RU tone atcl thie al eee oe
Ch. 24 LAWS OF NEW YORK
4. If any person under the age of eighteen years is an inmate of any institution and a
public charge upon the state or any political subdivision, the benefits allowed hereunder
shall be payable to the state or political subdivision to the extent of the reasonable
charges for care and maintenance, during the continuance as a public charge in such
institution of such beneficiary and until he shall have attained the age of eighteen years.
Any sum or sums remaining after such payments shall be distributed as provided in this
section.
5. The term ‘‘dependent blind or physically disabled’, as used in this section in relation
to dependent children, means totally blind or physically disabled dependent children whose
disablement is total and permanent.
6. All questions of dependency shall be determined as of the time of the injury.
7. The workers’ compensation board may in its discretion require the appointment of a
guardian for the purpose of receiving benefits payable to a minor child or a dependent
blind or physically disabled child. In the absence of such a requirement by such board
the appointment of a guardian for such purposes shall not be necessary.
8. In the case of a death of a volunteer ambulance worker, on or after the enactment
date of this chapter, that results from services performed in the line of duty, if there be a
surviving spouse and a surviving child or children of the deceased under the age of
eighteen years or under the age of twenty-five years who is enrolled as a full time
student in any accredited educational institution or a surviving child or children of any
age dependent blind or physically disabled, to such spouse one hundred sixty-five dollars
for each week until remarried, and the additional amount of one hundred thirty-five
dollars for each week for such child or children, share and share alike, until the age of
eighteen years or under the age of twenty-five years who is enrolled as a full time
student in any accredited educational institution or until the removal of the dependency of
the blind or physically disabled child or children. In the case of the death of such
surviving spouse, the surviving child or children of the deceased ambulance worker, at the
time under eighteen years of age or under the age of twenty-five years who is enrolled as
a full time student in any accredited educational institution or dependent through mental
or physical infirmity, shall have his or their benefit increased to three hundred dollars for
each week, share and share alike, and the same shall be payable until he or they shall
reach the age of eighteen years or twenty-five years, as the case may be, or until such
dependent blind or physically disabled condition shall have been removed. Upon the
remarriage of such surviving spouse prior to the statutory termination of benefits to all
such children, such spouse shall be paid the lump sum of seventeen thousand one hundred
sixty dollars; and the surviving child shall continue to receive weekly payments of one
hundred thirty-five dollars; if there be two surviving children, each shall receive one
hundred twelve dollars and fifty cents per week; and if there be more than two surviving
children, they shall receive three hundred dollars per week, share and share alike; and the
same shall be payable until he or they shall reach the age of eighteen years or twenty-five
years, as the case may be, or until such dependent blind or physically disabled condition
shall have been removed. Upon statutory termination of payments to all such children,
the payments to the surviving spouse shall be increased to three hundred dollars for each
week until such spouse remarries, and upon such remarriage, such spouse shall be paid
the lump sum of thirty-one thousand two hundred dollars. In no event shall the total
amount payable for each week under this subdivision exceed three hundred dollars.
9. In the case of a death of a volunteer ambulance worker, on or after the enactment
date of this chapter, that results from services performed in the line of duty, if there be
surviving a child or children of the deceased under the age of eighteen years or under the
age of twenty-five years who is enrolled as a full time student in any accredited
educational institution or a dependent blind or physically disabled child or children of any
age, but no surviving spouse, for the support of such child or children until the age of
eighteen years or twenty-five years as the case may be, or until the removal of the
dependency of such blind or physically disabled child or children, three hundred dollars,
share and share alike, for each week; provided that the total amount payable for each
week under this subdivision shall not exceed three hundred dollars per week.
82 Additions in text are indicated by underline; deletions by strikeouts
1988 REG
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1988 REGULAR SESSION Ch. 24
10. In the case of a death of a volunteer ambulance worker, on or after the enactment
date of this chapter, that results from services performed in the line of duty, if there be
no surviving spouse or child of the deceased under the age of eighteen years or under the
age of twenty-five years who is enrolled as a full time student in any accredited
educational institution or dependent blind or physically disabled child of the deceased of
any age, then for the support of grandchildren or brothers and sisters under the age of
eighteen years or under the age of twenty-five years who is enrolled as a full time
student in any accredited educational institution if dependent upon the deceased at the
time of the injury, one hundred twelve dollars and fifty cents for each week for the
support of each such person until the age of eighteen years or twenty-five years as the
case may be, and for the support of each parent or grandparent of the deceased, if
dependent upon the deceased at the time of the injury, one hundred eighty dollars for
each week during such dependency, but in no case shall the aggregate amount payable
under this subdivision exceed three hundred dollars per week.
§ 7-a. Date of death benefits
All weekly benefits payable under section seven of this article shall accrue as of the
date of death of the volunteer ambulance worker. In the event that a person or persons
entitled to weekly benefits shall die before a determination is made on the merits of their
claim, and such determination on the merits is ultimate y in their favor, then all weekly
benefits due from the date of death of the volunteer ambulance worker up to the date of
death of the person or persons entitled to such weekly benefits shall be paid to the
executor or administrator of the estate of such person or persons.
§ 8. Permanent total disability benefits
In the case of total disability adjudged to be permanent the volunteer ambulance
worker shall be paid three hundred dollars for each week during the continuance thereof;
provided, however, that the volunteer ambulance worker is injured in the line of duty on
or after the enactment date of this chapter. Permanent total disability, within the
meaning of this section, shall exist only if the earning capacity of the volunteer
ambulance worker has been lost permanently and totally as the result of the injury. The
loss of both hands, or both arms, or both feet, or both legs, or both eyes, or any two
thereof, shall, in the absence of conclusive proof to the contrary, constitute permanent
total disability, but in all other cases permanent total disability shall be determined in
accordance with the facts. Notwithstanding any other provisions of this chapter, an
injured volunteer ambulance worker disabled due to the loss or total loss of use of both
eyes, or both hands, or both arms, or both feet, or both legs, or any two thereof shall not
suffer any diminution of such weekly benefit by engaging in business or employment
provided his weekly earnings or wages, when combined with his weekly benefit shall not
be in excess of four hundred fifty dollars for the period beginning on or after the
enactment date of this chapter; and further provided that the application of this section
shall not result in reduction of benefits which an injured volunteer ambulance worker who
is disabled due to the loss or total loss of use of both eyes, or both hands, or both arms, or
both feet, or both legs, or any two thereof would otherwise be entitled to under any other
provisions of this article.
§ 9. Temporary total disability benefits
In the case of temporary total disability the volunteer ambulance worker shall be paid
three hundred dollars for each week during the continuance thereof; provided, however,
that when the volunteer ambulance worker is injured in the line of duty on or after the
enactment date of this chapter. Temporary total disability, within the meaning of this
section, shall exist only if the earning capacity of the volunteer ambulance worker has
been lost temporarily and totally as the result of the injury. In case of temporary total
disability and permanent partial disability both resulting from the same injury, if the
temporary total disability continues for a longer period than the number of weeks set
forth in the following schedule, the period of temporary total disability in excess of such
number of weeks shall be added to the period provided in section ten of this chapter: arm,
Additions in text are indicated by underline; deletions by strikeouts 83
Me PSII Tay PORT ie a! i — _ a = ee _- ~
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Ch. 24 LAWS OF NEW YORK
thirty-two weeks; leg, forty weeks; hand, thirty-two weeks; foot, thirty-two weeks; ear,
twenty-five weeks; eye, twenty weeks; thumb, twenty-four weeks; first finger, eighteen
weeks; great toe, twelve weeks; second finger, twelve weeks; third finger, eight weeks;
fourth finger, eight weeks; toe other than great toe, eight weeks. In any case resulting
in loss or partial loss of use of arm, leg, hand, foot, ear, eye, thumb, finger or toe, where
the temporary total disability does not extend beyond the periods above mentioned for
such injury, benefits shall be limited to the schedule contained in section ten of this
chapter.
§ 10. Permanent partial disability benefits
1. In the case of disability partial in character, but permanent in quality, the volunteer
ambulance worker shall be paid one hundred fifty dollars for each week for the period
specified in this subdivision, provided, however, that when the volunteer ambulance
worker is injured in the line of duty on or after the enactment date of this chapter, such
payment shall, be as follows:
a. Loss of member.
Member lost Number of weeks
enn TT eT TTT TTT rt ee 312
rrr errr fo Tirta. 288
|S es 244
POG « csuww cea s peewee cise venwmmenn ans s cbse € 455 RRERS Ya PE ROSIE ess 205
BD on crane ne nee smemnme nes sou «WSs? #1 KE RII HH 2 SORRY § € #4 v mmcenliouee «x 160
(0 ee ee ee Te ee rere ress 75
Finst: Piers «cis sswew cease pds ewewee css own es mma dad som TESS 46
rR GiB oc oo cc pqreen 00s 40a mmm cones mums 613 RUS FEE PORES geo 38
Second finger ............cc cece cece eee eee e eee e nee eee eeneeeneees 30
(oc ee eer errr ree te ere er ee 25
Toe other than: great: G06 « <s ssnswes cess weve vain een an hntiee OEE HE 16
Poavth, S066 s scree 255995 erwnmma ness s wmcmnn 0 5 RAR EHTS RRS ERY See 15
If more than one phalange of a digit shall be lost, the period shall be the same as for the
loss of the entire digit. If only the first phalange shall be lost, the period shall be
one-half the period for loss of the entire digit. The period for loss or loss of use of two or
more digits, or one or more phalanges of two or more digits, of a hand or foot, may be
proportioned to the period for the loss of use of the hand or foot occasioned thereby, but
shall not exceed the period for the loss of a hand or foot. If an arm or leg shall be
amputated at or above the wrist or ankle, the period for such loss shall be in proportion to
the period for the loss of the arm or leg. In the case of loss of binocular vision or of
eighty per centum or more of the vision of an eye, the period shall be the same as for the
loss of the eye.
b. Loss of hearing. In the case of the complete loss of the hearing of one ear, sixty
weeks; for the loss of hearing of both ears, one hundred fifty weeks.
c. Total loss of use. In the case of permanent total loss of use of a member, the
period shall be the same as for the loss of the member.
d. Partial loss or partial loss of use. Except as above provided in this subdivision, in
the case of permanent partial loss or loss of use of a member, the period shall be for the
proportionate loss or loss of use of the member.
e. Disfigurement. In the case of serious facial or head disfigurement, including a
disfigurement continuous in length which is partly in the facial area and also extends into
the neck region as described in this paragraph, the volunteer ambulance worker shall be
paid in a lump sum a proper and equitable amount, which shall be determined by the
workers’ compensation board. If the earning capacity of the volunteer ambulance worker
shall have been impaired, or may in the future be impaired, by any serious disfigurement
in the region above the sterno clavicular articulations anterior to and including the region
of the sterno cleido mastoid muscles on either side, the volunteer ambulance worker shall
be paid in a lump sum a proper and equitable amount which shall be determined by such
84 Additions in text are indicated by underline; deletions by strikeouts
1988 REGU
board. Tw
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1988 REGULAR SESSION Ch. 24
board. Two or more serious disfigurements, not continuous in length, resulting from the
same injury, if partially in the facial area and partially in such neck region, shall be
deemed to be a facial disfigurement. An award, or the aggregate of the awards, to a
volunteer ambulance worker under this paragraph shall not exceed five thousand dollars.
f. Total or partial loss or loss of use of more than one member. In any case in which
there shall be a loss or loss of use of more than one member or parts of more than one
member set forth above in paragraphs a to e, both inclusive, of this subdivision, but not
amounting to permanent total disability, the periods for loss or loss of use of each such
member or part thereof shall run consecutively.
g. Other cases. In all other cases of permanent partial disability the volunteer
ambulance worker shall be paid for each week, during the continuance thereof, as follows:
(1) If the percentage of loss of earning capacity is seventy-five per centum, or greater,
he shall be paid one hundred fifty dollars for each week, provided, however, that the
volunteer ambulance worker is injured in the line of duty on or after the enactment date
of this chapter.
(2) If the percentage of loss of earning capacity is fifty per centum, or greater, but less
than seventy-five per centum, he shall be paid one hundred dollars for each week,
provided, however, that the volunteer ambulance worker is injured in the line of duty on
or after the enactment date of this chapter.
(3) If the percentage of loss of earning capacity is twenty-five per centum, or greater,
but less than fifty per centum, he shall be paid thirty dollars for each week.
(4) If the percentage of loss of earning capacity is less than twenty-five per centum, he
shall not be paid any weekly benefit.
Permanent partial disability, within the meaning of this paragraph, shall exist only if
the earning capacity of the volunteer ambulance worker has been permanently and
partially lost. as the result of the injury. The workers’ compensation board shall
determine the degree of such disability and such board may reconsider such degree on its
own motion or upon application of any party in interest.
2. An award made to a claimant under this section shall in case of death arising from
causes other than the injury be payable to and for the benefit of the persons following:
a. If there be a surviving spouse and no child of the deceased under the age of
eighteen years, to such spouse.
b. If there be a surviving spouse and surviving child or children of the deceased under
the age of eighteen years, one-half shall be payable to the surviving spouse and the other
half to the surviving child or children.
c. If there be a surviving child or children of the deceased under the age of eighteen
years, but no surviving spouse, then to such child or children.
d. If there be no surviving spouse and no surviving child or children of the deceased
under the age of eighteen years, then to such dependent or dependents as defined in
section seven of this article, as directed by the workers’ compensation board; and if there
shall be no such dependents, then to the estate of such deceased in an amount not
exceeding reasonable funeral expenses as provided in subdivision one of section seven of
this article, or, if there be no estate, to the person or persons paying the funeral expenses
of such deceased in an amount not exceeding reasonable funeral expenses as provided in
such subdivision one.
3. An award for disability may be made after the death of the volunteer ambulance
worker.
§ 11. Temporary partial disability benefits
In the case of temporary partial disability the volunteer ambulance worker shall be paid
for each week during the continuance thereof, as follows:
1. If the percentage of loss of earning capacity is seventy-five per centum, or greater,
he shall be paid one hundred fifty dollars for each week, provided, however, that the
Additions in text are indicated by underline; deletions by strikeouts 85
aniline Taian i wanes’. ca teins eddie
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Ch. 24 LAWS OF NEW YORK
volunteer ambulance worker is injured in the line of duty on or after the enactment date
of this chapter.
2. If the percentage of loss of earning capacity is fifty per centum, or greater, but less
than seventy-five per centum, he shall be paid one hundred dollars for each week,
provided, however, that the volunteer ambulance worker is injured in the line of duty on
or after the enactment date of this chapter.
3. If the percentage of loss of earning capacity is twenty-five per centum, or greater,
but less than fifty per centum, he shall be paid thirty dollars for each week.
4. If the percentage of loss of earning capacity is less than twenty-five per centum, he
shall not be paid any weekly benefit.
Temporary partial disability, within the meaning of this section, shall exist only if the
earning capacity of the volunteer ambulance worker has been temporarily and partially
lost as the result of the injury. The workers’ compensation board shall determine the
degree of such disability and such board may reconsider such degree on its own motion or
upon application of any party in interest.
§ ll-a. Repair or replacement of prosthetic devices
If, as a result of services performed in line of duty, a volunteer ambulance worker
damages or loses any prosthetic devices required to be worn or used by him, whether or
not he is injured, such prosthetic device shall be repaired, or replaced in the discretion of
the workers’ compensation board, and necessary medical, surgical or other attendance or
treatment, nurse and hospital service, in connection therewith shall be furnished, in the
Same manner as a prosthetic device would be furnished, replaced or repaired and
treatment and care provided under the provisions of section sixteen of this article.
Damage to or loss of a prosthetic device shall be deemed an injury, except that no
disability benefits shall be payable with respect to such injury under sections eight, nine,
ten and eleven of this article. The term “prosthetic device” as used in this section
includes an artificial limb, artificial eye, eyeglasses, contact lens, hearing aid, denture or
dental appliance or any surgical appliance required to be worn or used by the volunteer
ambulance worker, but shall not include shoes or any other article considered as ordinary
wearing apparel, whether or not specially constructed.
§ ll-b. Hazardous exposures
If, as a result of services performed in line of duty, a volunteer ambulance worker is
exposed to or comes in contact with any poisons, gases, x-rays, radium, radioactive
materials or other potentially harmful substances or matter, the captain or other execu-
tive officer of the ambulance department or ambulance district of which he is a member
may authorize the volunteer ambulance worker to obtain such examinations, tests,
treatment and care as are immediately necessary to determine whether he is injured.
Any such authorization may be granted prior to the giving of a notice of injury under this
chapter. In any such case, the volunteer ambulance worker shall be deemed to have been
injured and shall be entitled to treatment and care and disability benefits as provided in
this chapter.
§ 12. Nonschedule adjustments
Notwithstanding any other provision of this chapter, in any case coming within the
provisions of sections ten and eleven of this article, in which the right to benefits has been
established and benefits have been paid for not less than three months, in which the
continuance of disability cannot be ascertained with reasonable certainty, the workers’
compensation board may, in the interest of justice, approve a nonschedule adjustment
agreed to between the claimant and the political subdivision liable for the payment of
benefits or its insurance carrier. The provisions of subdivision five-b of section fifteen of
the workers’ compensation law shall apply in any such case.
86 Additions in text are indicated by underline; deletions by strikeouts
1988 RE
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1988 REGULAR SESSION Ch. 24
§ 13. Reclassification of disabilities
Subject to the limitations in section fifty-one of this chapter and in section one hundred
twenty-three of the workers’ compensation law as made applicable to this chapter by
section fifty-seven of this chapter, the workers’ compensation board may at any time,
without regard to the date of the injury, upon its own motion, or on application of any
party in interest, reclassify a disability upon proof that there has been a change in
condition, or that the previous classification was erroneous and not in the interest of
justice.
§ 14. Previous disability
The fact that a volunteer ambulance worker has suffered previous disability or received
benefits therefor as provided in the workers’ compensation law, or this chapter shall not
preclude him from benefits for a later injury nor preclude death benefits for death
resulting therefrom; provided, however, that a volunteer ambulance worker who is
suffering from a previous disability shall not receive benefits for a later injury in excess
of the benefits allowed for such injury when considered by itself and not in conjunction
with the previous disability. Notwithstanding the foregoing provisions of this section, if
a volunteer ambulance worker has previously incurred permanent partial disability
through the loss or loss of use of one hand, one arm, one foot, one leg, or one eye, and
suffers the loss or loss of use of another such major member or eye, he may be adjudged
permanently totally disabled and receive benefits for permanent total disability as
provided in section eight of this article.
§ 15. Expense for rehabilitating injured volunteer ambulance workers
A volunteer ambulance worker, who as a result of injury is or may be expected to be
totally or partially incapacitated for a remunerative occupation and who, under the
direction of the state education department is being rendered fit to engage in a remunera-
tive occupation, may receive such additional financial benefit necessary for his rehabilita-
tion as the workers’ compensation board shall determine. Not more than thirty dollars
per week of such additional amount shall be expended for maintenance. Such expense
and such of the administrative expenses of the state education department as are properly
assignable to the expenses of rehabilitating such volunteer ambulance workers shall be
paid out of the vocational rehabilitation fund created pursuant to subdivision nine of
section fifteen of the workers’ compensation law. Any such volunteer ambulance worker
for the purposes of such fund shall be considered an employee of the political subdivision
liable for the payment of benefits to such volunteer ambulance worker under this chapter
and such “employer” or its insurance carrier, as the case may be, shall make the same
financial contribution to such fund as required by subdivision nine of section fifteen of the
workers’ compensation law in every case of injury causing death of a volunteer ambu-
lance worker in which there are no persons entitled to financial benefits under this
chapter other than (1) funeral expenses and (2) the death benefit provided in subdivision
two of section seven of this article.
§ 16. Treatment and care
A volunteer ambulance worker injured in line of duty shall be entitled to receive
medical, surgical, chiropractic and other attendance and treatment, nurse and hospital
service, medicine, crutches, artificial members, devices, appliances, and apparatus, includ-
ing the replacement and repair thereof, for such period as the nature of the injury or the
process of recovery may require and the political subdivision liable for the payment of
benefits to the volunteer ambulance worker under this chapter because of such injury
shall be liable therefor and the cost thereof shall be audited, raised and paid as provided
in section thirty of this chapter. The provisions of sections thirteen to thirteen-l, both
inclusive, and sections nineteen to nineteen-b, both inclusive, of the workers’ compensa-
tion law, to the extent that such provisions are not inconsistent with this chapter, shall be
applicable in relation to any injured volunteer ambulance worker, political subdivision and
third persons as fully as if set forth in this chapter.
Additions in text are indicated by underline; deletions by strikeouts 87
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Ch. 24 LAWS OF NEW YORK
§ 17. Aliens
Financial benefits payable under this chapter to aliens not residents or about to become
nonresidents of the United States or Canada shall be in the same amount as provided for
residents, except that dependents in any foreign country shall be limited to surviving
spouse and child or children, or, if there be no surviving spouse or child or children, to the
surviving father or mother whom the volunteer ambulance worker has supported, either
wholly or in part, for a period of one year prior to the date of the injury, and except that
the workers’ compensation board may at its option, or upon the application of the politica]
subdivision or its insurance carrier shall, commute as of the date of death all financial
benefits to be paid to such aliens, by paying or causing to be paid to them one-half of the
commuted amount of such financial benefits as determined by such board. In the case of
a resident alien about to become a nonresident the future payments of such benefits shall
be commuted as of the date of nonresidence.
§ 18. Disposition of accrued benefits upon death
Except as otherwise provided in section ten of this article, in the case of the death of an
injured volunteer ambulance worker to whom there was due at the time of his death any
benefits under the provisions of this chapter, the amount of such benefits shall be payable
to the surviving spouse, if there be one, or, if none, to the surviving child or children of
the deceased under the age of eighteen years, and if there be no surviving spouse or
children, then to the dependents of such deceased or to any of them as the workers’
compensation board may direct, and if there be no surviving spouse, children or depend-
ents of such deceased, then to his estate. An award for disability may be made after the
death of an injured volunteer ambulance worker.
§ 19. Exclusiveness of remedy
The benefits provided by this chapter shall be the exclusive remedy of a volunteer
ambulance worker, or his Spouse, parents, dependents, next of kin, executor or adminis-
trator, or anyone otherwise entitled to recover damages, at common law or otherwise, for
Or on account of an injury to a volunteer ambulance worker in line of duty or death
resulting from an injury to a volunteer ambulance worker in line of duty, as against (1)
the political subdivision liable for the payment of such benefits, (2) the political subdivi-
sion regularly served by the ambulance company of which the volunteer ambulance
worker is a member, whether or not pursuant to a contract for ambulance services, even
though any such political subdivision is not liable for the payment of such benefits in the
circumstances, and (3) any person or company acting under governmental or statutory
authority in furtherance of the duties or activities in relation to which any such injury
resulted; provided, however, that the benefits provided by this chapter shall not be the
exclusive remedy as against persons who, in the furtherance of the same duties or
activities, are not similarly barred from recourse against the volunteer ambulance worker,
or his executor or administrator.
§ 20. Other remedies of volunteer ambulance workers; subrogation
The provisions of section twenty-nine of the workers’ compensation law to the extent
that such provisions are not inconsistent with the provisions of this chapter, shall be
applicable as fully as if set forth in this chapter.
§ 21. Assistance to other states, the Dominion of Canada, property ceded to the
federal government and to Indian reservations
1. Whenever an ambulance company or ambulance department in this state shall
answer a call to furnish assistance to any political subdivision or territory of another state
of the United States or of the Dominion of Canada, or property ceded to the federal
government, the provisions of this chapter shall apply with respect to the volunteer
ambulance workers of such ambulance company or department, while such assistance is
being rendered or while going to or returning from the place from where the assistance is
to be or was rendered, to the same extent and in the same manner as if such service had
88 Additions in text are indicated by underline: deletions by strikeouts
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1988 REGULAR SESSION Ch. 24
been rendered in or for the area regularly served by such volunteer ambulance workers;
provided, however, that there shall be deducted from any amounts payable under this
chapter any amounts recoverable by or payable to any such volunteer ambulance worker
under the laws applicable in the political subdivision or territory for which the call for
assistance was made.
2. The provisions of this chapter shall apply with respect to volunteer ambulance
workers of ambulance departments and ambulance companies of other states of the
United States and of the Dominion of Canada who render service in this state in answer to
a call for assistance to the territory regularly served by an ambulance department or
Canada, as the case may be, in answer to a call for assistance; provided, however, that
there shall be deducted from any amounts payable under the provisions of this chapter to
a volunteer ambulance worker of such other states or of the Dominion of Canada, any
amounts recoverable by or payable to such volunteer ambulance worker under the laws of
the state served by such volunteer ambulance worker or of the Dominion of Canada, as
the case may be.
3. Whenever an ambulance company or ambulance department in this state shall
answer a call for assistance to be rendered to any part of an Indian reservation the
provisions of this chapter shall apply with respect to the volunteer ambulance workers of
such ambulance company or department, while such assistance is being rendered or while
going to or returning from the place from where the assistance is to be or was rendered,
to the same extent and in the same manner as if such service had been rendered in or for
the area regularly served by such volunteer ambulance workers.
§ 22. Revenues and benefits from sources other than this chapter
Benefits, savings or insurance of the injured or deceased volunteer ambulance worker,
or insurance carried for his benefit under subsection (a) of section four thousand two
hundred thirty-seven of the insurance law, shall not be considered in determining the
benefits to be paid and provided under this chapter, nor shall such benefits be diminished
or reduced by reason of the payment to an injured volunteer ambulance worker of salary,
wages or other remuneration by any political subdivision liable for the payment of such
benefits.
§ 23. Assignments, exemptions
Benefits payable under this article shall not be assigned, released or commuted, except
as provided by this chapter, and shall be exempt from all claims of creditors and from
levy, execution and attachment or other remedy for recovery or collection of a debt, which
exemption may not be waived. Such benefits shall be paid only to volunteer ambulance
workers or their dependents except as otherwise provided in this chapter.
§ 24. Waiver agreements void
No agreement by a volunteer ambulance worker to waive his right to benefits under
this chapter shall be valid.
§ 25. Limitation of time
No limitation of time provided in this chapter shall run as against any person who is
mentally incompetent or a minor so long as he has no committee or guardian.
Additions in text are indicated by underline; deletions by strikeouts 89
ty Dies
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Ch. 24 LAWS OF NEW YORK
ARTICLE III
LIABILITY FOR BENEFITS; INSURANCE
Section 30. Liability for and payment of benefits.
31. The insurance contract.
32. Group insurance.
§ 30. Liability for and payment of benefits
Except as otherwise provided in article five of the workers’ compensation law! and in
section twenty-one of this chapter:
1. If at the time of injury the volunteer ambulance worker was a member of an
ambulance company of a county, city, town, village or ambulance district ambulance
department, any benefit under this chapter shall be a county, city, town, village or
ambulance district charge, as the case may be, and any claim therefor shall be audited in
the same manner as other claims against the county, city, town, village or ambulance
district and the amount thereof shall be raised and paid in the same manner as other
county, city, town, village or ambulance district charges.
2. If at the time of injury the volunteer ambulance worker was a member of an
ambulance company incorporated under the not-for-profit corporation law, or any other
law, and located in a city, village, or ambulance district, protected under a contract by the
ambulance department or ambulance company of which the volunteer ambulance worker
was a member, any benefit under this chapter shall be a city, village or ambulance district
charge, as the case may be, and any claim therefor shall be audited in the same manner as
other claims against the city, village or ambulance district and the amount thereof shall
be raised and paid in the same manner as other city, village or ambulance district charges.
3. If at the time of injury the volunteer ambulance worker was a member of a
voluntary ambulance service as defined in subdivision three of section three thousand one
of the public health law, registered pursuant to the provisions of section three thousand
four of the public health law or certified pursuant to the provisions of section three
thousand six of the public health law and organized as an unincorporated association or
duly incorporated under the laws of this state not protected under a contract by the
county, city, town, village or ambulance district, any benefit under this chapter shall be a
voluntary ambulance service charge and any claim therefor shall be audited in the same
manner as other claims against the voluntary ambulance service and the amount thereof
shall be raised and paid in the same manner as other voluntary ambulance service
charges. No charge shall be made against a voluntary ambulance service that does not
have coverage under this chapter.
4. If at the time of injury the volunteer ambulance worker was a member of an
ambulance company incorporated under the not-for-profit corporation law, or any other
law, and located outside of a city, village or ambulance district any benefit under this
chapter shall be a town charge and any claim therefor shall be audited and paid in the
same manner as town charges and the amount thereof raised upon the property liable to
taxation in such outside territory protected by such ambulance company in the same
manner as town charges therein are raised.
5. If at the time of injury the volunteer ambulance worker was a member of an
ambulance company or ambulance department operating in, or maintained jointly by two
or more villages, or two or more towns, or two or more ambulance districts, any benefit
under this chapter shall be a charge against such villages, towns or ambulance districts,
in the proportion that the full valuation of taxable real estate in each bears to the
aggregate full valuation of the taxable real estate of all such villages, towns or
ambulance districts and the amount thereof shall be audited, raised and paid in the same
manner as other village, town or ambulance district charges. Full valuation shall be
determined by dividing the assessed valuations of taxable real estate of each such village,
town or ambulance district as shown by the latest completed assessment roll of the
village, town or ambulance district by the equalization rate established by the authorized
state agency or officer for such roll; provided, however, in a county having a county
90 Additions in text are indicated by underline; deletions by strikeouts
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1988 REGULAR SESSION Ch. 24
department of assessment the full valuation in towns and ambulance districts shall be
determined by applying the state equalization rate established for the town, or the town
in which the ambulance district is located, to the appropriate portion of the last completed
county roll.
6. The provisions of subdivisions one to five, inclusive, of this section shall not apply if
the injury results from services performed when assistance js being rendered to:
a. Another city, town which has a town ambulance department, village or ambulance
district, including one protected under a contract by the ambulance department or
ambulance company of which the volunteer ambulance worker is a member;
b. The area of a town protected by an ambulance company incorporated under the
not-for-profit corporation law, or any other law, and located outside of a city, village or
ambulance district;
ce. The unorganized area of a town (outside of a city, village, or ambulance district,)
and also outside the area protected by an ambulance company incorporated under the
not-for-profit corporation law, or any other law, and located outside of a city, village, or
ambulance district;
d. The joint area protected by an ambulance company or ambulance department
operating in, or maintained jointly by two or more villages, or two or more towns, or two
or more ambulance districts;
e. An ambulance department of a county which has an ambulance department; or
f. A county which has requested ambulance aid pursuant to the general municipal law,
pursuant to a call to furnish assistance to any such municipal corporation, district or area
in cases of accident or other emergencies, or for other authorized purposes, or while
going to or returning from the place where the assistance is to be or was rendered, or if
death shall result from the effects of any such injury, and in any such case any such
benefit shall be a charge against such aided municipal corporation, district or area and
after audit shall be paid and the amount thereof shall be raised upon the property liable to
taxation in such municipal corporation, district or area, in the same manner as other
charges against the same are raised, except that in the cases described in paragraphs b
and c of this subdivision, the town in which the district or area is located shall be
primarily liable for such payment. If there is no property liable to taxation in any area
described in paragraph d of this subdivision, the benefit shall be a town charge and any
claim therefor shall be audited and paid in the same manner as town charges and the
amount thereof shall be raised upon the taxable real property in the town in the same
manner as town charges therein are raised.
In the case of a false call for assistance, any such benefit shall be audited, raised and
paid in the manner provided in subdivisions one to five, inclusive, of this section, as the
case may be.
The term “assistance”, as used in this section, includes the services rendered in case of
an accident or other emergency, including stand-by service, to aid an ambulance depart-
ment, ambulance company, or any unit thereof, other than that of which the volunteer
ambulance worker is a member.
7. Any political subdivision may finance the payment of any benefits to be paid and
provided under this chapter by the issuance of serial bonds or capital notes pursuant to
the local finance law unless it is required by some law, other than this chapter, to pay
such benefits from current funds.
8. Any political subdivision may contract for insurance indemnifying against the
liability imposed by this chapter and the cost of such insurance shall be audited, raised
and paid in the same manner as benefits are required to be audited, raised and paid in this
section.
9. Insurance authorized to be purchased pursuant to subdivision eight of this section
may be secured from the state fund or any stock corporation, mutual corporation or
reciprocal insurer authorized to transact the business of workers’ compensation in this
State. If such insurance is not secured, the political subdivision liable shall be deemed to
have elected to be a self-insurer unless it is a participant in a county plan of self-insurance
Additions in text are indicated by underline; deletions by strikeouts 91
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AER AIR Et ING LEM RII U ETS ey 3:
Ch. 24 LAWS OF NEW YORK
or its liability for benefits under this chapter is covered by a town’s participation in a
county plan of self-insurance as provided in subdivision three of section sixty-three of the
workers’ compensation law. Every such self-insurer shall file with the chairman of the
workers’ compensation board a notice of such election prescribed in form by such
chairman. For failure to file such notice within ten days after such election is made, the
treasurer or other fiscal officer of such political subdivision shall be liable to pay to the
chairman of the workers’ compensation board the sum of one hundred dollars as a
penalty, to be transferred to the state treasury to reimburse it on account of expense of
administering this chapter and the workers’ compensation law. A notice of election to be
a self-insurer for compensation and benefits to volunteer ambulance workers under the
provisions of the workers’ compensation law and the general municipal law in effect prior
to March first, in the year of enactment of this chapter, which was filed prior to such date
pursuant to the provisions of subdivision four of section fifty of the workers’ compensa-
tion law as in effect prior to such date shall be deemed to be a notice of election filed
under this section unless the chairman of the workers’ compensation board is notified to
the contrary. The provisions of subdivision five of section fifty of the workers’ compen-
sation law shall be applicable to such self-insurers.
10. The governing board of a political subdivision liable for the payment of such
benefits may authorize the treasurer or other fiscal officer thereof to pay the financial
benefits provided for in this chapter to the person entitled thereto without waiting for an
award in any case in the manner provided in section forty-nine of this chapter. The
amount payable prior to an award pursuant to such authorization shall constitute a
settled claim within the meaning of the local finance law.
11. A contract for ambulance service, for the purposes of this section, shall be deemed
in full force and effect if negotiations are pending for the renewal thereof.
12. Where a city, village, ambulance district or town is furnished service by an
ambulance company, ambulance department, or any unit thereof pursuant to a contract
entered into prior to the enactment date of this chapter with another city, village,
ambulance district, or an incorporated ambulance company having its headquarters
outside the city, village or ambulance district receiving such service and the liability for
benefits under this chapter in relation to volunteer ambulance workers rendering such
service pursuant to such contract on and after the enactment date of this chapter is not
covered pursuant to a county self-insurance plan pursuant to section sixty-three of the
workers’ compensation law, the contract may be amended after a public hearing held in
the manner provided by law for the amendment of any such contract, or at the option of
the contracting parties without a public hearing, to provide for payment by the city,
village or ambulance district receiving such service to the city, village, ambulance district
or town in which such incorporated ambulance company has its headquarters, of a sum in
addition to the amount to be paid for such service pursuant to the contract, to provide for
any increase in cost, or new or added cost, to such city, village, ambulance district or town
for insurance coverage for liability for benefits under this chapter on and after the
enactment date of this chapter, by reason of the service rendered pursuant to such
contract. Where such service is received pursuant to a contract entered into prior to the
enactment date of this chapter with an incorporated ambulance company having its
headquarters outside the city, village or ambulance district receiving such service, then
whether or not such contract is amended as provided in this section, or a contract entered
into on or after the enactment date of this chapter so provides, a city, village or
ambulance district receiving such service on and after the enactment date of this chapter
pursuant to a contract, shall pay to the city, village, ambulance district or town in which
such incorporated ambulance company has its headquarters a sum in addition to the
amount to be paid for such service pursuant to the contract, to provide for any increase in
cost, or new or added cost, to such city, village, ambulance district or town for insurance
coverage for the liability for benefits under this chapter on and after the enactment date
of this chapter by reason of the service rendered pursuant to such contract. Any such
additional sum so paid shall not be subject to division with a volunteer ambulance
company as otherwise provided by law in the case of contracts for such service.
1 Workers’ Compensation Law § 60 et seq.
92 Additions in text are indicated by underline; deletions by strikeouts
1988 REGU
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§ 31. The insurance contract
1. The provisions of subdivisions one, two, four, five and seven of section fifty-four of
the workers’ compensation law, in relation to the insurance contract, which are not
inconsistent with this chapter, shall be applicable as fully as if set forth herein. The
insurance carrier shall be a party to all hearings and determinations by the workers’
compensation board or the courts and shall have the right to raise or plead any defense
available to the political subdivision liable in the first instance for the benefits to be paid
and provided by this chapter.
2. A contract of insurance indemnifying against the liability imposed by this chapter
issued by an insurance carrier to a county or a town and in force on or after the
enactment date of such chapter, shall contain a provision reading as follows: “This
contract does not provide (a) any coverage under the Workers’ Compensation Law or the
Volunteer Ambulance Workers’ Benefit Law for which any ambulance district would be
liable under such laws, (b) any workers’ compensation benefits for ambulance district
officers and employees for which any ambulance company would be liable under the
Workers’ Compensation Law, or (c) any volunteer ambulance workers’ benefits for any
volunteer ambulance workers’ for which any ambulance district would be liable under the
Volunteer Ambulance Workers’ Benefit Law.” The foregoing provision does not apply in
relation to volunteer ambulance workers’ benefit coverage and volunteer ambulance
workers’ benefits provided for and in relation to the following named ambulance districts
which have expressly requested coverage under this contract pursuant to the provisions
of section thirty-two of this article, to wit: (If there are no exceptions, enter “No
exceptions’’). ;
3. An insurance contract to indemnify against liability imposed by this chapter
originally issued to take effect on or after March first, next succeeding the enactment
date of this chapter, and any renewal thereof, (a) shall be a separate and distinct contract,
(b) shall not be attached as an endorsement or rider to, or in any other way form a part
of, a workers’ compensation insurance contract, (c) shall not have attached thereto any
endorsement or rider covering any liability under the workers’ compensation law and (d)
shall not be on a contract form used by the insurance carrier for the purpose of insuring
employers against liabilities imposed by the workers’ compensation law, or is attached to
any such form as an endorsement or rider.
4. An insurance contract to indemnify against liability imposed by this chapter
originally issued to take effect prior to the enactment date of such chapter, shall not be
renewed to continue in effect on or after March first, in the year of the enactment of this
chapter, if (a) it is attached as an endorsement or rider to, or in any other way forms a
part of, a workers’ compensation insurance contract, (b) it has attached thereto any
endorsement or rider covering liability under the workers’ compensation law or (c) it is on
a contract form used by the insurance carrier for the purpose of insuring employers
against liabilities imposed by the workers’ compensation law, or is attached to any such
form as an endorsement or rider.
§ 32. Group insurance
1. Notwithstanding any provision of section thirty of this article, any town may
contract for a single policy of insurance indemnifying (a) all ambulance districts wholly
within such town which are liable for the payment of benefits under this chapter, (b) all
territory within such town outside cities, villages and ambulance districts which is liable
for the payment of benefits under this chapter, and (c) the town in relation to such
ambulance districts, and outside territory, against liability imposed by this chapter, if a
town has any such liability and contracts for such a single policy, then and in that event
only any such policy, if requested by the board of trustees of any village wholly within
the town, or by the board of ambulance commissioners of any ambulance district wholly
within the town, shall also indemnify such village or ambulance district against such
liability. The cost of such insurance shall be a town charge and shall be levied and
collected in the same manner as other town charges only in the territory of such town
which is liable for the payment of benefits under this chapter and which is outside of any
Additions in text are indicated by underline; deletions by strikeouts 93
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Ch. 24 LAWS OF NEW YORK
village and ambulance districts not covered by such a policy. Nothing in this section
contained shall impose any additional liability on any town for any benefit payments in
relation to volunteer ambulance workers.
2. Notwithstanding any other provision of section thirty of this article, any group of
cities, villages, ambulance districts or town boards acting for and on behalf of ambulance
districts or territories outside any such municipal corporations or districts which are liable
for the payment of benefits under this chapter, all of which cities, villages, districts and
territories are located in whole or in part within one county, may elect by resolution of the
governing board of each member of the group to be insured against liability imposed by
this chapter, as a group under a single policy. Such resolutions shall be filed with the
chairman of the board of supervisors. The group shall file with the chairman of the
board of supervisors an agreement, signed by the officer of the governing body designat-
ed by such resolution, agreeing to the effective date of such policy and to the population
of each such city, village, ambulance district and such territory outside any such
municipal corporation or district, and, if any such ambulance district lies wholly or partly
within two or more towns, the population of the district within each such town. The
population shall be that which is shown by the latest federal census, or, if not shown by
such census, then as estimated. The estimate used for any village, district or other area
in a town plus the estimated or actual population of all other villages, districts and areas
in such town shall not exceed the population of such town as shown by the latest federal
census. It shall be the duty of the chairman of the board of supervisors of the county,
upon the filing of such resolutions and agreement, promptly to contract for insurance
indemnifying against the liability imposed by this chapter in the manner provided in
section thirty of this article. Except by mutual consent of the participating members, a
member may withdraw from such a group only upon the anniversary date of the policy,
and then only upon thirty days’ notice of withdrawal by mail to the chairman of the board
of supervisors. The cost of such insurance shall be apportioned by the clerk of the board
of supervisors of the county to each such city, village, ambulance district and such
territory outside such municipal corporations and districts, in the proportion that the
agreed population bears to the entire population of the group. Refunds, dividends and
discounts in relation to such insurance shall be distributed or credited according to the
same apportionment. Upon notification by the clerk of the board of supervisors, the chief
fiscal officer of each such city, village or ambulance district shall pay to the county
treasurer, from moneys available or made available, the amount apportioned to such city,
village or district. Upon like notification, the supervisor of each town in which such
ambulance district is located in whole or in part, or in which such outside territory is
located, shall pay to the county treasurer the amount apportioned for such district, in
whole or in part, or territory, as the case may be, using moneys raised or made available
for the purposes of ambulance service in such district or outside territory, or if there be
no such moneys or insufficient moneys, using funds of the town available or made
available, which funds shall be a charge upon such district or territory for which the town
shall be reimbursed. The county treasurer shall pay the cost of such insurance with such
moneys, or if any apportioned share has not been paid, the county treasurer shall advance
the amount necessary from moneys of the general fund upon resolution of the board of
supervisors. Any such advance shall be repaid as soon as moneys are available therefor.
If any apportioned share remains unpaid, the county may recover the same by action at
law. If any member of the group shall fail to pay its apportioned share within thirty days
after notice that such amount has become due and payable, the chairman of the board of
supervisors may terminate the participation of such member in the group by notice by
mail to such member on a date specified in the notice, and a copy of such notice shall be
filed by the chairman of the board of supervisors with the insurance carrier, who shall
notify the chairman of the workers’ compensation board of the termination of coverage in
the same manner as provided for cancellation of policy under subdivision five of section
fifty-four of the workers’ compensation law. If any village or ambulance district is
located in two or more counties, it may elect to join such a group in one of such counties.
If any ambulance district includes territory in more than one county, it shall become a
participant only if all the town boards acting for and on behalf of such district shall have
elected that such district shall become a participant in such a group, and in such case such
town boards shall elect as to which county group it shall join. If any participating
94 Additions in text are indicated by underline; deletions by strikeouts
1988 RE
ambulan:
one coun
such dist
within ea
populatio
any city,
changed
in the me
tion shal!
filed in t.
policy an
3. Eac
identify «
covered t
Section
DH oren or oven en en en ene
§ 40. Not
Notice o.
chapter sh.
ninety days
is filed pur
death. Eit
benefits or
name and
eo
a
time, place
his behalf «
their behal
county, the
the clerk 01
delivering :
YORK
section
ents in
‘oup of
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e liable
sts and
of the
sed by
ith the
of the
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ulation
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ay area
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federal
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1 such
gg
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1988 REGULAR SESSION Ch. 24
ambulance district includes territory in more than one town, whether or not in more than
one county, the amount of cost of insurance, refund, dividend or discount apportioned to
such district shall be apportioned in the proportion that the population of the district
within each such town bears to the population of the entire district. The figure used for
population ‘n such case shall be the one stated in the agreement. If the boundaries of
any city, village, ambulance district or such outside territory in the group shall be
changed during the effective period of any such insurance policy, or if there are changes
in the membership of the group, the agreement heretofore mentioned concerning popula-
tion shall be appropriately amended by a supplementary agreement to be executed and
filed in the same manner as the original agreement, in which case the coverage of the
policy and the apportionment of the cost thereof shall be changed accordingly.
3 Each policy issued pursuant to subdivisions one and two of this section shall
identify clearly each city, town, village, or ambulance district and outside territory
covered thereby.
ARTICLE IV
PROCEDURE
Section 40. Notice of injury or death.
41. Claim for benefits.
42. Reports of injuries, claims and proceedings.
43. Determination of claims for benefits.
44, Presumptions.
45. Modification of awards, decisions or orders.
46. Appeals.
47. Costs and fees.
48. Representation before the workers’ compensation board.
49. Benefits; how payable.
50. Payments pending controversies.
51. Fund for reopened cases.
52. Awards to nonresidents; nonresident compensation fund.
53. Enforcement of payment.
54. Aggregate trust fund.
55. Penalty for false representation.
56. Non-duplication of benefits.
57. Miscellaneous provisions.
58. Application of provisions of workers’ compensation law.
59. Liberal construction.
60. Administrative expenses.
61. Death or disability due to disease or malfunction of heart or coronary
arteries; claims and procedures.
§ 40. Notice of injury or death
Notice of an injury or death for which benefits are to be paid or provided under this
chapter shall be given to the political subdivision liable for the payment thereof within
ninety days after such injury or death except that such notice need not be given if a claim
is filed pursuant to section forty-one of this article within ninety days after such injury or
death. Either such notice may be given by any person claiming to be entitled to such
benefits or by someone in his behalf. The notice shall be in writing, shall contain the
name and address of the volunteer ambulance worker, and state in ordinary language the
time, place, nature and cause of the injury and shall be signed by him or by a person on
his behalf or, in case of death, by any one or more of his dependents, or by a person on
their behalf. The notice shall be given to the clerk of the board of supervisors of the
county, the comptroller or chief financial officer of the city, the town clerk of the town,
the clerk of the village or the secretary of the ambulance district, as the case may be, by
delivering it to such officer or by registered letter properly addressed to such officer.
Additions in text are indicated by underline; deletions by strikeouts 95
eae, ach ahs ahaha ee eee
PROT Te ry ee Wynne
eee
Ch. 24 LAWS OF NEW YORK
The failure to give notice of injury or notice of death shall be a bar to any claim under
this chapter unless such failure is excused by the workers’ compensation board on any of
the following grounds, (1) that for some sufficient reason the notice could not have been
given, (2) that a member of a body in charge of, or any officer of, the ambulance district
or ambulance company had knowledge within such ninety-day period of the injuries or
death, (3) that the political subdivision, or its insurance carrier had not been prejudiced by
a delay in giving such notice, or (4) that the cause of disablement or death was not known
to be the result of service performed in line of duty as a volunteer ambulance worker in
sufficient time to comply with the provisions of this section.
§ 41. Claim for benefits
The right to claim benefits under this chapter shall be barred, except as hereinafter
provided, unless within two years after the injury, or, if death results therefrom, within
two years after such death, a claim for the benefits under this chapter shall be filed with
the chairman of the workers’ compensation board and a copy of such claim shall be filed
with the same officer to whom a notice of injury must be given under section forty of this
article. The right of a volunteer ambulance worker or his dependents to claim benefits
under this chapter for disablement or death, as the case may be, caused by disease shall
not be barred by the failure of the volunteer ambulance worker or his dependents to file a
claim within either such period of two years, provided such claim shall be filed after either
such period of two years and within ninety days after disablement or ninety days after
knowledge that the disease is or was due to service as a volunteer ambulance worker,
whichever is the later date. The claim shall be in substantially the same form and shall
give substantially the same information as is required to be given in a claim under the
provisions of section twenty-eight of the workers’ compensation law. Notwithstanding
the provisions of any other law, any such claim need not be sworn to, verified or
acknowledged. No case in which an advance payment is made to a volunteer ambulance
worker or to his dependents in case of death shall be barred by the failure of the
volunteer ambulance worker or his dependents to file a claim, and the workers’ compensa-
tion board may at any time order a hearing on any such case in the same manner as
though a claim for benefits had been filed.
The date of injury caused by disease shall be the date of contracture of such disease as
determined by the workers’ compensation board on the hearing of the claim and the
responsibility of the political subdivision liable for the payment of benefits and its
insurance carrier shall be fixed by the date of injury as so determined.
§ 42. Reports of injuries, claims and proceedings
If an injury is one for which an insurance carrier might be liable under a contract of
insurance or a county plan of self-insurance might be required to pay, the officer to whom
a notice of injury is required to be delivered or mailed and with whom the claim in relation
to such injury is required to be filed under the provisions of this chapter shall send a copy
of such notice and claim and a copy of any notice of a proceeding relating to an injury or
claim to such insurance carrier or county plan of self-insurance, as the case may be,
promptly after receiving the same. The political subdivision liable for the payment of
benefits under this chapter shall keep such records and make such reports to the
chairman of the workers’ compensation board as required by section one hundred ten of
the workers’ compensation law, which by section fifty-seven of this article is made
applicable to this chapter. Failure to comply with the provisions of this section shall not
relieve such an insurance carrier of liability or a county plan of self-insurance from its
obligation to pay.
§ 43. Determination of claims for benefits
The provisions of section twenty of the workers’ compensation law shall be applicable
as fully as if set forth in this chapter, except that the waiting period of seven days for the
presentation of claims for benefits shall not apply to the presentation of claims for
benefits under this chapter.
96 Additions in text are indicated by underline; deletions by strikeouts
1988 REGULAF
§ 44. Presump
If a claim for
therefrom, is file
this article, the
presumed in the
1. That the c
2. That suffi:
3. That the i
ambulance work
4. That the in
ambulance work:
5. That the
claimants for be
contained therei:
§ 45. Modifica!
The provision:
applicable as ful
§ 46. Appeals
The provisions
applicable as fu’
modification or
provided by sect:
§ 47. Costs anc
The provisions
applicable as full
§ 48. Represeni
The provisions
inconsistent with
in this chapter.
§ 49. Benefits;
Except as oth:
chapter, benefits
twenty-five of th
five, other than t!
Shall be applicab
§ 50. Payments
In order that
promptly where .
of or injuries to
political subdivis
ambulance distric
agree that any o
insurance carrie
conceded to be e
Controversy, and
any such payme:
controversy in th
Ac
°
’ YORK
n under
n any of
ve been
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uries or
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ed with
be filed
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renefits
se shall
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1988 REGULAR SESSION Ch. 24
§ 44. Presumptions
If a claim for benefits is filed within two years after the injury, or, if death results
therefrom, is filed within two years after such death, as provided in section forty-one of
this article, then in any proceeding for the enforcement of such claim, it shall be
presumed in the absence of substantial evidence to the contrary:
1. That the claim comes within the provisions of this chapter.
2. That sufficient notice thereof was given.
3. That the injury was not occasioned by the wilful intention of the injured volunteer
ambulance worker to bring about the injury or death of himself or another.
4. That the injury did not result solely from the intoxication of the injured volunteer
ambulance worker while acting in line of duty.
5. That the contents of medical and surgical reports introduced in evidence by
claimants for benefits shall constitute prima facie evidence of fact as to the matter
contained therein.
§ 45. Modification of awards, decisions or orders
The provisions of section twenty-two of the workers’ compensation law shall be
applicable as fully as if set forth in this chapter.
§ 46. Appeals
The provisions of section twenty-three of the workers” compensation law shall be
applicable as fully as if set forth in this chapter except that reimbursement following
modification or recession upon appeal shall be paid from administration expenses as
provided by section sixty of this article.
§ 47. Costs and fees
The provisions of section twenty-four of the workers’ compensation law shall be
applicable as fully as if set forth in this chapter.
§ 48. Representation before the workers’ compensation board
The provisions of section twenty-four-a of the workers’ compensation law which are not
inconsistent with the provisions of this chapter shall be applicable as fully as if set forth
in this chapter.
§ 49. Benefits; how payable
Except as otherwise provided in subdivisions one and two of section seven of this
chapter, benefits under this chapter shall be paid in the manner provided in section
twenty-five of the workers’ compensation law. The provisions of such section twenty-
five, other than those relating to welfare, pension or benefit plans, agreements and trusts,
shall be applicable as fully as if set forth in this chapter.
§ 50. Payments pending controversies
In order that the benefits to be paid and provided under this chapter shall be paid
promptly where such benefits are conceded to be due to any person because of the death
of or injuries to a volunteer ambulance worker, but controversy exists as to which
political subdivision is liable for the payment thereof, the municipal corporations and
ambulance districts involved in such controversy and their insurance carriers, if any, may
agree that any one or more of such municipal corporations or ambulance districts or its
insurance carrier shall pay or provide the benefits to, or in relation to, the person
conceded to be entitled to such benefits without waiting for a final determination of the
controversy, and may carry out the provisions of such an agreement. Notwithstanding
any such payment, any party to the agreement may seek a final determination of the
controversy in the same manner as if such benefits had not been paid or provided and any
Additions in text are indicated by underline; deletions by strikeouts 97
t
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Ch. 24 LAWS OF NEW YORK
such payment or provision of benefits shall not prejudice any rights of the political
subdivision or its insurance carrier paying or providing the same, nor be taken as an
admission against interest. After a final determination the parties to the agreement shall
make any necessary and proper reimbursement to conform to the determination.
§ 51. Fund for reopened cases
The provisions of section twenty-five-a of the workers’ compensation law shall be
applicable as fully as if set forth in this chapter, except that, other than with respect to
the annual assessment under such section, payments to an executor or administrator of
the estate of a volunteer ambulance worker pursuant to subdivision two of section seven
of this chapter shall not constitute payment of benefits for the purpose of determining the
amount of the payment to the fund for reopened cases. Benefits paid to volunteer
ambulance workers and other persons entitled to benefits under this chapter from the
fund for reopened cases shall be in accordance with the provisions of this chapter.
§ 52. Awards to nonresidents; nonresident compensation fund
The provisions of section twenty-five-b of the workers’ compensation law shall be
applicable as fully as if set forth in this chapter.
§ 53. Enforcement of payment
1. The provisions of section twenty-six of the workers’ compensation law, other than
the portions relating to section fourteen-a, subdivision eight of section fifteen and section
fifty of the workers’ compensation law, shall be applicable as fully as if set forth in this
chapter.
2. The provisions of section. fifty-four-b of the workers’ compensation law shall be
applicable as fully as if set forth in this chapter.
§ 54. Aggregate trust fund
The provisions of section twenty-seven of the workers’ compensation law which are not
inconsistent with the provisions of this section, shall be applicable as fully as if set forth
in this chapter with respect to claims for benefits under this chapter.
§ 55. Penalty for false representation
If, for the purpose of obtaining any benefit or payment under the provisions of this
chapter, or for the purpose of influencing any determination regarding any benefit or
payment under the provisions of this chapter, either for himself or for any other person,
any person wilfully makes a false statement or representation, he shall be guilty of a
misdemeanor.
§ 56. Non-duplication of benefits
If benefits are required to be paid under this chapter in the event of injury to or death
of a volunteer ambulance worker, the volunteer ambulance worker or other persons
entitled to such benefits shall not receive workers’ compensation under the provisions of
the workers’ compensation law in relation to such injury or death.
§ 57. Miscellaneous provisions
The provisions of article seven of the workers’ compensation law! which are not
inconsistent with the provisions of this chapter shall be applicable as if fully set forth
herein. The reference to sections twenty-five-a and fifty of the workers’ compensation
law in section one hundred twenty-three of the workers’ compensation law shall be
deemed to refer to sections fifty-one and thirty of this chapter.
1 Workers’ Compensation Law § 110 et seq.
98 Additions in text are indicated by underline; deletions by strikeouts
1988 REGU
§ 58. Appl
All the pc
compensatio
law which a
this chapter
provisions 0
chapter by t
§ 59. Libe:
The provis
to the conte
effectuate tl
§ 60. Adm:
1. The cl
control, as s
chapter, and
ascertain th
personal ser
tions made <¢
personnel, r
additional si
and the dey
rendered by
other direct :
fiscal year ir
preparations
employees a)
apportioned
the state pe:
chapter and
expenses wh
and such pre
be made anc
such prepar:
section.
2. An ite
Inspection in
publication, |
ed.
3. The es
fiscal years «
of this chapt
first, in the |
soon as prac
chapter, ass
expenses fo
following th
after the clo
year, that th
the total inc
Secured sha]
by the state
chapter and
1988 REGULAR SESSION Ch. 24
§ 58. Application of provisions of workers’ compensation law
All the powers and duties conferred or imposed upon the chairman of the workers’
compensation board and the workers’ compensation board by the workers’ compensation
law which are necessary for the administration of this chapter and not inconsistent with
this chapter are, to that extent, made applicable to this chapter, even though such
provisions of the workers’ compensation law are not expressly made applicable to this
chapter by the provisions of this chapter or the workers’ compensation law.
§ 59. Liberal construction
to the contents of any such notice or claim, shall be construed liberally in order to
§ 60. Administrative expenses
1. The chairman of the workers’ compensation board and the department of audit and
control, as soon as practicable after April first, next succeeding the enactment of this
chapter, and annually as soon as practicable after April first in each year thereafter, shall
ascertain the total amount of expenses, including in addition to the direct costs of
2. An itemized statement of the expenses so ascertained shall be open to public
inspection in the office of the chairman for thirty days after notice to all carriers by
publication, before an assessment maybe made upon such carriers as hereinafter provid-
by the state for the payment in the first instance of the expenses of administering this
chapter and in connection with the preparations for the taking effect thereof.
Additions in text are indicated by underline; deletions by strikeouts 99
Bs Actua i ile Re Bie Mais bisa S dibs. ct
cesbeto riley ;
PN Se
4. The board shall keep an accurate record of all hearings held and the board, in its
discretion may assess against each insurance carrier twenty-five dollars for each ad-
journed hearing held at the request of the insurance carrier. Where the decision of a
referee is affirmed by the board upon review, the board shall assess against each
insurance carrier seeking such review the sum of twenty-five dollars and may assess
against any other party the sum of five dollars. These assessments shall be applied
toward the total amount of administration expenses.
5. The provisions of subdivision two of section one hundred fifty-one of the workers’
compensation law shall not be applicable with respect to the apportionment and assess-
ment of the expenses of administering this chapter, but shall be applicable with respect to
the apportionment and assessment to replenish the fund for reopened cases under section
twenty-five-a of the workers’ compensation law and section fifty-one of this article.
6. Notwithstanding the provisions of subdivision three of this section, the chairman
may require that partial payments for expenses of the fiscal year beginning April first, in
the year of the enactment of this chapter, and for each fiscal year thereafter, shall be
made on June thirtieth, September thirtieth, December thirty-first and March tenth of
each year, or on such other dates as the director of the budget may prescribe, by each
insurance carrier, including the state insurance fund. Each such payment shall be a sum
equal to twenty-five per centum of the annual expenses assessed upon each carrier,
including the state insurance fund, as estimated by the chairman. The balance of
assessments for the fiscal year beginning April first, in the year of the enactment of this
chapter and each fiscal year thereafter, shall be paid upon determination of the actual
amount due in accordance with the provisions of subdivision three of this section. Any
overpayment of annual assessments resulting from the requirements of this subdivision
shall be refunded or at the option of the assessed shall be applied as a credit against the
assessment of the succeeding fiscal year. The requirements of this subdivision shall not
apply to those carriers whose estimated annual assessment is less than one hundred
dollars and such carriers shall make a single payment of the estimated annual assessment
on or before September thirtieth of the fiscal year.
7. Commencing with the fiscal year beginning April first, in the year following the
year of the enactment of this chapter, the provisions of subdivision six of this section shall
be applicable to any county, city, town, village or other political subdivision failing to
secure insurance pursuant to subdivisions eight and nine of section thirty of this chapter.
§ 61. Death or disability due to disease or malfunction of heart or coronary arteries;
claims and procedures
1. A claim for benefits for the death or disability of a volunteer ambulance worker due
to disease or malfunction of the heart or of one or more coronary arteries filed in
accordance with section forty-one of this article, shall not be denied provided the claimant
introduces evidence which establishes that a volunteer ambulance worker suffered
disease or malfunction of the heart or of one or more coronary arteries which caused the
disablement or death of the volunteer ambulance worker, and that such disease or
malfunction resulted from the duties and activities in which the volunteer ambulance
worker was engaged as set forth in section five of this chapter for which benefits shall be
paid, unless it can be shown by substantial evidence to the contrary that the duties and
activities of the volunteer ambulance worker in which the volunteer ambulance worker
was engaged at the time of such disease or malfunction did not cause or precipitate such
disease or malfunction; and further provided that the injury did not result solely from the
intoxication of the volunteer ambulance worker while acting in line of duty or was not
occasioned by the wilful intention of the volunteer ambulance worker to bring about the
injury or death of himself or another.
2. The chairman of the workers’ compensation board shall promulgate rules and
regulations providing a priority for controverted claims for benefits filed as provided in
subdivision one of this section. Such rules and regulations shall also prescribe a form to
be used for making claims for such benefits. Such form shall specifically request the
information necessary in order to receive an award of benefits.
100 Additions in text are indicated by underline; deletions by strikeouts
Ch. 24 LAWS OF NEW YORK
1988 REGI
3: This ‘
law.
Section 9
9)
§ 90. Refe
Where th:
law are ma
following te
following mr
1. “Ace
2. “Depe
lance worke
3. “Emp
injured in |
4. “Emp
5. “Emp
pursuant to
6. “Injur
7. “Injur
8. “Insw
9. “Same
In the same :
for assistan
10. “Wor
worker or h
except when
Where an:
reference th:
also has bee
the applicab
provisions o!
§ 91. Effec
If any cla
adjudged by
affect, impai
the clause, s
the controve
§ 32. Thi
which it sha
1988 REGULAR SESSION Ch. 24
3. This section shall not be construed to repeal by implication any existing provision of
law.
ARTICLE V
SAVING CLAUSES
Section 90. References to workers’ compensation law.
91. Effect of unconstitutionality in part.
§ 90. References to workers’ compensation law
Where the provisions of any section or part of any section of the workers’ compensation
law are made applicable to this chapter and are incorporated herein by reference, the
following terms used in such provisions of the workers’ compensation law shall have the
following meanings when read in connection with this chapter:
1. “Accident” means “injury” as defined in this chapter.
2. “Dependent husband” means the “surviving spouse” of a female volunteer ambu-
lance worker, as defined in this chapter.
3. “Employee” means a volunteer ambulance worker who has been or might be
injured in line of duty or who dies or might die from the effects of such an injury.
4, “Employment” means service of a volunteer ambulance worker in line of duty.
5. ‘Employer’ means the political subdivision liable for payment of financial benefits
pursuant to this chapter.
6. “Injury” means “injury” as defined in this chapter.
7. “Injured worker” means injured volunteer ambulance worker.
8. “Insurance carrier” means “insurance carrier’ as defined in this chapter.
9. “Same employ” means the same ambulance department or ambulance company, or
in the same service for a political subdivision, or district or area thereof, pursuant to a call
for assistance.
10. “Workers’ compensation” means the benefits payable to a volunteer ambulance
worker or his dependents pursuant to this chapter, including medical treatment and care,
except when a different meaning obviously is intended.
Where any such section is so made applicable and is so incorporated, and there is a
reference therein to another section or provision of the workers’ compensation law which
also has been made applicable to this chapter, such reference shall be deemed to include
the applicable section or provision of this chapter if such inclusion is consistent with the
provisions of this chapter.
§ 91. Effect of unconstitutionality in part
If any clause, sentence, paragraph, subdivision, section or part of this chapter shall be
adjudged by any court of competent jurisdiction to be invalid, such judgment shall not
affect, impair or invalidate the remainder thereof, but shall be confined in its operation to
the clause, sentence, paragraph, subdivision, section or part thereof directly involved in
the controversy in which such judgment shall have been rendered.
§ 32. This act shall take effect on the first day of January next succeeding the date on
which it shall have become a law.
Additions in text are indicated by underline; deletions by strikeouts 101
Nt gt ies tea sein Rar tee RRNA Og Tea "
Ce ne ee
a as
scamees asa’
Ch. 768 LAWS OF NEW YORK
§ 2. This act shall take effect immediately.
VOLUNTEER AMBULANCE WORKERS’ BENEFITS—LIABILITY OF
VOLUNTEER AMBULANCE COMPANY
CHAPTER 769
S.9338
Approved Dec. 26, 1988, effective Jan. 1, 1989
AN ACT to amend the volunteer ambulance workers’ benefit law, in relation to liability for
benefits and the maximum death benefit
The People of the State of New York, represented in Senate and Assembly, do enact
as follows:
§ 1. Section two of the volunteer ambulance workers’ benefit law, as amended by
chapter four hundred eighty-one of the laws of nineteen hundred eighty-eight, is amended
to read as follows:
§ 2. Purpose
In recognition of the unselfish service given to the people of New York state by these
volunteer ambulance workers, government has undertaken to provide for them and their
families some measure of protection against loss from death or injuries in the line of duty.
This chapter establishes a system of benefits for volunteer ambulance workers and
provides for the administration of such system by the workers’ compensation board and
the chairman of such board.
It is hereby declared that this chapter is intended to effectuate the objects and purposes
of section eighteen of article one of the state constitution and that the relationship
between the political subdivision or volunteer ambulance company liable for benefits
under this chapter and a volunteer ambulance worker
entitled to such benefits is that of employer and employee within the meaning of such
provision of the state constitution.
§ 2. Subdivision one of section seven of such law is amended to read as follows:
1. The reasonable funeral expenses of the deceased volunteer ambulance worker shall
be paid in an amount not exceeding two three thousand dollars. If such funeral expenses
shall have been paid by a person entitled to benefits under this section or by others, the
funeral expenses awarded shall be made payable to such beneficiary or others; otherwise
they shall be payable to the undertaker who provided the burial. Funeral expenses shall
be awarded in all death cases.
§ 3. Section thirty of such law, subdivision nine as amended by chapter four hundred
eighty-one of the laws of nineteen hundred eighty-eight, is amended to read as follows:
§ 30. Liability for and payment of benefits
Except as otherwise provided in article five of the workers’ compensation law! and in
section twenty-one of this chapter:
1. If at the time of injury the volunteer ambulance worker was a member of an
ambulance company of a county, city, town, village or ambulance district ambulance
department, any benefit under this chapter shall be a county, city, town, village oF
ambulance district charge, as the case may be, and any claim therefor shall be audited in
the same manner as other claims against the county, city, town, village or ambulance
1614 Additions in text indicated by underline; deletions by strikeouts-
1988 REG!
district anc
county, cit)
2. fF at
ambulance
law, and lo:
ambulance
was a mem
charge, as 1
other claim
be raised a1
3. If at
voluntary a
of the pub!
four of the
thousand si
duly incorp
county, city
voluntary a
manner as «
shall be ra
charges. N
have covere
4. If at
ambulance «
law, and la
chapter sha
same manne
taxation in
manner as t
5. If at
ambulance c
or more vill:
under this ¢
in the prop
aggregate :
ambulance c
manner as
determined |
town or am
Village, tow:
State agenc:
department
determined |
M which the
County roll.
for
act
ance
2 or
ad in
ance
1988 REGULAR SESSION Ch. 769
district and the amount thereof shall be raised and paid in the same manner as other
county, city, town, village or ambulance district charges.
9. If at the time of injury the volunteer ambulance worker was a member of an
ambulance company incorporated under the not-for-profit corporation law, or any other
jaw, and located in a city, village, or ambulance district, protected under a contract by the
ambulance department or ambulance company of which the volunteer ambulance worker
was a member, any benefit under this chapter shall be a city, village or ambulance district
charge, as the case may be, and any claim therefor shall be audited in the same manner as
other claims against the city, village or ambulance district and the amount thereof shall
be raised and paid in the same manner as other city, village or ambulance district charges.
3. If at the time of injury the volunteer ambulance worker was a member of a
voluntary ambulance service as defined in subdivision three of section three thousand one
of the public health law, registered pursuant to the provisions of section three thousand
four of the public health law or certified pursuant to the provisions of section three
thousand six of the public health law and organized as an unincorporated association or
duly incorporated under the laws of this state not protected under a contract by the
county, city, town, village or ambulance district, any benefit under this chapter shall be a
voluntary ambulance service charge and any claim therefor shall be audited in the same
manner as other claims against the voluntary ambulance service and the amount thereof
shall be raised and paid in the same manner as other voluntary ambulance service
charges. No charge shall be made against a voluntary ambulance service that does not
have coverage under this chapter.
4. If at the time of injury the volunteer ambulance worker was a member of an
ambulance company incorporated under the not-for-profit corporation law, or any other
law, and located outside of a city, village or ambulance district any benefit under this
chapter shall be a town charge and any claim therefor shall be audited and paid in the
same manner as town charges and the amount thereof raised upon the property liable to
taxation in such outside territory protected by such ambulance company in the same
manner as town charges therein are raised.
5. If at the time of injury the volunteer ambulance worker was a member of an
ambulance company or ambulance department operating in, or maintained jointly by two
or more villages, or two or more towns, or two or more ambulance districts, any benefit
under this chapter shall be a charge against such villages, towns or ambulance districts,
in the proportion that the full valuation of taxable real estate in each bears to the
aggregate full valuation of the taxable real estate of all such villages, towns or
ambulance districts and the amount thereof shall be audited, raised and paid in the same
manner as other village, town or ambulance district charges. Full valuation shall be
determined by dividing the assessed valuations of taxable real estate of each such village,
town or ambulance district as shown by the latest completed assessment roll of the
village, town or ambulance district by the equalization rate established by the authorized
state agency or officer for such roll; provided, however, in a county having a county
department of assessment the full valuation in towns and ambulance districts shall be
determined by applying the state equalization rate established for the town, or the town
in which the ambulance district is located, to the appropriate portion of the last completed
county roll.
Additions in text indicated by underline; deletions by strikeouts 1615
O
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Se Sg
Fy
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ae
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ie ;
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,
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LAWS OF NEW YORK
% Any political subdivision may finance the payment of any benefits to be paid and
provided under this chapter by the issuance of serial bonds or capital notes pursuant to
the local finance law unless it is required by some law, other than this chapter, to pay
such benefits from current funds.
8 7. Any political subdivision may contract for insurance indemnifying against the
liability imposed by this chapter and the cost of such insurance shall be audited, raised
and paid in the same manner as benefits are required to be audited, raised and paid in this
section.
98. Insurance authorized to be purchased pursuant to subdivision eight seven of this
section may be secured from the state fund or any stock corporation, mutual corporation,
group self-insurers or reciprocal insurer authorized to transact the business of workers’
compensation in this state. If such insurance is not secured, the political subdivision
liable shall be deemed to have elected to be a self-insurer unless it is a participant in a
county plan of self-insurance or its liability for benefits under this chapter is covered by a
town’s participation in a county plan of self-insurance as provided in subdivision nine of
section sixty-three of the workers’ compensation law. Every such self-insurer shall file
with the chairman of the workers’ compensation board a notice of such election prescribed
in form by such chairman. For failure to file such notice within ten days after such
election is made, the treasurer or other fiscal officer of such political subdivision shall be
liable to pay to the chairman of the workers’ compensation board the sum of one hundred
dollars as a penalty, to be transferred to the state treasury to reimburse it on account of
expense of administering this chapter and the workers’ compensation law. A notice of
election to be a self-insurer for compensation and benefits to volunteer ambulance
workers under the provisions of the workers’ compensation law and the general municipal
law in effect prior to March first, in the year of enactment of this chapter, which was filed
prior to such date pursuant to the provisions of subdivision four of section fifty of the
workers’ compensation law as in effect prior to such date shall be deemed to be a notice
of election filed under this section unless the chairman of the workers’ compensation
1616 Additions in text indicated by underline; deletions by strikeouts-
1988
boar:
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10
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awar
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settle
11
deem
42
ambu
enter
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§ 4.
RO
AN AC}
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reti;
2 €h2 FR gFeEeLEERELERE 2 £2 2 B
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1988 REGULAR SESSION Ch. 770
poard is notified to the contrary. The provisions of subdivision five of section fifty of the
workers’ compensation law shall be applicable to such self-insurers.
19 9. The governing board of a political subdivision liable for the payment of such
penefits may authorize the treasurer or other fiscal officer thereof to pay the financial
pnenefits provided for in this chapter to the person entitled thereto without waiting for an
award in any case in the manner provided in section forty-nine of this chapter. The
amount payable prior to an award pursuant to such authorization shall constitute a
settled claim within the meaning of the local finance law.
31 10. A contract for ambulance service, for the purposes of this section, shall be
deemed in full force and effect if negotiations are pending for the renewal thereof.
32 11. Where a city, village, ambulance district or town is furnished service by an
ambulance company, ambulance department, or any unit thereof pursuant to a contract
entered into prior to the enactment date of this chapter with another city, village,
ambulance district, or an incorporated ambulance company having its headquarters
outside the city, village or ambulance district receiving such service and the liability for
benefits under this chapter in relation to volunteer ambulance workers rendering such
service pursuant to such contract on and after the enactment date of this chapter is not
covered pursuant to a county self-insurance plan pursuant to section sixty-three of the
workers’ compensation law, the contract may be amended after a public hearing held in
the manner provided by law for the amendment of any such contract, or at the option of
the contracting parties without a public hearing, to provide for payment by the city,
village or ambulance district receiving such service to the city, village, ambulance district
or town in which such incorporated ambulance company has its headquarters, of a sum in
addition to the amount to be paid for such service pursuant to the contract, to provide for
any increase in cost, or new or added cost, to such city, village, ambulance district or town
for insurance coverage for liability for benefits under this chapter on and after the
enactment date of this chapter, by reason of the service rendered pursuant to such
contract. Where such service is received pursuant to a contract entered into prior to the
enactment date of this chapter with an incorporated ambulance company having its
headquarters outside the city, village or ambulance district receiving such service, then
whether or not such contract is amended as provided in this section, or a contract entered
into on or after the enactment date of this chapter so provides, a city, village or
ambulance district receiving such service on and after the enactment date of this chapter
pursuant to a contract, shall pay to the city, village, ambulance district or town in which
such incorporated ambulance company has its headquarters a sum in addition to the
amount to be paid for such service pursuant to the contract, to provide for any increase in
cost, or new or added cost, to such city, village, ambulance district or town for insurance
coverage for the liability for benefits under this chapter on and after the enactment date
of this chapter by reason of the service rendered pursuant to such contract. Any such
additional sum so paid shall not be subject to division with a volunteer ambulance
company as otherwise provided by law in the case of contracts for such service.
1 Workers’ Compensation Law § 60 et seq.
§ 4. This act shall take effect January first, nineteen hundred eighty-nine.
ROOSEVELT ISLAND OPERATING CORPORATION—RETIREMENT
BENEFITS FOR EMPLOYEES
CHAPTER 770
A.10589-A
Memorandum relating to this chapter, see Legislative Memoranda, post
Approved and effective Dec. 26, 1988
AN ACT to amend chapter eight hundred ninety-nine of the laws of nineteen hundred eighty-
four, relating to the creation of the Roosevelt Island operating corporation, in relation to
retirement benefits for unionized employees of the Roosevelt Island operating corporation
1617
Additions in text indicated by underline; deletions by strikeeuts-
VOLUNTEER EMERGENCY SERVICES
Fire protection in New York State is a primary service of local governments. The organizational aspects of such
service throughout the State are diverse and numerous organizational methods are used. The greater share of fire
protection in the State is provided by volunteer firefighters. Of the 1,809 municipal fire departments in New York
State, 1,713 are fully volunteer. Volunteer firefighters in the State number approximately 111,000. Emergency
medical services are provided by various systems in New York State, including municipal ambulance services,
emergency rescue and first-aid squads attached to fire companies, and volunteer ambulance corps. Of the 1,189
emergency medical services in the State, approximately 966 are volunteer services (this includes those attached to
volunteer fire companies).
Volunteer emergency services have been suffering from numerous problems, among which are the recruitment and
retention of members, the inability to purchase much needed (and State-mandated) equipment and apparatus, and
the need for improvement in methods of training. In 1987, the Senate Majority Task Force on Volunteer Emer-
gency Services (chaired by Senator Jay P. Rolison, Jr.) was created to study the organization and delivery of vol-
unteer emergency services. The Task Force held hearings across the State in the latter half of 1987 to gather input
from volunteers as to what they were seeking in terms of legislation that would best address their problems and
developed a legislative agenda to aid in the solution of those problems.
To aid volunteer ambulance workers, the Legislature passed, and the Governor signed (after 3 previous vetoes),
comprehensive legislation that authonzes the creation of volunteer ambulance districts by municipalities outside of
New York City and provides disability compensation and benefits through a new Volunteer Ambulance Workers’
Benefit Law (A. 8515-B, Chapter 24, L. 1988) which parallels, in most respects, the benefits provided to volunteer
firefighters in the Volunteer Firefighters’ Benefit Law. Rural fire districts, which tend to have the most difficult tume
finding members, were aided by legislation that streamlines the process by which towns and villages may form joint
fire distncts (S. 7865-A, Chapter 241, L. 1988).
Of particular concern to volunteer firefighters has been the adoption by the State Department Labor of federal Oc-
cupational Safety and Health Administration standards for uniforms and equipment. Due to the limited resources
of many volunteer fire companies, it has been extremely difficult, if not impossible, for these companies to purchase
such required items, while the Governor has vetoed legislation in past years that would allow for funding of up to —, }, yt
75% of the cost of these items (Veto 62, 1986). In 1988, the Senate attempted to break this stalemate by passing /
legislation that would, among other things, help both volunteer fire and volunteer ambulance companies by creating C " 7 La |
a fire and ambulance loan assistance program that would make low-interest loans available to eligible fire, ambu- \ |
lance, and emergency service organizations to be used to purchase necessary equipment (S. 943-C, Veto 16, 1988).—/
For more information, see the Health & Health Care Financing, “Emergency Medical Services” section and a 1989
SRS /ssues in Focus on volunteer emergency services, #88-120, “Volunteer Ambulance Workers--Issues in 1988,”
#88-56 “Volunteer Firefighters--Issues in 1988,” #86-63, “Massive Surgery for Emergency Medical Services,” and
#82-132, “Fire Protection and the Impact on Municipal Budgets.”
ENACTED LEGISLATION
Ambulance District/Volunteer A. 8515-B
Ambulance Workers’ Benefit Law Chapter 24
S. 9338
Chapter 769
Chapter 24, along with its chapter amendment, Chapter 769, allows the creation of ambulance districts by towns
as special improvement districts, without the necessity of special State legislation, for each town that wishes to do
sO, enacts a comprehensive new chapter of consolidated laws entitled the “Volunteer Ambulance Workers’ Benefit
Law” (VAWBL), and otherwise amends numerous existing provisions of law currently applicable to fire districts and
volunteer firefighters to make them applicable as well to ambulance districts and volunteer ambulance workers.
Local Government 26-21
Smee eS Sa
to furnish prehospital emergency treatment, (3) contract with 1 or more such entities to staff, equip, and supply
EMS or ambulance vehicles suitable for such purposes, or (4) employ any combination of the above methods. Also
¢ formulate rules and regulations relating to the use of such apparatus and equipment in the provision of EMS
contract;
¢ purchase or provide insurance indemnifying against liability for thenegligent operation of an EMS or ambulance
service and the negligent use of other equipment or supplies incidental to the furnishing of an EMS or am-
bulance service;
¢ provide for the administration and coordination of an EMS or ambulance service, including operation of an
emergency medical communications system and medical control; and
to the operation of the ambulance district to the commissioners, which board shall act in an advisory capacity
to the town board with regard to other functions related to the operation of the district.
by law. Expands the definition of improvement district,” for the purposes of the altemate method of establishing
such districts, to include an ambulance district in any town.
26-22 Summary of Legislation 1988
1
duties. States that except in accordance with provisions of the Municipal Home Rule Law or other laws passed
by the Legislature, a county charter or charter law cannot supersede any general or special law enacted by the Leg-
islature in the VAWBL. Amends the Village Law to allow a village board of trustees to establish or abolish a
board(s) of ambulance commissioners.
FM
‘
Amends numerous provisions of the Workers’ Compensation Law (WCL) to reflect that Workers’ Compensation
(WC) coverage for volunteer ambulance workers will now be provided under the VAWBL, but that coverage will
be provided under the WCL itself for paid ambulance district employees and for any county fire coordinator, deputy |
fire coordinator, or comparable county official who is also a volunteer ambulance worker. Specifies that any con-
tract for WC coverage issued to a county or town that does not self-insure in relation to ambulance districts on or
after January 1, 1989, must include a disclaimer, such as is already required on contracts in relation to fire districts,
that such contract does not provide coverages under the WCL or VAWBL for which any ambulance district would
be liable under such laws. Further specifies that insurance contracts to secure WC benefits for an ambulance district
issued to take effect on or after January 1, 1990, or any such contract renewed to continue in effect on or after such
date, must provide WC coverage for all ambulance district officers, whether elective or appointive, and all ambulance
district employees, whether or not compensated for their services, unless the board of ambulance commissioners (by
resolution) elects not to provide such coverage for any | or more or any class of such officers or employees in the
manner now set forth for fire districts.
Stipulates that where a town participates in a county self-insurance WC plan, in addition to payments with respect
to the liability of the town, the county must make payments with respect to that portion of the liability of all villages
and ambulance districts within such town and all territory within such town outside of cities, villages, and ambulance
districts, arising out of the death of or injury to volunteer ambulance workers. Provides, however, that the county
shall not be obligated to make such payments in the case of a village or ambulance district located in more than |
town unless the town board of each town containing part of the district (by resolution) elects to become a partic-
ipant in the plan. Further states that participation in a plan by an ambulance district shall make the county liable
for such payments where the town or towns in which the ambulance district is located are not participants in the
plan. Uses the definition of “injury” that is stated in the VAWBL.
VAWBL--Generally
Enacts the Volunteer Ambulance Workers’ Benefit Law, which provides a system of benefits for volunteer ambu-
lance workers killed or injured in the line of duty similar to those provided under the Volunteer Firefighters’ Benefit
Law (VFBL). Provides for the administration of this system of benefits by the Workers’ Compensation Board and
the Chairman of such Board. Defines “volunteer ambulance worker” as an active volunteer member of an ambu-
lance company, as specified on a list regularly maintained by that company. Defines an “ambulance company,” in
turn as any voluntary or municipal ambulance service registered or certified pursuant to the Public Health Law ex-
cept a fire company emergency rescue and first aid squad subject to the General Municipal Law. Delineates the
coverage and benefits available to volunteer ambulance workers and their dependents. Specifies the duties and ac-
tivities in relation to which benefits shall be paid to volunteer ambulance workers, which include the following:
e necessary travel to, working at, and necessary travel returning from an accident, alarm of accident, or other duty
to which the ambulance department, company, or unit has responded or is otherwise authorized to respond;
e while within the State, personally assisting another ambulance department, company, or unit;
¢ while within the State, performing duties at an ambulance facility or elsewhere directly related to the prevention
of accidents or other disasters or the delivery of emergency health care;
* while within the State, working in connection with a fund-raising activity of their ambulance company, in-
cluding necessary travel directly connected to such activity, but not including competitive events in which vol-
unteer ambulance workers are competitors, such as baseball or football; and
° while within the State and pursuant to orders or authorization, working in connection with the construction,
testing, inspection, repair, or maintenance of ambulance facilities and/or vehicles and equipment.
Also includes training sessions, conferences, drills, meetings, and the like, with various restrictions. Stipulates that
benefits under VAWBL coverage shall not be paid in certain instances, including in performance of the following:
° hide or service rendered by a volunteer ambulance worker while on a leave of absence or suspended from
uty;
Local Government 26-23
° work, service, or activities in which the volunteer ambulance worker has been ordered not to Participate.
VAWBL--Benefits
of the volunteer ambulance worker while acting in the line of duty or by the willful intention of such worker to bring
about the injury or death of him/herself or another.
Provides numerous death benefits, including, but not limited to the following:
a paymen
and in school full-time, or of any age and blind or physically disabled, until the spouse remarmies, whereupon
a lump sum of $31,200 shall be paid to such spouse.
Member Lost Number of Weeks
Am 312
Leg 288
Hand 244
Foot 205
Eye 160
Thumb 75
First Finger 46
Great Toe 38
Second Finger 30
Third Finger 25
Toe Other Than Great Toe 16
Fourth Finger 15
26-24 Summary of Legislation 1988
addressed and for temporary partial disability, the weekly payment of benefits shall be determined by the percentage
of loss in earning capacity, as follows:
Percentage of Loss of Benefit
Earning Capacity Per Week
75% or greater $150
50%-74% 100
25%-49% 30
Less than 25% 0
Includes numerous other provisions regarding the determination of the degree of disability and of the disability
benefits to be paid in each case. Stipulates that the degree of such disability will be determined by the Workers’
Compensation Board, which may also reconsider such degree on its own motion or upon application of any party
in interest.
Delineates coverage and benefits for the repair or replacement of prosthetic devices lost or damaged in the line of
duty, including eyeglasses and dentures, and for hazardous exposures. Provides that the Board may make non-
schedule adjustments or reclassify disabilities in certain circumstances. Allows coverage and benefits for death or
disability of volunteer ambulance workers who suffered previous disability, and for the expense of rehabilitating in-
jured volunteer ambulance workers. Specifies the types of treatment and care to which such workers are entitled.
Provides for financial benefits for aliens who are volunteer ambulance workers and their dependents and for the
disposition of accrued benefits upon the death of any volunteer ambulance worker, and states the exclusiveness of
remedy of the benefits provided in the VAWBL for volunteer ambulance workers and their dependents. Also states
that provisions of the WCL pertaining to the subrogation of claims, to the extent that such provisions are not in-
consistent with the provisions of the VAWBL, are to be fully applicable as if set forth in the VAWBL. Provides
coverage and benefits for volunteer ambulance workers who respond to calls for assistance in other political subdi-
visions or other states, Canada, property ceded to the federal government, or Indian reservations as well as for vol-
unteer ambulance workers from other states or Canada who respond to calls for assistance in this State.
Specifies that revenues and benefits from sources other than the VAWBL shall not be considered in determining
benefits paid and provided under the VAWBL. Declares that benefits are payable only to volunteer ambulance
workers and their dependents, except as otherwise provided, and are exempt from all claims of creditors and from
any remedy for the collection of debt; voids all waiver agreements by a volunteer ambulance worker in regards to
these benefits; and stipulates that no limitation of time as provided in the VAWBL shall run against any person
who 1s mentally incompetent or a minor as long as he/she has no committee or guardian.
VAWBL--Liability
Establishes liability for benefits for volunteer ambulance workers and provisions for the payment of benefits similar
to provisions enacted for volunteer firefighters under the VFBL. Specifies the unit of government or other entity
against which any VAWBL benefit is to be a charge, depending upon the type of ambulance organization involved
and the geographic area to which assistance was being rendered at the time of the injury. Permits a political sub-
division to finance the payment of benefits through the issuance of serial bonds or capital notes and to contract for
insurance indemnifying against VAWBL liability. Stipulates that such insurance for a political subdivision may be
secured from the State Insurance Fund or any insurer authorized to transact WC business within the State. Specifies
that if such insurance is not secured, the subdivision will be deemed to have elected to be self-insured unless it is a
Participant in or such coverage is included in its participation in a county plan of self-insurance. Allows a subdivi-
sion or ambulance district that is provided ambulance service by an entity outside its limits under a contract entered
into before January 1, 1989, which contract does not cover the liability for VAWBL benefits, to amend such con-
tract to provide for payment for such coverage, but requires the subdivision or ambulance district to pay for such
coverage in any event if the contract is with an incorporated ambulance service. Incorporates by reference the WCL
Provisions pertaining to the insurance contract.
Stipulates that the insurance carrier is to be a party to all hearings and determinations by the Board or the courts
and has the right to raise or plead any defense available to the subdivision liable for the benefit in the first instance.
Includes several detailed provisions aimed generally at ensuring that contracts providing VAWBL coverage are kept
separate and distinct from those providing WCL coverage and that contracts for VAWBL coverage issued to towns
Local Government 26-25
provided to volunteer firefighters under the VFBL. Similarly permits any group of cities, towns, villages, or am-
bulance districts within a single county to elect to be insured for VAWBL coverage as a group. Includes adminjs-
trative procedures for such group insurance.
VAWBL--Procedure
to the insurance carrier or county plan of self-insurance. Establishes certain presumptions in favor of a claim filed
within the 2-year period in any proceeding for the enforcement of such claim.
assessment after April 1, 1990; and requires the Chairman, as soon as practicable after Apnil 1, 1990, to assess upon
and collect from each carrier its proportion of such consolidated expenses for the fiscal years ending March 31, 1989,
and March 31, 1990, and annually thereafter , to reimburse the State for its costs of administering the program.
modifies terms used in the WCL when used in reference to the VAWBL where such terms are applicable, and
contains a severability clause. Effective January 1, 1989. (Amends: Town Law; Education Law; Election Law;
Estates, Powers and Trusts Law; Executive Law; General Municipal Law; Insurance Law; Municipal Home Rule
Law; Village Law; Workers’ Compensation Law; New York State Defense Emergency Act)
26-26 Summary of Legislation 1988
TOWN LAW
»f Decisions
rather than through a special district, in
those parts of the town outside villages.
Op.Atty.Gen. (Inf.) 87-64.
-16. Police districts
A town is not authorized to adopt a
local law establishing a part-town Police
district. Op.State Compt. 86-53.
‘17. Electrical power districts
A town may not establish an electrical
power district either under the Town
ae or by local law. Op.State Compt.
—44, '
listricts
Decisions
district to a disposal facility owned and
operated by a waste water disposal dis-
trict in an adjacent town. Op.State
Compt. 8646.
nt districts
Yecisions
area already served by public water.
Op.State Compt. 87-53. its
tion -
ited to the town board pursuant to
extension of a sewer, wastewater
ty treatment, park, public parking,
district, the improvements pro-
0 be expended for the im rovement
im amount to be expended for the
4 maximum amount is stated in the
d place where said board will meet
persons interested in the subject
d shall cause a copy of such order,
ished at least once in the official
> not less than ten nor more than
for the hearing as aforesaid, and
ited on the signboard of the town
section thirty of this cha ter, not
before the day designated for the
TOWN LAW § 198
Historical.and Statutory Notes
1988 Amendment. L.1988, c. 24, § 2, cable to petitions. for the establishment
eff. Jan. 1, 1989, made Provisions appli- or extension of ambulance districts.
§ 198. Powers of town boards with respect to improvement
districts RL ST Pi apy BE I] i
The town board of every town, except as otherwise provided by law, shall
have authority to and may exercise the following powers with respect to
improvement districts, heretofore or hereafter established, subject to the
provisions of this article: _ sails a in eget ot a oo
[See main. volume for tect Of L:to WO}. iss,: 5
10-f. Ambulance districts. ‘After an ambulance district has been estab-
lished, including ambulance districts established prior to the effective date
of this subdivision® pursuant to this article and article twelve-A of this
chapter or any other provision of' law, the town board may: ett
other place for treatment of such illness or injury, and to that end may:
(i) Acquire by gift or purchase ‘one or mo
ment, and may operate, maintain,
supplies and equipment; A dotela
personnel except an emergency; rescue and first aid squad of a fire
department or fire company which is subject to the provisions of section
two hundred nine-b of the general municipal law for operation, mainte-
nance and repair of such emergency medical service or ambulance vehicles
and for the furnishing of
(iv) Employ any combination of: the methods authorized in subpara-
graphs (i), (ii) and (iii) of this paragraph; my
(b) formulate rules and regulations relating to the use of such apparatus
and equipment in the provision of emergency medical services or ambu-
lance service, fix a schedule of’ fees or charges to be paid by persons
requesting the use of such facilities, provide for the collection of such fees
and charges, or formulate rules and regulations for. the collection thereof
by the individuals, municipal corporations, associations, or other organiza-
tions furnishing service under contract as provided in: subparagraph (ii) of
paragraph (a) of this subdivision; i ar 3 EER
(c) purchase or provide insurance indemnifying against liability for the
negligent operation of such emergency medical service or ambulance
3
§'198
TOWN LAW
service and the negligent use of other equipment or supplies incidental to
the furnishing.of such emergency medical service or ambulance service;
(d) ‘provide ‘for' the administration and coordination of such emergency
medical service or ambulance service including but not limited to operation
of an emergency, medical communications system and medical control; and
(e) establish by local law a district board of ambulance commissioners,
and delegate. ministerial functions related to the operation of the ambu-
lance district to the commissioners. The district board of ambulance
commissioners shall act in an advisory capacity to the town board with
regard’to other functions related to the operation of the district.
The town board may appoint members to the district board of ambulance
commissioners or may provide that the commissioners be elected pursuant
to the procedures in article thirteen of this chapter for the election of
improvement district commissioners. If appointed by the town board, the
town board shall appoint the members to terms 80 fixed that at least one
will expire at the end of each calendar year. No term shall exceed three
atinead IG Bis
(Asamendéd'L.1988,'c: 24, § 3) ©”
°°3 Jan’'1,°1989, ore PRI eul, <6
oe GOORINGT 9 ; .
Soucy ope rdsee mam volume for text of 11 to 13] a
a? 48S Ey sbdpeld OF HIS Te. Ti. are ' j r
eh Siddiga eatsike Histo cal and Statutory Notes A’G
"“y9gs-“‘Ameridment. © Subd.’ 10-f. —” og fs
L.1988, ¢2 24,3§°3, eff. Jan. 1, 1989, add- xsift
ed subd. 10sfo1.g) Mosc ew a do:
digg
png PALI es Notes of Decisions, Sek’
1, ‘Sewer: districts °°°'"" ~~ -
‘The cost of ‘constructing park facilities
undertaken solely ‘for the purpose of in
creasing the possibility of obtaining
state and federal aid for a sewer district
project may not be jncluded as a part of
the cost‘of the district. Op.State Compt.
SSH QQ EMEA ARON 332 So
aA ‘town, !on behalf. of a town sewer
district, can, contract with a county to :
provide sewer service to properties with-
in a county, sewer district, the cost of
such a-contract would be financed by the , .
county in the same manner as other
operation .and maintenance costs in-
curred by the district. Op.State Compt.
91-24. '
3. Water districts—Generally, ,
A town. may require district property
owners to connect to a district water
system. Op.State Compt. 88-30.
A:towh may obtain an easement on
behalf of its water district in a privately
owned lake for the purpose of drawing 8
supply ‘of:-drinking water and it may
take reasonable measures to make the
lake a satisfactory source of drinking ,
water ‘at «the district's expense. . Op.
Stite Conapt. BEBE! = CE
7. —— Pipes, mains and conduits”:
Town, water district, and county” wa-
ter authority acted appropriately: and
within their authority in terminating wa-
ter service to service line and in direct-
ing property owner to install a new’one,
where there was willful waste by use of
water through improper and ngetoct
aa é oo _= ree V
own Oo amburg (4 Dept. 992),
A.D.2d —, 583 N.Y.S.2d 79. ‘>
10. —— Rates and charges)
Town Law which provides for uniform
service charge for installation of supply
pipe within bounds of public highway
was not authority for applying to‘real
estate development a loca! law “Which
required all new customers of water dis-
trict to pay initial hookup fee; Sétvice
charge provided for in Town Law applies
only if town performs installa and
plans for development called for devel-
opers’ installation of all water ‘apply
pipes. Coconato v. Town of Esopus,
1989, 152 A.D.2d 89, 547 N.Y5.2d-953,
appeal denied 76 N.Y.2d 701f2658
N.Y.S.2d 891, 557 N.E.2d 1187.
Even though Town Law 3U 8
town board to set up and raise ‘Water
TOWN LAW
8 incidenta! to
alance, Service;
ich emergency
d to operation
l control; and’
ommisgioners,
of the ambu-
of ambulance
m board with
trict.
of ambulance
cted pursuant
he election of
wn board, the
t at least one
| exceed three
mn
d conduits
nd county wa-
ropriately and
erminating wa-
} and in direct-
tall a new one,
raste by use of
and imperfect
sing, Inc. v.
Yept.1992) __
79.
ges
es for uniform
tion of supply
ublic highway
plying to real
al law which
s of water dis-
9 fee; service
m Law applies
stallation, and
led for devel-
water supply
n of Esopus,
N.Y.S.2d 9583,
2d 701, 558
1187.
w authorizes
i raise water
TOWN LAW
rates, charge for hook up to town water
system is not within its purview. Coco-
nato v. Town of Esopus, 1989, 152
A.D.2d 39, 547 N.Y.S.2d 953.
A town board, on behalf of a water
district, may establish a schedule of wa-
ter rates under which senior citizens
meeting certain income criteria are
charged at a reduced rate. Op.State
Compt. 88-57.
11. Park districts—Generally
A town board may exclude nonresi-
dents of a park district from the facili-
ties of the district. Op.State Compt.
88-25.
§ 202
16. Refuse and garbage districts .,;
Town boards, on: behalf. of garbage
and refuse collection. districts, can con-
‘ tract with villages located within the
town, but excluded: from that district,
for the collection of’ village garbage.
Op.State Compt. 91-14,‘ :!
A town may provide: refuse and gar
bage collection service by either forming
a refuse and garbage district financed
on a benefit or we valorem basis, with
the cost of management, maintenance
and operation paid for by user fees; or
‘refuse and garbage collection. may be
provided as a town function by general
town tax revenues or.by a: system of
user fees. _Op. State Compt. 86-88... a
ime
TIO.
§ 200. Petition for street improvement and proceedings thereon
Notes of Decisions 115i tO Qiite
Construction with other laws ‘A
'e. Construction with other laws ~~.
Although construction of second
phase of industrial access road should
have been authorized pursuant to High-
way Law, rather than Town Law, de
fense of laches was sortable . besosacig
78 proceedings with hated i eat Haid
of road already completed, where nearby
. property owner had actual knowledge of
town. board’s intent to: construct second
phase and to finance. it as special assess-
ment against. landowner’s. property.
Harriman. Woods Associates. v. Town.of
Monroe, 1990, 168 Ror areys 781, 568
N.Y.5-2d 931. DEOT!
Cae Coiba
rant if
§ 200-a. Construction and repair of sidewalks. pursuant, too or-
der of town board
t
a! id 10 Ri Leeoae WERG 22 Eg
[See main volume for text of first, second and third cutee pars.]
The town board may adopt a local law apportioning the expense of
building, relaying or repairing any sidewalk within such town between the
town and owners of the respectiv
street or county
(As amended L.1991, c. 255, § 1.)
e lots and parcels of: land’ abutting any
or state highway within the town along which it i is desired
that sidewalks be built, relaid or repaired.
is GOL & ES Oe fa
~
ihe
a
Historical and a inate
1991 Amendments. oe par.
L.1991, c. 255, § 1, eff. July 1, 1991,
added closing par. | ‘relating. to sidewalk
expenses. _
or P ot
Y. + PSR A
§ 202. Expenses of improvement; how raised
[See main volume for text of 1 and 2].
3. The expense of the establishment of a park, public parking, “i
lighting, snow removal, water supply, water, water storage and distribu-
tion, sidewalk, refuse and garbage, aquatic plant
growth control district,
ambulance district, harbor improvement district, public dock district, fallout
shelter district, or beach erosion control district, and providing improve-
ments or services, or both, therefor, and of constructing lateral water
mains pursuant to paragraph (b) of subdivision one of section one hundred
5
Deletions From the Volunteer . S. 6703-A
Firefighters’ Benefit Law Chapter 621
f
F
;
=
Deletes from the Volunteer Firefighters’ Benefit Law the provision that allows the Workers’ Compensation Board
to commute in half, as of the date of death, all financial benefits to aliens who are nonresidents or about to become
nonresidents of the United States or Canada. Also deletes another provision of such law which provides for a dis-
cretionary penalty of $25 for each adjourned hearing held at the request of the insurance carner. Effective January
1, 1989, and applies to all hearings continued or adjourned after such date and all injuries or deaths to alien volunteer
firefighters occurring after such date. (Amends: Volunteer Firefighters’ Benefit Law)
Group Self-Insurers and Volunteer S. 8677-A
Ambulance Companies Chapter 481
Amends the Volunteer Ambulance Workers Benefits Law (VAWBL) by expanding the definition of “insurance
carner” to include group self-insurers and permits insurance authorized to be purchased by volunteer ambulance
companies for volunteer ambulance workers to be obtained from said group self-insurers. Provides that if a county
has elected to establish a self-insurance plan for itself, it may elect to extend coverage under such plan to voluntary
ambulance companies upon the same terms and conditions as coverage applies to volunteer firefighters. Amends
the definition of “Workers’ Compensation and Employers’ Liability Insurance” to include volunteer ambulance
workers’ benefit insurance provided pursuant to VAWBL. Deletes from VAWBL the provision that allows the
Workers’ Compensation Board to compute, as of the date of death, all financial benefits to aliens who are nonresi-
dents or about to become nonresidents of the United States or Canada. Also removes the authority of the Workers’
Compensation Board to assess $25 against each insurance carrier for each adjourned hearing held at the request of
the carner. Makes technical and conforming amendments throughout VAWBL to reflect the fact that a volunteer
ambulance company rather than an ambulance district or political subdivision may be the affected entity. Effective
January 1, 1989. (Amends: Volunteer Ambulance Workers’ Benefit Law; Workers’ Compensation Law; Insurance
Law)
VETOED LEGISLATION
Creation of a Fire and Ambulance S. 943-C
Loan Assistance Program Veto 16 ;
Authonzes and directs the State Fire Administrator to provide loans to districts, fire companies, and volunteer am-
bulance services for the purchase and upgrade of facilities, apparatus, and equipment, from moneys available for this
purpose in the New York State Fire and Ambulance Assistance Fund. Provides that loans authorized for such
purposes may be undertaken by a district, fire company, or volunteer ambulance service on or after April 1, 1989,
provided, however, that loans for the purpose of personal protective firefighting will be given preference for a 2-year
| penod. Stipulates that no loan shall have an interest rate exceeding 3% and that any loan made for the acquisition
or purchase of equipment, apparatus, ambulances, or rescue vehicles that are proven to be wholly manufactured and
| constructed in the State shall receive a 1% reduction in the interest rate. Mandates that all loans be secured by
collateral sufficient to repay the principal and interest when due.
Ce ee ee et ee
Creates an advisory council on fire and ambulance loan assistance to advise and assist the State Fire Administrator
in making determinations on loan applications. Details the contents of an application and sets up criteria by which
the State Fire Administrator may make determinations on loan applications. Establishes in the joint custody of the
State Comptroller and the Commissioner of Taxation and Finance a nonlapsing revolving fund, to be known as the
New York State Fire and Ambulance Assistance Fund, which shall consist of all moneys to be paid into or credited
to the Fund. States that the moneys in such Fund, when allocated, are to be available for the repayment of advances
to the Fund, loans to eligible entities, and administrative expenses. (Executive Law; State Finance Law)
Justification-- Volunteer fire and ambulance companies have seen little or no increase in public funds and fund-
raising revenues, as well as high interest rates for financing the acquisition, repair, replacement, and rehabilitation
of facilities, apparatus, and equipment. Unless some action is taken by the State to assist these volunteer organ-
izations, this funding problem could become a public safety problem. The Commonwealth of Pennsylvania, which
Local Government 26-31
has had a similar low-interest revolving loan fund in place since 1975, has made over $63 million in low-interest
loans available to the volunteer fire and ambulance services in that State. This legislation would benefit the State
by making the lowest rate loans available to Organizations who intend to purchase equipment or apparatus made
in New York.
Reasons for Veto-- The Governor believes the bill, which does not specify the initial appropnation necessary to
fund the program, could create a financial obligation which the State may not be in a position to support and that
merits can be evaluated against other competing demands. He says he has been advised by the Division of the
Budget that the bill’s failure to prohibit use of State funds to repay or cover a share of the loan and the establish-
ment of a fixed interest rate also raises questions of fiscal impact. He also says that the New York State Profes-
sional Firefighters Association also recommended disapproval since the bill does not cover facilities. apparatus, and
IMPORTANT BILLS
Enhanced Emergency Telephone S. 8531
System Surcharge Passed Senate
Adds a new Article 6 to the County Law entitled “Enhanced Emergency Telephone System Surcharge,” which au-
thonzes any county (except in New York City) to enact a local law or resolution to impose a surcharge on each
selective routing, automatic number identification, and automatic location identification. States that pursuant to
such local law or resolution, the board (a board of supervisors of a county or an elected county legislative body) shall
E911 system is to become effective.
Requires that any such surcharge meet the following requirements:
¢ be imposed on a per-access line basis on all current bills rendered for local exchange access service within a 911
service area, and in no event exceed 35¢ per access line per month;
¢ have uniform application and be imposed throughout the entire county to the greatest extent possible, in con-
formance with the availability of such E911 system within the county; and
¢ not be imposed upon more than 50 exchange access lines per customer per location.
Requires that the appropriate service supplier(s) serving a 911 service area act as collection agent for the county and
remit the funds collected as the surcharge to the chief fiscal officer of the county every 2 months, with such funds
to the customer, and that such service supplier annually must provide to the county an accounting of the surcharge
amounts billed and collected.
Specifies that each service supplier customer is liable to the county for the surcharge until it has been paid to the
county, except that payment to a service supplier is sufficient to relieve the customer from further liability for such
26-32 Summary of Legislation 1988
PSS CLIN TON
J
i Distic CoN out 7. vy dete)!<al
Tra Clair - EuS + bike Gibvdey
(oss: b\e Ueduesdoy We
ef):
— Pac Amaia Lagan (Sark Aa)’
Final Report
on the
Air Ambulance Conference
June 23 - June 24, 1988
Albany, New York
Final Report
on the
Air Ambulance Conference
June 23 - June 24, 1988
Albany, New York
Sponsored by
National Highway Traffic Safety Administration
and
New York State Police Aviation Unit
-prepared for-
NEW YORK STATE POLICE AVIATION UNIT
State Campus Building 22
Albany, New York
Under a Grant from the
DEPARTMENT OF TRANSPORTATION
THE NATIONAL HIGHWAY TRAFFIC SAFETY ADMINISTRATION
Grant Number: DTNH-84-Z-05141
EEE
certified public accountants One Lincoin Center in principal areas of the world
Coo ers Syracuse. New York 13202
& Ly rand telephone (315) 474-8541
February 7, 1989
Mr. Michael Gilbertson
NYS Department Of Health
Corning Tower, 729
Albany, New York 12237
Pi eas
Dear Mr. Gilbertson:
A copy of the final report on the air ambulance conference held
in Albany last summer is enclosed for your reference. We
Sincerely appreciate the time and effort you contributed through
your participation in the program. The report has been reviewed
and accepted by the New York State Police Aviation Unit and the
National Highway Traffic Safety Administration who co-sponsored
the conrterence.
It was a pleasure for us to serve as the facilitators and to have
the opportunity to spend the two days with you discussing this
important issue. If you have any questions or comments regarding
the report, please feel free to contact me at (315) 474-8541. I
hope we will have an opportunity to work together again soon. |
Sincerely,
z
Sandra H. Martin
Manager
Strategic Planning
and Operations
SHM: MM
Enclosur?
cenified Public accountants One Uncoin Center norreace areas of ire wore
Coo ers Syracuse, New York 13202
& Ly if nd teiepnone (315) 474-8541
December 15, 1988
Col. Gary E. Preston
Director of Operations-Aviation Unit
New York State Police
Status Campus, Building 22
Albany, New York 12226
Dear Col. Preston:
Coopers & Lybrand is pleased to submit this final report from our
project to conduct a national air ambulance conference. This
work was funded by a grant from the Department of Transportation,
National Highway Traffic Safety Administration. The conference’s
purpose was to identify key issues involved in the operation of
both public and private air ambulance services that could be
studied at the national level to establish guidelines for the
provisions of these services. We are proud to have had an oppor-
tunity to assist the New York State Police and the Department of
Transportation in this important project.
The cooperation and technical assistance of a number of people
was critical to the successful completion of this project. We
wish to thank you and your organization, the conference partici-
pants, and Mr. Charles Glass, of the National Highway Traffic
Safety Administration, for the assistance and cooperation we
received during the entire project.
If you have questions regarding these materials, or if we can be
of further assistance, please contact Ms. Sandra Martin at 315-
474-8541.
Very truly yours,
an
ii.
Tits
IV.
TABLE OF CONTENTS
BACKGROUND
. History of Helicopter Air
Ambulance Services .....++ + «© « « «
. Regulatory Environment .
AIR AMBULANCE CONFERENCE
Purpose ...-+ + «© © © © © © © © © #© © »
Approach . . . -« «© «© © © © © © © © © #© © »
CONFERENCE RESULTS
Patient Care Issues ..... .
Flight Safety Issues ..... .
Financial Issues ....--e++s.«. -»
Regulatory and Management Issues
Differences in The Study of
Public and Private Services .... .
REFERENCES
APPENDICES
A. Bibliography
B. Discussion Papers
. Air Ambulance Issues
. Privatization of Public Sector Services
C. Air Ambulance Conference Attendance List
D. Other Air Ambulance Issues Identified
at the Conference
Page
Or
I
OF >
I. BACKGROUND
HISTORY OF HELICOPTER AIR AMBULANCE SERVICES
The use of helicopters for medical transport first
occurred during World War II when the military evacuated wounded
soldiers from the battlefield to emergency treatment facilities.
The military increased its use of helicopters for medical trans-
port during the Korean War and expanded its service to full aero-
medical operation (i.e, rescue, evacuation and stabilization) by
1362, during the Vietnam War.
The first civilian use of helicopters for medical
transport occurred during the early 1960’s. Police agencies used
helicopters to transport injured civilians to an appropriate site
for medical care. These public helicopter operations were not
dedicated solely to air ambulance operations but typically served
several functions such as traffic surveillance and police-related
work.
Through the enactment of the National Highway Safety
Act in 1966, the Federal Department of Transportation was
directed to provide a uniform standard for the States’ highway
safety programs. The Act provided states with matching funds
for Emergency Medical Services (EMS) research and demonstration
projects. During 1968 and 1969, seven states initiated heli-
copter air ambulance programs as research and demonstration pro-
jects. It was during this era that one of the premiere public
aeromedical transport services was developed by the State of
Maryland. In 1973, this multi-purpose public safety service,
operated by the State Police, was integrated into the statewide
EMS system.
Concurrent with the passage of the National Highway
Safety Act in 1966, a White Paper entitled Accidental Death and
Disability: The Neglected Disease of Modern Society was pub-
lished. This paper provided additional support for the use of
helicopters in civilian emergency medical service programs by
HISTORY OF HELICOPTER AIR AMBULANCE SERVICES - Continued
recognizing that helicopters have proven useful, "to move phy-
sicians and equipment to the accident site and to evacuate
casualties from major highways from remote areas, or from a
community hospital to a more specialized center". (1)
A direct application of the military’s experience in
helicopter support, as part of an emergency medical service
system, is present in the Military Assistance to Safety and
Traffic (MAST) program. This program uses military aeromedical
helicopters and personnel to assist the local Emergency Medical
Service system in serving the civilian population. MAST began in
1969 as a demonstration program under federal research and
development grant funding and was subsequently signed into law in
1973, permitting Department of Defense helicopters to serve
civilians. MAST is administered by a committee representing six
government agencies from the Departments of Defense, Transporta-
tion and Health and Human Services.
During the 1972-1980 time period, several publicly
owned and operated air ambulance helicopter programs were
developed. The helicopters used in these programs continued to
serve multi-purpose public safety functions. Financial support
for the development of publicly-funded projects was authorized in
1982 when the National Highway Traffic Safety Administration
(NHTSA) issued revised criteria for use of Federal Highway Safety
Grant Funds permitting states to use such funds for helicopters
used in EMS programs.
The first private air ambulance helicopter service
dedicated to patient transfers and offering advanced life support
was started in October, 1972 in Denver, Colorado. Private
helicopter air ambulance programs experienced slow growth through
the late 1970’s, but grew rapidly from 1978 to the present (see
Exhibit I). As of the end of 1986, it was estimated that there
were 155 private air ambulance helicopter programs in operation.
EXHIBIT |
GROWTH IN U.S. HELICOPTER
EMS PROGRAMS
1972 - 1987
150
a | an
5
= fd
=
a.
(100 faa
=
id le
8 fa
: a fa
= 7 ee
LZ)
| cee aa
‘72 '73 '74 '75 '76 '77 '78 ‘79 ‘80 ‘81 ‘82 ‘83 ‘84 ’85 ‘86 °87
Years |
Figure 1.—Growth in U.S. helicopter EMS programs.
Source: "Commercial Emergency Medical Service Helicopter Operations, Safety Study”,
National Transportation Safety Board, January 28, 1988.
1-3
HISTORY OF HELICOPTER AIR AMBULANCE SERVICES - Continued
Some public agencies continue to provide air ambulance
transportation in their helicopters. However, the majority of
helicopter medical transport today is provided by commercial con-
tractors who lease helicopters and pilots to the hospital or by
hospitals who own and operate their own helicopter. According to
a 1988 National Transportation Safety Board study, approximately
95,000 people in medical need were transported by private air
ambulance helicopters in the United States in 1986. In 1987,
this figure was projected to exceed 100,000. Public-operated air
ambulance helicopters transported approximately 10,000 to 15,000
patients in 1986. (2)
The majority of helicopter pilots involved in air
ambulance operations began their flight training in the military.
The health care personnel included in most helicopter medical
transport activities consists of a flight nurse and/or para-
medic(s), and occasionally a physician. This staff generally
possesses expertise in managing critically ill or injured
patients, especially those with substantial trauma injuries.
Most helicopter air ambulance programs provide service
for a variety of critically ill or injured patients including
cardiac patients, trauma victims, neonates and obstetrical
emergencies. In addition to evacuating patients directly from
‘the scene of an accident or reported life-threatening illness,
air ambulance helicopters also participate in interfacility
transfers. This service is valuable when the patient requires
more rapid specialized care and the unique treatment needs of a
critically ill or injured patient can be better delivered by a
more sophisticated level facility. Interfacility transport
accounts for approximately 70 percent of all commercial air
ambulance flights. (2)
REGULATORY ENVIRONMENT
Despite the rapid growth of air ambulance services,
there are only a few states with regulations pertaining to heli-
copter medical transport. These regulations have not been co-
ordinated between states and vary in scope and content.
Federal regulations applicable to helicopter air
ambulance services are contained in the Code of Federal Regula-
tions, Title 14, Chapter 1 (Federal Aviation Administration,
DOT), Part 135 - Air Taxi Operators and Commercial Operators. As
indicated by the heading of Part 135, these Federal Aviation
Regulations (FARs) are designed to regulate air taxi operations
and air commerce of persons or property, for compensation or hire
(not including air carriers). The content of these regulations
includes, but is not limited to:
certification of pilots,
information concerning pilots’ medical certificates,
recent flight experience of the pilot-in-command,
instrument rating requirements for pilots,
general operating and flight rules,
responsibility and authority of pilot in command,
. pre-flight action requirements,
required safety equipment,
. fuel requirements,
weather minimums,
designated emergency equipment and practices,
13
REGULATORY ENVIRONMENT - Continued
crew requirements,
. flight time limitations and rest requirements.
Chapter 4 of the Highway Safety Act includes Section
402 (Highway Safety Program) which in general, establishes stan-—
dards for states and their local political subdivisions to pro-
mote highway safety. (3) Standard 11 specifically discusses
requirements for emergency medical services. The purpose of this
standard is to provide an emergency care system that will:
. Provide quick identification and response to acci-
dents.
. Sustain and prolong life through proper first aid
measures, both at the scene and in transit.
. Provide the coordination, transportation, and com-
munications necessary to bring the injured and
definitive medical care together in the shortest
predictable time, without simultaneously creating
additional hazards.
Guidelines established by this standard include, but
are not limited to the state designating:
. training and licensing requirements for all rescue
personnel,
. requirements for types and numbers of emergency
vehicles,
. requirements for the use of two-way communication,
. coordination of emergency medical services.
II. AIR AMBULANCE CONFERENCE
PURPOSE
The rapid growth of private sector emergency medical
services helicopter programs and the lack of a consistent regu-
latory environment has resulted in increased attention to the
issues surrounding private and public air ambulance services.
Recent studies have included: Air Ambulance Guidelines published
by NHTSA and the American Medical Association in 1981, updated in
1986 (6); a 1987 study by the Pittsburgh Press entitled "Rescue
at Risk" (4); a 1988 safety study by the National Transportation
Safety Board (2); and a 1988 report by the Commission on
Emergency Medical Services of the American Medical Association
(5). Numerous conferences addressing air ambulance issues have
also been held, including the 1985 EMS Futures Conference of the
American College of Emergency Physicians.
In 1988, the National Highway Traffic Safety Adminis-
tration, through a contract with the New York State Police Avia-
tion unit, sponsored a conference to identify the issues that are
involved in the current operation of both public and private air
ambulance services. The purpose of the conference was to reach a
consensus among a select group of leaders in the public and
private sector as to key issues currently surrounding the
provision of helicopter ambulance services and their relative
importance. The ranked issues identified at the conference could
then be used to guide a comprehensive study at the national
level. The study would be the first step in the establishment of
a national policy on the provision of emergency medical heli-
copter services, examining each issue and making recommendations
for both the public and private sector.
APPROACH
The New York State Police Aviation unit engaged
Coopers & Lybrand to gather the necessary background information
on air ambulance issues, facilitate the conference and summarize
the results. The major steps in the process were to:
. Identify interested public and private sector air
ambulance leaders;
. Request and review the current literature (published
and unpublished) identifying relevant issues;
. Group the literature into issue categories and
abstract relevant documents;
. Provide the abstracted information to conference
participants;
. Conduct the conference, identifying and prioritizing
key issues within each category;
. Assemble a summary of the conference results into a
final report.
Over 45 individuals were contacted in February 1988
requesting written materials that would lead to the definition of
air ambulance issues. Position papers, literature, legislative
studies and other relevant materials were requested. Approxi-
mately 75 items were received. A complete listing is contained
in the Bibliography in Appendix A.
In preparation for the conference, the written materi-
als were reviewed and two documents abstracting the relevant
issues were prepared. One document addressed the privatization
of public sector services and the other addressed issues specific
il=Z
APPROACH - Continued
to air ambulance services. (These documents can be found in
Appendix B). The air ambulance issues were grouped into four
categories: patient care; flight safety; financial issues and
regulation/management structure.
Representatives from 30 organizations were invited to
attend the conference and 17 were able to participate. The con-
ference was held in Albany, New York on June 23 and June 24,
1988. A complete attendance list is contained in Appendix C.
Each participant was provided the abstracted information in ad-
vance of the meeting and was asked to come prepared to identify
and prioritize issues in each of the four categories.
Issues were initially identified and ranked in three
small breakout groups and then reviewed and ranked by the full
group of conference participants. A formal group process, the
Nominal Group Technique (NGT), was used to structure the group
discussions. NGT is an effective tool that maximizes the number
of ideas that can be considered; equalizes the participants’
opportunity to present ideas; allows the group to fully explore
the problem; and balances discussion among the issues presented.
NGT includes a formal voting system that results in a prioritized
listing of ideas.
ia—3
III. CONFERENCE RESULTS
Using the nominal group technique (NGT), conference
participants were asked to identify the air ambulance issues that
should be addressed in a national study. Conference participants
were divided into three small work groups and then reconvened as
a full conference. The listing and ranking of issues occurred in
each of the small groups and the results summarized for the
larger group’s consideration. The final prioritized list of
issues in each category is the result of the final voting by the
full conference group.
PATIENT CARE ISSUES
Conference participants were asked to respond to the
following question:
issues should be examined in order to develop air ambu-
lance service guidelines that would best serve the
"If a national study were conducted, what patient care
public interest?"
The five highest priority issues identified by the
group are presented below in rank order:
1. Composition of the medical crew on the air ambulance
service.
The staffing of the medical crew of air ambulance
services was identified as the highest priority
patient care issue. The number of medical crew
members required and the skill level (basic emer-
gency medical technician; paramedic; registered
nurse; physician) of each member was recommended for
further study.
rLi=1
2. Quality assurance.
Audit of air ambulance patient care and other qual-
ity assurance programs were considered to be key
issues to be addressed by a national study. Measur-
ing the appropriateness of care and the impact of
helicopter transport on patient outcome were in-
cluded under this issue.
3. Protocol for appropriate use of air ambulance
services.
Criteria for the utilization of air ambulance
services should be addressed. This issue includes
flight authorization procedures and criteria for use
of air ambulance services rather than other alterna-
tives (i.e., ground transport). Access to air ambu-
lance services, including the triage of calls was
-ranked the third most important patient care issue.
4. Medical direction of air ambulance services.
The physician management (administrative medical
accountability) of air ambulance services was iden-
tified as an important issue impacting patient care.
5. Hospital categorization and designation.
The identification of the level of medical service
provided by hospitals was ranked fifth. The scope
of this issue includes a review of: criteria for
designating hospitals to receive helicopter
patients; criteria for by-passing hospitals (over-
fly); and identifying the appropriate authority for
categorizing hospitals by level of service.
Although not ranked in the top five, over 25 additional
patient care issues were identified by the conference partici-
pants. A listing of these issues can be found in Appendix D.
LLiL~2
FLIGHT SAFETY ISSUES
The conference participants were asked to respond to
the following question:
"If a national study were conducted, what flight safety
issues should be examined in order to develop air ambu-
lance service guidelines that would best serve the
public interest?"
The five highest priority issues identified by the
group are presented below in rank order:
1. Federal Aviation Regulations (FAR) specific for
emergency medical services.
Whether or not there should be federal aviation
regulations (FAR), specific for emergency medical
services (EMS), was the highest ranked flight safety
issue. The applicability of specific EMS regula-
tions to both private and public air ambulance was
also recommended for further study.
2. Minimum aircraft type for emergency medical
services.
The appropriate aircraft for emergency medical
services missions was the second highest priority in
terms of flight safety issues. This issue includes
a review of the appropriate size of EMS aircraft,
geographic range, instrument capabilities, safety
features, etc.
Liles
FLIGHT SAFETY - Continued
3.
Safety training for flight and medical crew.
Initial training and ongoing in-service education on
flight safety for both flight and medical crew mem-
bers was a key issue identified. Included in this ©
issue was a broad scope of safety considerations.
such as patient loading, defibrillation on the air-
craft, smoking, patient evacuation in emergencies,
etc.
Weather minimums (IFR/VFR).
Weather minimums for visual flight rules (VFR) and
instrument flight rules (IFR) for both day and night
was an issue identified for a national study. The
number of weather reporting stations was also dis-
cussed under this issue.
Flight crew employment standards.
Minimum qualifications for air ambulance pilots
would be reviewed under this topic. Specifically,
crew skill levels, medevac experience, medical cer-
tification and pilot judgment skills would be re-
viewed. In determining what the standards should
be, criteria other than just flight hours should be
examined.
In addition to the five highest priority issues listed
here, approximately 30 other flight safety issues were raised by
the conference participants. These issues are listed in
Appendix D.
IITI-4
FINANCIAL ISSUES
Conference participants were asked to respond to the
following question:
"If a national study were conducted, what financial
issues should be examined in order to develop air
ambulance service guidelines that would best serve the
public interest?"
The five highest priority issues identified by the
group are presented below in rank order:
kw
Funding Sources.
The sources of financial support for air ambulance
services was the highest ranked financial issue
identified for further study. A broad scope of
considerations were included in this issue including
federal, state and local governmental funding and
subsidies, as well as third-party insurance coverage
of air ambulance services. The existence and amount
of Medicare, Medicaid and private insurance coverage
of medical transports was recommended for inclusion
under this issue.
Geographic allocation of air ambulance resources to
preclude duplication of effort and underserved
areas.
This highly ranked issue included the study of the
need for air ambulance services. Geographic cover-
age issues were identified in terms of both under-
served areas (rural and urban areas with little or
no air ambulance services) and duplication of ser-
vices (areas with multiple air ambulance providers).
Methods for defining urban and rural air ambulance
service needs were recommended for further review.
ItI=5
FINANCIAL ISSUES (Continued)
In
Economics of multi-role versus dedicated air medical
services.
The economics of using helicopters for multiple
purposes (e.g., EMS and public safety) as compared
to having helicopters dedicated strictly to EMS was
recommended for examination. This issue, as it
pertains to both public and private services in both
urban and rural areas, should be included ina
national study.
Standardized cost comparison guidelines.
In order to accurately compare the cost of operating
air ambulance services, the conference participants
felt a standardized approach for cost accounting
among services should be studied. This was felt to
be important so that comparisons between public and
private service options and among air ambulance
providers could be done in a uniform manner. It was
also felt that the review of such a system should
include accounting systems, reporting formats and
methods to account for all of the costs (including
overhead and administration) associated with the
provision of the service.
Cost benefit analysis of air ambulance services.
Assessing the benefits of air ambulance services was
recommended for further study by the conference
participants. The examination of the costs and
benefits of air ambulance service should consider
the long and short term effects on patient outcome
and comparisons of air ambulance services to ground
transport.
addition to the five highest ranked issues listed
here, 20 other financial issues were raised by the conference
participants.
These issues are listed in Appendix D.
LLi~6
REGULATORY AND MANAGEMENT ISSUES
Conference participants were asked to respond to the
following question:
"Tf a national study were conducted, what regulatory
and/or management issues should be examined in order to
develop air ambulance service guidelines that would
best serve the public interest?"
The five highest priority issues identified by the
group are presented below in rank order:
1. Who should regulate air ambulance services?
The identification of the appropriate source of
regulation of the air ambulance industry was the
highest ranked regulatory/management issue raised by
the conference participants. The level of responsi-
bility for regulation (i.e., federal, state, local)
and appropriate department(s) within each level
should be identified.
Integration of the air medical program into the EMS
systen.
The relationship between air ambulance services and
the remainder of the emergency medical services
system was recommended for inclusion in a national
study. The relationship between the ground trans-
port system and the air ambulance providers, the
liaison between air ambulance services and the state
EMS system, the relationship of air transports and
the hospital categorization system and how air
ambulance services fit into the EMS organizational
structure should be examined.
se
REGULATORY AND MANAGEMENT ISSUES (Continued)
Kr
Minimum standards and qualifications for air
ambulance providers.
This highly ranked issue encompasses the licensing
of air ambulance operators and crew members, the
certification of aircraft, a review of the character
and competence of providers, and criteria for
assessing financial feasibility of entering into the
provision of air ambulance services.
Management factors.
The control, quality assurance and data for assess-
ing flight safety, patient care, cost, personnel and
equipment was recommended for inclusion in a
national study.
Certification and designation of receiving facili-
ties.
The certification and designation of hospitals
receiving air ambulance patients was an issue recom-
mended for further examination.
In addition to the five highest priority issues listed
here, over 40 other regulatory and management issues were raised
by the conference participants. These issues are listed in
Appendix D.
LLi“s
DIFFERENCES IN THE STUDY OF PUBLIC AND PRIVATE SERVICES
After the conference participants had identified and
prioritized the issues in each of the four categories, they were
- asked to determine whether or not a national study would need to
address the issues identified differently for private providers
than public providers. For each of the high priority issues
identified the group was asked:
"Are the differences between public and private air
ambulance services significant enough to warrant sepa-
rate examination of this issue by a national study?"
For the most part, the conference participants felt
each of the issues should be examined in the same way for public
and private providers of air ambulance services. The outcome of
a national study would, of course, need to recognize the signifi-
cant differences between private industry and governmental opera-
tions. For example, within the study of air ambulance funding
sources, the national study would need to assess whether public
funds should be used for private services and, if so, how that
privatization should occur. Since private enterprise cannot levy
taxes, the method (contract, subsidy, etc.) by which public funds
could be used to support private air ambulance services would
have to be addressed in the study.
Similarly, in reviewing the issue of whether or not
there should be federal aviation regulations (FAR) specifically
for EMS, the national study would need to determine who would
fall under such regulations. Currently, public providers are
exempt from the federal regulations pertaining to air ambulance
carriers. Resolving the FAR issue for public providers would
have to consider intergovernmental jurisdictional issues as well
as other relevant differences between the public and private
sector.
Lil=9
Accidental Death and Disability: The Neglected Disease
of Modern Society (Washington, D.C. National Institute of
Health/National Academy of Sciences, 1966), p.- 15. |
"Commercial Emergency Medical Service Helicopter Operations,
Safety Study", National Transportation Safety Board, Janu-
ary 28, 1988.
Highway Safety Act of 1966, Revised July 1987, Section 402.
"Rescue at Risk", Andrew Schneider, The Pittsburgh Press,
February 8, 1987 - December 27, 1987.
American Medical Association, "Air Ambulance Report and
Recommendations", February 29, 1988.
Air Ambulance Guidelines, NHTSA and AMA Commission on EMS,
May, 1986.
|
APPENDIX A: BIBLIOGRAPHY
A. BIBLIOGRAPHY
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ASHBEAMS. Safety Guidelines. San Diego: ASHBEAMS, October 1987.
American Society for Testing and Materials (ASTM). "Standard Practice for
Establishing the Qualifications of EMS Aeromedical Personnel." i?
November 1985.
American Society for Testing and Materials (ASTM). "Standard Specifications
for Rotary Wing Basic Life Support Transport Units, Annual Book of ASTM
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Anderson, Thomas E., M.D., Leicht, Michael J., M.D., FACEP, Rose, William,
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Apte, Robert. Chief-Air Rescue Division, Dade County Fire Department. Memor-
andum on Air Rescue Data. Dade County, Florida, 25 March 1988.
Blum, Mark S. Emergency Medical Services. Bureau, DeKalb County, Georgia.
Letter to Ms. Dallas Jankowski, Director, Emergency Health Section,
Georgia Department of Health Resources summarizing the DeKalb County
Department of Public Safety's position regarding proposed helicopter
rules and regulations. As Presented at the Air Ambulance Helicopter
Forum at Jekyll Island. DeKalb County, 3 October 1986.
Blum, Mark S. Emergency Medical Services Bureau, DeKalb County, Georgia.
Letter on Air Ambulance Service. DeKalb County, 5 April 1988.
Bock, H.C., M.D. "Standard of Practice for Establishing The Qualifications of
EMS Aeromedical Personnel." November 1985.
Boston Med Flight. "Annual Report 1985-1986." Boston.
Boston Med-Flight. Meeting Minutes of the Helicopter Utilization Review Com-
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Brosnan, George, Col., Cowley, R. Adams, M.D., and King, Leonard T. "A Spe-
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Burke, John P., M.D., Christison, M.P.A., Clemmer, Terry P., Larson, Keith,
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Clemmer, Terry P., M.D., FCCP, Fox, Jolene, R.N., Menlove, Ronald L., Ph.D.,
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Clemmer, Terry, P., M.D., Gibbons, Harry L., M.D., Menlove, Ronald L., Ph.D.,
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Medicine. (June 1985): 547-552.
Clemmer, Terry P., M.D., Gibbons, Harry, M.D., M.P.H., and Thomas, Frank, M.D.
"Air Ambulance Regulations: A Model." Aviation, Space and En-
vironmental Medicine (July 1986): 699-705.
Clemmer, Terry P., M.D., Orme, James F. Jr., M.D., and Thomas, Frank, M.D. "A
Survey of Advanced Trauma Life Support Procedures Being Performed By
Physicians and Nurses Used on Hospital Aeromedical Evacuation Ser-
vices." Aviation, Space and Environmental Medicine. (December 1985):
1213-1215.
The College of Engineering Sciences, Arizona State University. Air Medical
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for U.S. Department of Transportation. Tempe, May 1970.
Colorado Department of Health, Emergency Medical Services Division. Colorado
Air Ambulance Guidelines. by the Colorado State Advisory Council on
Emergency Medical Services. January 1985.
Committee on Trauma of the American College of Surgeons. "Appendix F to the
Hospital Resources Document: Field Categorization of Trauma Patients
(Field triage)." American College of Surgeons Bulletin (October 1986):
17 +20;
Darr, Thomas B. "Pondering Privatization May Be Good for Your Government."
Governing (November 1987): 42-50.
Department of California Highway Patrol, Air Operations Section. Upgrade of
Helicopters EMS Capabilities. Sacramento: November 1981.
Department of California Highway Patrol, Enforcement Services Division, Air
Operations Section. Helicopter Utilization, Service Duplication and
Reimbursement Opportunities. December 1981.
Emergency Nurses Association/National Flight Nurses Association. "Staffing of
Critical Care Air Medical Transport Services." Rapid City, South
Dakota, July 1986.
Fives, Timothy J. Program Director, UCLA MEDSTAR. "“Hospital-Based Helicopters
in the Incident Command System." Los Angeles.
Florida Department of Health Services, Office of Emergency Medical Services.
Air Medical Evacuation Plan. December 1987.
Geddis, Phil and Ryno, Gary. "Air Beat-San Diego County." Air Beat, Journal
of the Airborne Law Enforcement Association 25 (November/December
1986): 24-27, 35.
Gills, Karl B. "An Administrative Reply to EMS Aircraft Crashes." American
Medical Journal (January/February 1987): 18-20.
Gold, Elayne G. and Winegar, Laurel A. "The Medevac Report, A Staff Report by
The Assembly Program Development Group to Stanley Fink, Speaker, New
York State Assembly." Albany, 1 April 1985.
Hewitt, Sam. Tracor Aviation, Inc. Letter Regarding Air Ambulance Service.
11 March 1988.
Huntley, Henry C., M.D. "How Effective Are Our Emergency Services." Hospital
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Jagerson, Terry D., and McDaniels, Bob. "California Law Enforcement Officers
Proposed Statewide Lifesaving Helicopter Program."
Maryland Department of Transportation. State of Maryland Helicopter Procure-
ment Request for Proposals. Baltimore/Washington International Air-
port: February 1988.
Maryland State Police. Aviation Division Manual, State of Maryland.
McLean, CDR Dennis, REARM, Risk Evaluation and Aviation Resource Management,
U.S. Coast Guard, Flight Safety Branch.
Minnesota Department of Health, Emergency Medical Services Section. Minnesota
Air Ambulance Operations Guidelines. Minneapolis: September 1986.
Morgan, Marshall T., M.D. "“Aeroview (an editorial)." Spring 1988.
Morgan, Marshall T., M.D. "Helicopter Air Ambulances in Pre-Hospital Care."
Emergency Medical Care Digest 7 (February 1987).
The National Flight Nurses Association Standards Committee. Practice Stan-
dards for Flight Nursing. Columbia, Maryland: National Flight Nurses
Association, 1986.
National Transportation Safety Board. Safety Study--Commercial Emergency
Medical Service Helicopter Operations. Springfield, Virginia: Na-
tional Technical Information Service, January 1988.
The North Carolina Medical Care Commission. "Report and Recommendations on
the Safety of Air Ambulance Service in North Carolina." May 1988.
North Carolina Department of Human Resources Division of Facility Services,
Office of Emergency Medical Services. Report of the Task Force on Air
Ambulance Services in North Carolina. Raleigh: November 1984.
Ondrey, Thomas, and Schneider, Andrew. Rescue at Risk. Pittsburgh: Pitts-
burgh Press, 1987.
Pack, Janet Rothenberg. "Privatization of Public Sector Services in Theory
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523-540.
Participants attending the National Public Service Medevac Symposium. Air
Medical Services Issue Paper. Charleston, May 1985.
Pangia, Michael J. "Aeromedical Law Liabilities in Hospital-Based Programs."
American Medical Journal (July/August 1987): 18-19.
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APPENDIX B:;: DISCUSSION PAPERS
. Air Ambulance Issues
Privatization of Public Sector Services
Coopers
-&Lybrand
| cenified public accountants
|
AIR AMBULANCE ISSUES
Air Ambulance Conference
June 23-June 24, 1988
BACKGROUND
HISTORY OF EMS HELICOPTER PROGRAMS
The history of utilizing helicopters for medical trans-
port extends back approximately 35 years when the United States
Military began evacuating wounded soldiers by helicopter to
emergency treatment facilities. Civilian use of helicopters for
this purpose began slowly in the early 1960s when police agencies
occasionally transported injured civilians in their aircraft
whose primary use was that of traffic surveillance and other
police work. These flights rarely provided definitive health
care during transit, but merely a more rapid means of transport
for the patient to an emergency care facility.
The first commercial EMS helicopter service dedicated
to patient transfers and offering advanced life support was
started in October 1972 in Denver, Colorado. Although there was
little significant growth until late in that decade, use of
commercial EMS helicopters has increased rapidly since 1980 (see
Exhibit on page 2).
Some public agencies continue to provide periodic
medical transportation in their helicopters. However, the
majority of EMS helicopter transport today is provided by com-
mercial contractors who lease helicopters and pilots to the
hospital or by hospitals who own and operate their own commercial
helicopter. During 1986, approximately 95,000 people in medical
need were transported by commercial EMS helicopters in the United
States. In 1987, this figure was projected to exceed 100,000.
Public-use helicopters transported approximately 10,000 to 15,000
patients in 1986. (1)
Currently there are approximately 155 commercial EMS
helicopter programs, using approximately 187 helicopters. (1)
Most of these programs operate with helicopters and pilots pro-
vided under contract to hospitals by commercial operators.
GROWTH IN U.S. HELICOPTER
EMS PROGRAMS
1972 - 1987
150
. ie
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= LZ)
=
4.
yy 100 1 |
s |
se i |
rs va
5 ™ ri |
S
=) |
a | ae |
E |
W222 2 22a |
'72 '73 '74 '75 '76 '77 ‘78 '79 ‘80 ‘81 ‘82 ‘83 ‘84 ‘85 '86 ‘87
Years |
Figure 1.—Growth in U.S. helicopter EMS programs.
Source: "Commercial Emergency Medical Service Helicopter Operations, Safety Study”,
National Transportation Safety Board, January 28, 1988.
The majority of helicopter pilots involved in EMS
missions began their flight training in the military. The health
care personnel included in most EMS helicopter activities con-
sists of a flight nurse and/or paramedic(s), and occasionally a
physician. This staff generally possesses expertise in managing
critically ill or injured patients, especially those with sub-
stantial trauma injuries.
Most EMS helicopter programs provide service for a
variety of critically ill or injured patients including cardiac
patients, trauma victims, neonates and obstetrical emergencies.
In addition to evacuating patients directly from the scene of an
accident or reported life-threatening illness, EMS helicopter
programs also participate in interfacility transfers. This
service is valuable when the patient requires more rapid special-
ized care and the unique treatment needs of a critically ill or
injured patient can be better delivered by a more sophisticated
level facility. Interfacility transport accounts for approxi-
mately 70 percent of all commercial EMS flights. (1)
In August 1987, the Pittsburgh Press reported that
there were 231 medevac programs operating in 46 states and the
District of Columbia. (2) The locations of these services are
shown on the map on page 4.
America’s helicopter medevac programs
Two hundred and thirty-one helicopter ambulance services are run in 46 states and the District of Columbia by hospitals, the
military and state and local poiice and rescue services. At least 19 additional programs are scheduled to start within the next
six months.
Medevac sites
wf 156 Hospital based
%e (30 Public service
Ng 33. Miltary
@ 12 Independent
cs 2 Soon to be
aw opened
oneness!
+
ao
&
N.M. @
+
“Alaska has one public service
and one hospital base.
*Hawaii has a military medevac
site.
Colo. %
*. Ras
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Rich Stemnnauser/The Pittsburgh Press
Source: Andrew Schneider, "Rescue at Risk", The Pittsburgh Press, February 8, 1987-
December 27, 1987.
REGULATORY ENVIRONMENT
Despite the rapid growth of air ambulance services,
there are only a small number of states with regulations pertain-
ing to medevac services. The federal regulations pertaining to
air ambulance operations are limited to Federal Aviation Adminis-
tration (FAA) rules for commercial services and National Highway
Traffic Safety guidelines for Emergency Medical Services (EMS).
The rules controlling aviation activity in the United
States are contained in the Code of Federal Regulations, Title
14; Aeronautics and Space. Chapter 1 contains the rules that
address civilian aviation, and these rules are administered and
enforced by the Federal Aviation Administration (FAA). The rules
contained in Chapter 1 are often called the Federal Aviation
Regulations. (1) Portions of these rules control the operations
of commercial EMS helicopters. The content of these regulations
includes, but is not limited to:
certification of pilots,
. information concerning pilots’ medical certificates,
recent flight experience of the pilot-in-command,
instrument rating requirements for pilots,
general operating and flight rules,
. responsibility and authority of pilot in command,
. pre-flight action requirements,
. required safety equipment,
. fuel requirements,
. weather minimums,
> ee
designated emergency equipment and practices,
. crew requirements,
flight time limitations and rest requirements.
Chapter 4 of the Highway Safety Act includes Section
402 (Highway Safety Program) which in general, establishes stan-
dards for states and their local political subdivisions to pro-
mote highway safety. (3) Standard 11 specifically discusses
requirements for emergency medical services. The purpose of this
standard is to provide an emergency care system that will:
. Provide quick identification and response to
accidents.
. Sustain and prolong life through proper first aid
measures, both at the scene and in transit.
. Provide the coordination, transportation, and com-
munications necessary to bring the injured and
definitive medical care together in the shortest
predictable time, without simultaneously creating
additional hazards.
Guidelines established by this standard include, but
are not limited to the state designating:
. training and licensing requirements for all rescue
personnel,
. requirements for types and numbers of emergency
vehicles. |
requirements for the use of two-way communication,
. coordination of emergency medical services.
CURRENT ISSUES
REGULATION/MANAGEMENT. STRUCTURE
The Pittsburgh Press conducted a ten month study of
helicopter ambulance programs and found "uncontrolled growth with
an almos< total lack of federal or state regulations resulting in
little control over who flies, what they fly or where a patient
is taken" (Andrew Schneider, Pittsburgh Press, October 4, 1987).
This study also concluded that there were pockets of fierce com-
petition in the nation’s system that spawned "unsavory marketing
techniques."
In August 1987, the Pittsburgh Press reported that
there were 231 helicopter ambulances with another 19 programs
scheduled to begin operation by February 1988. A major problem
with the soaring growth of the nation’s medical programs, accord-
ing to the newspaper, is that there is little or no regulation.
"Concerns were repeatedly raised by flight nurses, paramedics and
physicians over the widespread lack of laws, rules or regulations
to ensure that they were allowed to take their patients to the
hospital best suited to handle their injuries." (2) Of the 199
non-military programs interviewed by the Pittsburgh Press, 64%
agreed that strong federal regulations are needed while 83%
believe that state regulations are needed to ensure safety and
prevent abuse of the medical systen. While opinion seems to vary
on whether state or federal government should provide regulation,
there seems to be a general consensus among EMS and aviation
personnel that a regulated system is essential.
Larry Jordan, President of the National Association of
State Emergency Medical Services Directors, states, "We’ve got to
look at the system. There are too many helicopters in too many
locations, all trying to serve the same purpose, and frankly,
there are just too many cases where the needs of the patients
aren’t best served by the political and economic concerns of
hospitals operating the helicopter programs." While Mr. Jordan
agrees that state trauma systems would facilitate regulation, he
contends that "they must be comprehensive and uniform throughout
the Country." (2)
>
po
Matt Matthiesen, Pennsylvania State EMS Director, when
commenting on his State’s attempt to regulate air ambulances,
stated, "There is nothing in the regulations that will demand
that the use of these medical aircraft be controlled and coordi-
nated to ensure that the patients that need medevac, can get it
and then are taken to the hospital best suited to handle their
problem." (2)
Officials in other states report that "efforts to
regulate medevac operations often collapse into turf wars, ego
trips and frenzied assaults by lawyers determined to prevent
anyone from purloining patients from their hospital’s beds." (2)
published in June 1985 concluded the following:
Our study found differences in the medical capabilities
of air ambulance services currently operating in the
United States. Of all surveyed air ambulance services,
69% favor air ambulance regulations. As would be
expected, hospital programs, because of their sophisti-
cated medical teams and their retrofitted aircraft,
favor air ambulance regulations to a greater degree
than do hospital-affiliated and private programs.
However, air ambulance services provided by hospitals
are limited by their use of helicopters (range is
approximately 150 radius miles), by their selection to
transport only critically ill or injured patients, and
by their expense. From our data, we would recommend
that rather than developing generalized and similar air
ambulance guidelines or regulations directed at all air
ambulance operators, guidelines should be directed at
levels of care provided. Guidelines or regulations
would then be specified for the level of care the air
ambulance service intends to provide. Patients who are
critically ill and require air transport would require
an air ambulance service with specified sophisticated
personnel and equipment. On the other hand, for the
non-acute stable patient who is being transported from
a hospital to a rehabilitation center, the requirements
of the transport personnel and equipment would be less
stringent. Using a levels approach to proposed regula-
tions and guidelines would assure patient safety with-
out excessive transport costs. We recommend that those
individuals currently writing proposed state or federal
regulations or guidelines strongly consider the devel-
opment of regulations or guidelines directed at levels
of air ambulance care. (4)
|
A nationwide survey of civilian air ambulance services
The 1987 National Transportation Safety Board (NTSB)
study of EMS helicopter accidents found that most EMS helicopter
programs have two management structures -- one for the pilots and
another for the medical personnel. According to NTSB, "The
interface of these two management structures is less than ideal,
since pilot management is often not on-site and the hospital
program management has no control over the pilots." NTSB goes on
to say that the EMS program management structure can have a
significant impact on the program and that communication between
the two management structures is essential to safe opera-
tions. (1)
Dr. Marshall T. Morgan, Director, Emergency Medical
Center and MedStar Helicopter Program, UCLA, believes that a
hospital-based air ambulance service "has no jurisdiction or
authority and serves only at the request of the responsible
public safety agency. The helicopter ambulance should be per-
ceived as simply a resource, at the disposal of these agencies,
to be used at these agencies’ discretion." Dr. Morgan sees
hospital-based helicopters as an integral part of an established
EMS system and maintains that "... the air ambulance service must
realize that its role in EMS is only to serve, not to direct or
initiate." (5)
FLIGHT SAFETY
The Pittsburgh Press concluded after its study of heli-
copter ambulance programs that lack of coordination and coopera-
tion between programs flying in the same city sometimes led to
pressure on crews to fly in unsafe condition. (2)
The newspaper conducted a survey of 251 Emergency
Medical Services (EMS) pilots asking them what they believed to
be the leading safety problems for air ambulances. Their re-
sponses, reported in the October 11, 1987 issue are presented
below:
. 33 percent believed competitive pressure was the
biggest threat to safety. They described this as
either pressure from their employer, hospital ad-
ministrators, fellow crew-members or themselves to
undertake flights when either the weather, the
mission or the aircraft were potentially unsafe.
. 28 percent named weather as the greatest hazard,
citing the lack of adequate weather information.
Most said that many of the flights they took were to
areas where FAA flight service weather briefings
were either outdated or unavailable.
. 14 percent cited poor equipment, ranging from the
aircraft’s engines not being powerful enough for the
mission to the lack of safety equipment such as
instruments for detecting and getting out of bad
weather, automatic pilots, searchlights and radar
altimeters. Some criticized unsafe design of the
helicopter’s interior and lack of safe seats and
shoulder harnesses for the medical team.
. Nine percent said fatigue was the leading problen.
They talked about having too few pilots and too many
missions, of working shifts of 24, 48 or 72 hours,
and sometimes flying in violation of federal rest
rule limitations.
10
. Eight percent expressed concerns about the absence
of federal and state regulations, and the sporadic
enforcement of the few that do exist; primarily
pilot’s hours, aircraft maintenance and inspection
of heliports and helipads.
. Five percent cited deficiencies in pilot’s skill and
decision-making abilities. They cited aviators who
don’t know their own or their aircraft’s limita-
tions, a lack of knowledge of what’s involved in an
EMS mission or unfamiliarity with terrain in which
they are flying.
. Three percent listed other problems such as no
barriers to protect the pilot from dangerous
patients and poorly secured medical equipment.
The 1987 National Transportation Safety Board (NTSB)
study of commercial EMS helicopter programs found that from 1980
through 1985, the accident rate for commercial EMS helicopters
was almost twice the rate of nonscheduled air taxi helicopter
operators and one and one-half times the rate for all turbine
helicopters. NTSB also found the fatal accident rate to be three
and one-half times higher for EMS helicopters. (1)
NTSB reported that weather-related accidents were the
most common type of EMS helicopter accident and the cause of the
largest number of fatalities. NTSB also found the interior
configuration of EMS helicopters not to be subject to review for
suitability to an aviation environment. NTSB also raised the
issues of helicopter cruise speeds, pilot fatigue and stress,
pilot training, EMS “crew member" training, shoulder harnesses
and lap belts, EMS program management and competition as perti-
nent to EMS helicopter safety.
Dr. Marshall Morgan, Director, Emergency Medical Center
and MedStar Helicopter Program, UCLA, in his February 1987
article, noted that crew safety is a shared responsibility. The
air ambulance service administration and the aviation contractor
11
must enforce sound safety practices and reinforce that the
"mission is always secondary to flight safety considerations.
Most of the fatal accidents suffered by air ambulance services
appear to have been the result of trying too hard - allowing the
desire to complete the mission to interfere with appropriate
decision to fly/not fly in marginal weather conditions." (5)
U. S. Coast Guard Commander Dennis McLean, in address-
ing the safety of EMS helicopter missions, applied a systems
approach to develop Risk Evaluation and Aviation Resource Manage-
ment (REARM). In this system, risk values are assigned to ele-
ments which impact upon the safety of an EMS mission. The ele-
ments, supervision, planning, crew selection, crew endurance,
weather and mission complexity, incorporate both health care and
non-health care aspects. Commander McLean maintains that the
unique "co-equal" partnership between EMS and aviation in pro-
viding pre-hospital helicopter service must function within a
systemmatic assessment of risk to ensure mission safety. (6)
12
PATIENT CARE
The issues within patient care include discussions of
the level of personnel (EMT-paramedic, nurse, physician) required
during flight, triage and transport to the appropriate facility
and response time.
The need for a physician on each EMS flight is pre-
sented in a February 1987 article in Emergency Medical Care
Digest reporting on a study by Dr. Kenneth Rhee from the Univer-
sity of Michigan published in the Annals of Emergency Medicine in
1986. The study found that the physician on board made a "unique
and important" contribution to the mission 22% of the time.
"Medical judgment was found to be the most important potential
contribution of the flight physician, who provides impetus and
direction for treatment. Thus, researchers concluded from their
four-month study that providing a physician for the one in five
patients who needs one as soon as the helicopter arrives on the
scene more than justifies the added cost to the program." (7) In
assessing how the physician’s presence benefitted the patient,
the study concluded, "In most cases, the physician’s judgment
alone (29 flights, 17%) or both his technical skill and judgment
(seven flights, 4%) contributed uniquely to patient care. Skill
alone was required on only two flights (1%). Physician contribu-
tion was most frequently appreciated with pediatric cardiac
patients. A significant association was noted between in-flight
TISS scores and the perceived need for physician services during
the flight."
An abstract of a study presented in the September/
October 1987 Aeromedical Journal, disagreed with the need for a
physician on board EMS flights. The study by Steven Murphy and
Lynn Eastes of Samaritan Air Evac in Phoenix, Arizona concludes,
"A well-trained flight nurse delivers optimum pre-hospital
patient care with essentially no need for direct physician in-
volvement in evaluation or treatment. Few direct physician
consultations resulted in significant changes in patient treat-
ment. The extra cost of staffing the helicopter with physicians
i3
on a routine basis cannot be justified under the pretext of
better patient care. Dollars would be better spent toward
improving flight nurse training and helicopter base-station
communications." (8)
The American Society of Hospital Based Emergency Air
Medical Services (ASHBEAMS) adopted standards in December 1985 as
follows, "Staffing the aircraft shall be commensurate with the
advanced life support environment afforded by the airborne
emergency care facility. The aircraft in fact, by virtue of
critical care staffing and medical retrofitting, becomes a
special care unit. The aeromedical crew must, at a minimun,
consist of at least one critical care provider who is a specially
trained registered nurse." (9)
In June 1986, the American College of Surgeons Board of
Regents recommended that "if only one medical crew member is
present, this should be a specially trained flight nurse". (10)
The Emergency Nurses Association and the National Flight Nurse
Association in their joint position paper contend that, "The use
of any level of EMT as the principal medical crew member for the
air transport of critically ill and injured patients from the
scenes of accidents cannot provide a level of care commensurate
with hospital emergency and critical care services; thus removing
a major advantage to its use. The use of any level of EMT as the
principal medical crew member for critical air medical transports
between hospitals significantly reduces the level of care already
established by the referring hospital." The Associations further
maintain that "air transport of the critically ill and injured
are functional extensions of hospital emergency and critical care
services" and staffing of those services "must minimally consist
of at least one specially trained registered professional
nurse". (10)
Public safety agencies in DeKalb County, Georgia (11)
and San Bernadino County, California (12) point to the Paramedic
as the best qualified individual for on-scene EMS helicopter
missions. Both point to the recognition of this by the federal
Department of Transportation as well as other state and local
authorities. San Bernadino goes on to support private EMS
14
helicopter services staffed by nurses as appropriate for critical
inter-hospital transfers.
A study presented in the September/October 1987 Aero-~
medical Journal reviewed the appropriateness of scene triage by
EMT-level pre-hospital providers. The study by Jack Rupp, Ana
Reynolds, Bob Walsh and Robert Falcone of Life Flight at Grant
Medical Center in Columbus, Ohio was designed to determine if
non-physician personnel could make accurate scene triage deci-
sions based on simple field criteria. The study concluded, “Nine
salvageable patients were deemed inappropriate for trauma center
management leading to an over-triage rate of 6.6%. These data
suggest non-physician pre-hospital personnel using simple physi-
ologic, anatomic or mechanism of injury criteria, do not over-
triage for trauma center admission. The rate of undertriage was
not addressed, and should be the subject of further study." (8)
The study of air ambulance services conducted by the
Pittsburgh Press concluded that patients are sometimes taken to
inappropriate hospitals not equipped to handle the severity of
their injuries. It cites an incident where a patient was taken
to the hospital providing the helicopter service rather than the
regional trauma center. (2)
A study presented in Aeromedical Journal reviewed the
issue of transporting trauma patients by helicopter from the
scene to a trauma center versus transporting the patient from the
community hospital. The study by Dianne Jedlicka, Mike Dick,
Joyce Zwart and Robert Falcone of Life Flight in Columbus, Ohio
concludes, "Aeromedical trauma transport from the scene versus
community hospital in identical populations, produces similar
- erude survival rates in a well-organized regional system. No
patient should await helicopter transport at the scene, when a
well-equipped community receiving facility is locally available.
However, time to definitive care is significantly increased when
the community hospital acts as a resuscitation intermediary, and
that small sub-population of injured patients who require immedi-
ate surgery to prevent exsanguination or eventual organ failure,
may suffer as a consequence. Rigid protocols based on Scene
Triage may help prevent transport delays to definitive care." (8)
15
The shorter response times of multi-purpose public
safety helicopters for on-scene (as opposed to inter-hospital),
EMS missions is discussed by representatives of the DeKalb
County, Georgia Department of Public Safety (11) and the San
Bernadino County Sheriff’s Department. The importance of a rapid
response for trauma victims is noted. The proximity of "multi-
role" EMS personnel to the incident eliminates the delay associ-
ated with the dispatch of a second single purpose EMS service.
According to the representative of San Bernadino County, "The
public safety aircraft already on patrol has a significant re-
sponse advantage over a single-function aircraft responding from
a base." (12)
J. Timothy Fives, Program Director of UCLA MedStar,
author of "Hospital-Based Helicopters in the Incident Command",
supports a system in which law enforcement agencies can "look to
the hospital-based aeromedical programs to set the trends in
patient care procedures and specialized equipment, particularly
in dedicated EMS helicopters". The Incident Command Systen, with
common structure and language, would provide clearly defined
guidelines with regard to responsibilities and application of
skills for both law enforcement and hospital-based helicopter
services. (13)
Sam Hewitt of Tracor Aviation, Inc. believes in an EMS
system "which utilizes both the public and private sector to the
greatest advantage possible",but "it is vital that a standard of
cooperation be established governed by a unilateral system which
will assure that the injured person or persons receive the type
of EMS which a given situation dictates to be in the injured
person’s best interest regardless of whether the service is
public or private." (14)
16
The cost-efficiency of multi-purpose operations that
can serve fire, police and emergency medical services roles is
noted by the San Bernadino County Sheriff’s Department. The
Sheriff’s Department feels patient revenues are insufficient to
support pre-hospital air ambulance services and that a public
subsidy is, therefore, required. "When that happens, there is no
advantage to privatization of air ambulance service. In fact,
once privatization eliminates public fleets, the public safety
agencies are hostage to virtually any subsidy demand. And if the
private provider becomes insolvent, it disappears with impunity
while the public entity is left with the responsibility, but no
assets. The impact of economics on maintenance and safety is
another issue to be considered." (12)
In the recently published study, Economic Impact of DRG
Payment Policies on Air-Evacuated Trauma Patients, the results
indicated:
",... that although high financial losses result when
caring for traumatized Medicare patients, DRG’s have
not had a major financial effect upon centers receiving
referred trauma patients because of the low numbers of
admitted traumatized Medicare patients. However, if
third-party payers were to enact the Medicare payment
system, devastating economic losses would be inflicted
upon major trauma centers." (15)
In another study, Impact of Prospective Payments ina
Tertiary Care Center Receiving Large Numbers of Critically Jii
Patients by Aeromedical Transport, the results indicated that,
"unless current and planned prospective payment policies are
modified, the use of aeromedical transport services to recruit
large numbers of critically ill patients to tertiary care centers
is economically prohibitive." (16)
In the West Virginia Air Medevac Project Final Report
of January 1986, a comparison between public service and
hospital-based air ambulance services defined the characteristics
for each model with respect to cost.
17
Public Service Model
. Aircraft and personnel are available for multiple
utilization. This significantly spreads the very
high cost of operating aircraft among several ser-
vice functions and reduces the cost of air emergency
medical transportation.
. Operation of an air emergency medical transportation
system by a public entity, especially in the case of
a statewide system, precludes duplication of man-
power and equipment and provides for the highest
degree of resource coordination and utilization
further contributing to a lower operational cost.
. Traditionally, public service models have been
financed by tax revenues and in most cases the
services provided to citizens are free. This is
especially beneficial to those citizens who suffer
critical injuries and illnesses since in many cases
the specialty care required added to longer stays in
intensive care units often will totally deplete any
medical insurance benefits available.
. Public service models, once established, may experi-
ence a larger degree of difficulty in increased
levels of funding to maintain the operation at peak
performance levels. Other states reported that,
while they were able to initially secure the funding
necessary to establish an adequate air emergency
medical transportation system, subsequent funding
requirements to replace aircraft and upgrade person-
nel skill levels was more difficult to obtain
through the public sector budget process.
18
Hospital-Based Mode
Because the aircraft and personnel are exclusively
used for air emergency medical transportation
services, the hospital must pay the total cost of
the operation.
Traditionally, patients are billed for all air
emergency medical transportation services by the
hospital operating the aircraft. These bills will
range from $1,000 to $3,000 depending on the level
of service provided and the distance involved in the
mission.
Because the funding process is solely contained
within the operating hospital, necessary increases
for replacement aircraft and personnel development
are relatively more easy to obtain than in the
public service model.
The major difference, as noted in the report, is that
"in the case of the public service model, financing is accom-
plished through tax revenues and the service is usually provided
to citizens at no cost." In the case of hospital-based models,
"it is documented that only some 28% of the cost of the service
is generated by patient transportation fees. The balance of the
cost must be generated by other departments of the hospital
operating the system, i.e., patients of that hospital must help
subsidize the air emergency medical transportation service." (16)
19
REFERENCES
1. “Commercial Emergency Medical Service Helicopter Operations,
Safety Study", National Transportation Safety Board, Janu-
ary 28, 1988.
2. Andrew Schneider, "Rescue at Risk", The Pittsburgh Press,
February 8, 1987 - December 27, 1987.
3. Highway Safety Act of 1966, Revised July 1987, Section 402.
4. Frank Thomas, M.D., et. al., "A nationwide survey of civil-
jan air ambulance services." Aviation Space, and Environ-
mental Medicine, 56:547-52, June 1985.
5, Marshall T. Morgan, M.D., "Helicopter Air Ambulances in Pre-
Hospital Care," Emergency Medical Care Digest, Vol. 7,
No. 2, February 1987.
6. REARM, Commander Dennis McLean, U.S. Coast Guard.
7. “Is the Flight Physician’s Medical Judgment Necessary?"
Emergency Medical Care Digest, February 1987.
8. “Abstracts, 8th Annual Ashbeams/NFNA Conference", Aero-
medical Journal, September/October 1987.
9. "Minimum Quality Standards", Ashbeams, January 1987.
10. Staffing of Critical Care Air Medical Transport Services",
Emergency Nurses Association and the National Flight Nurse
Association, Joint Position Paper, 1986.
11. Correspondence, DeKalb County Georgia Department of Public
Safety, April 1988.
(12. Correspondence, San Bernadino County California Sheriff’s
Department, April 11, 1988.
13. J. Timothy Fives, "Hospital-Based Helicopters in the
Incident Command System", UCLA MedStar.
14. Correspondence, Sam Hewitt, Tracor Aviation, Inc., March 11,
1988.
15. Frank Thomas, M.D., et. al., "The Economic Impact of DRG
Payment Policies on Air-Evacuated Trauma Patients", The
Journal of Trauma, Vol. 28, No. 24, April 1988.
16. Frank Thomas, M.D., et. al., "Impact of Prospective Payments
in a Tertiary Care Center Receiving Large Numbers of Criti-
cally Ill Patients by Aeromedical Transport", Critical Care
Medicine, Vol. 14, No. 3, March 1986.
17. Air Medevac Project, Final Report, State of West Virginia,
January 1986.
20
Coopers
-&Lybrand
cenified public accountants
RIVATIZATION OF PUBLIC SECTOR SERVICES
PRIVATIZATION OF PUBLIC SECTOR SERVICES
Air Ambulance Conference
June 23-June 24, 1988
"DRIVATIZATION OF PUBLIC SECTOR SERVICES IN THEORY AND PRACTICE"
ST
A recent (Summer 1987) article in the Journal of Policy
Analysis and Management reviews the major issues underlying the
privatization of public sector services. It presents the results
of a conference held in September 1986 on the issue, as well as
the work of the author. This article is particularly relevant to
the discussion of public versus private air ambulance services in
light of the recent growth in private sector alternatives to
public safety aviation services. The following discussion is
extracted from "Privatization of Public-Sector Services in Theory
and Practice", by Janet Rothenberg Pack (1).
The abstract of the article summarizes the key issues
presented in the paper. Air ambulance service (as both a public
safety and health care service) is viewed in the context of the
article as a "complex output" of public sector activity.
The last ten years have seen a marked in-
crease in the analysis and implementation of
private-sector alternatives to the production
of public-sector services. The impetus for
privatization has two sources: (1) opposi-
tion to further growth of the public sector,
and (2) the belief that the private sector
would be a more efficient producer. Yet as
privatization moves beyond the acquisition of
intermediate goods and services (payroll
processing and housekeeping services, for
example) to more complex public outputs (such
as education, social security, public safety,
the postal system, for example), it is sub-
ject to increasing challenge on both effi-
ciency and equity grounds. Nonetheless,
private alternatives to public production are
finding increased acceptance.
As government has taken on the production of
goods and services readily available from the
private sector and as the costs of regulation
and inadequacies of public production have
become exposed, the question that is being
posed is, "Can public financing be combined
with private production for a more efficient
result?"
Janet Pack describes three forms of public interven-
tion:
Public financing of goods and services,
Public production of goods and services, and
Regulation.
Privatization can take place, therefore, in one of the following
three ways:
1)
2)
3)
Divestiture or delegation of the public function -
This is accomplished by removing public financing
of the goods and services. The government no
longer underwrites the function and it is removed
from the public budget. Regulation by government
is continued and the regulatory expenses remain in
the public budget.
Maintaining public financing of the function, but
shifting the production of the goods and services
to the private sector - This is accomplished by
government contracting with the private sector for
the production of the goods and services, or by
government providing the public with vouchers for
the purchase of the goods and services. Public
financing is maintained in the governmental budget,
but the department producing the goods/service is
eliminated.
Deregulation - Privatization is accomplished
through removal of public finance, production and
regulation of the goods and services.
The push for privatization has been motivated by the
desire to reduce the size of the public sector (government
expenditures have increased from 9.9% of the gross national
product in 1929 to 34.3% of the GNP in 1984).
Of the three forms
of privatization described by Pack (divestiture, shifting produc-
tion and deregulation), most of the push has been to shift the
production, rather than the financing or regulation of goods and
services from the public to the private sector.
Those favoring privatization.of public production
believe that the public sector is jnefficient and that "...com-
petitive bidding by profit-maximizing firms for a well-specified
output guarantees that the product will be produced at the lowest
cost."
The author presents two arguments for public sector
intervention -- efficiency and equity:
Efficiency - The efficiency argument in favor of public
intervention is based on the need for regulation,
public financing or public production when private
markets, left to themselves, fail to produce the type
or quantity of goods desired by the public. Market
failure can be caused by the existence of pure public
goods (e.g. national defense), externalities (e.g.
pollution), or natural monopoly.
Equity - The equity argument in favor of public inter-
vention is based on the need to redistribute income (or
- goods and services) for the protection of the poor.
Public intervention is also viewed as necessary to
assure fairness and equal opportunity.
The author cautions, however, that these arguments can
over-simplify the privatization issue.
Clearly the arguments for public intervention
are both more complex and more subtle than
can be encompassed in the summary categories
of efficiency - market failure - and equity -
income distribution. Market failure offers
only an imperfect guide to whether or not
government should intervene by producing,
financing, or regulating the production of
goods and services.
In assessing whether or not public intervention is appropriate,
Pack argues that the reasons for that intervention and the
resulting benefits be fully considered and clearly understood.
She states,
... There is widespread agreement that
explicit consideration should be given to
whether the public intervention is an inm-
provement over the nonoptimal private state
of affairs.
She goes on to state that in the evaluation of the appropriate-
ness of public intervention, one should consider that,
... the complexity of public-private sector
interactions may reduce the potential gains
from privatization. Further reduction of the
scope for privatization arises from the other
motivations for public intervention - equity,
fairness, equal opportunity - which may be
exceedingly difficult to bring about without
substantial public intervention.
Although arguments in favor of privatization are based
primarily on efficiency, the results in terms of equity (redis-
tribution) must be considered. Pack states,
"The incentives of the producer, in par-
ticular the profit maximizing imperatives of
the private sector, make it more likely that
there will be attempts to exclude higher cost
activities... These difficulties cannot be
overcome simply by appropriate contract pro-
visions or different-valued vouchers. ...
precision in contract specifications is often
elusive and monitoring is difficult and
expensive.
In reviewing the current studies that have been con-
ducted on the issue, Pack concludes that little is actually known
about the real cost reduction or quality improvements of pri-
vatization. Of particular relevance to the case of air ambulance
service is her finding that "... we understand little about how
to avoid the possible diminution of quantity or quality that
allegedly occurs in the push for private profits in sectors where
consumers have little information or choice."
The article points out that the benefits of privatiza-
tion can only be realized where competition is actually in-
creased. Otherwise, government simply transfers the function
from the public to the private sector at a rate that may exceed
what is required to produce the goods or service.
Privatization is more difficult where the goods and
services are hard to define and there is a lack of agreement on
how to judge the elements of the product. Pack cites health care
and public safety (and hence air ambulance service) as examples
of this type of product. In this situation, public monitoring of
the results is difficult and expensive. She states, "The major
problems may be inherent in the nature of the activity, not in
the locus of production." Because of the inherent problems
associated with these types of goods and services, Pack suggests
that,
Regulation, combined with private production,
may help to overcome some of the problems.
Particularly in the absence of competition,
regulation may make better monitoring of
performance and limiting of rents [costs in
excess of what is required] possible.
The article presents the results of a survey by Poole
and Fixler on the privatization experience of state and local
governments. The four major findings are:
1) An impressive amount of privatization has already
occurred;
2) Although most privatization has been for inter-
mediate inputs (e.g. maintenance functions), con-
tracting out of public production and delivery of
simple final services is rising;
3) Research into relative costs shows that contracting
of both (intermediate inputs and final services)
results in substantial savings;
4) There is growing interest in (and some examples of)
privatizing complex public services (e.g. prisons,
police functions) ;
Their research also identified four major objectives to
privatization:
corruption,
low initial bids to get a foot in the door,
- poor quality,
reduced service to the poor.
The authors suggest ways to overcome these objectives such as
multi-year contracts, performance bonds and vouchers for the
poor. Pack cautions, however, that in the case of complex pro-
ducts, such as air ambulance services, that specifying, measuring
and monitoring quality is difficult and expensive and that
government may not be able to require adequate performance bonds.
Pack discusses the privatization of health care, in
particular. She states,
Privatization of health care does not mean
quite the same thing as in education or other
public activities. Although the financing of
health care has a large public element - 40%
coming from public funds..., the production
of health care is largely a private activity.
She suggests that governments deciding to go out to bid for
health care services should be particularly careful in specifying
quality. She states,
The success of the bidding system will depend
upon the possibilities for defining the
health services required of the supplier.
Most difficult of all is the specification of
quality. If the desired output is not well
specified and the lowest bidders are ac-
cepted, profit-maximizing suppliers will set
quality levels as low as the monitoring
mechanism allows.
The author, however, remains optomistic about the
public sector’s ability to specify quality because of the lengthy
history of third-party payors (Medicare, Medicaid and private
insurance companies) specifying output for contract purposes.
She views quantity and quality issues in health care to be more a
function of financing rather than production.
The author concludes the discussion of privatization
with the following statements.
Despite the theoretical cautions about the
appropriateness and difficulties of privatiz-
ing, particularly of contracting out public-
sector production activities, a substantial
amount of contracting out and privatization
appears to have taken place and still more is
planned. Consistent with the cautionary
discussion, however, government is not - or
not often - stepping back from previous com-
mitments for the financing of traditional
public-sector goods and services. Yet more
production activities are being shifted to
the private sector for intermediate public-
consumption items and for the final goods and
services delivered to consumers.
Nonetheless, privatization is still very
limited in terms of the types of activities
covered, the numbers of places involved and
its claim on the public budget. Whether or
not the next decade will be one in which such
activities multiply or should be encouraged
to multiply will depend upon answers to many
of the questions raised at the conference.
. How inefficient is public production?...
. How efficiently can the private sector
produce traditional public services?...
. How much needs to be spent on regulation
and monitoring by the public sector in
order to insure conformity with contract
specifications?
These constitute an important but narrow
subset of questions. They are important in
dealing with the kinds of goods and services
for which we are indifferent as to the pro-
ducer, except for efficiency considerations.
They may productively be raised for the many
goods and services produced by the public
sector in which the elements of publicness
are very limited.
Other difficult questions arise for those
activities in which the primary outputs are
equity-enhancing rather than efficiency-
enhancing activities. In these cases, the
most fundamental question of why this is a
public activity can not be answered simply,
and therefore neither can the question of the
appropriateness of privatization. The more
complex the underlying motives for public
financing and production - that is, the more
they combined both efficiency and a diversity
of equity goals - and the more the output is
seen as conferring both private and social
benefits, the less likely it is that a trans-
fer from public to private production will
proceed very far.
"PONDERING PRIVATIZATION MAY BE GOOD FOR YOUR GOVERNMENT"
PONDERING FRIVALL OAL SSS eee] O88 OO ooonr—
The November 1987 publication of Governing contains an
article on the privatization debate. The author, Thomas B. Darr,
summarizes the argument as follows:
. Advocates say privatization:
- saves tax dollars,
- increases public-sector productivity.
. Opponents say privatization raises serious issues
of:
- accountability,
- quality,
- flexibility, and
- integrity.
Darr describes privatization as a potential management
tool, forcing government to conduct more detailed cost and
management analyses and creating external competition for the
existing public service providers of the service. Government
must reconsider:
. the nature of the service,
. the rationale for providing it, and
. the means by which it is provided.
Privatization, in this view, can provide cost savings in two
ways - by private production of the services and by motivating
increased efficiency by public sector employees. :
In the article, Deputy Mayor Ed Richard of Cleveland,
Ohio cites three factors essential for successful privatization:
1) accurate cost accounting,
2) sensitive labor relations, and
3) skillful management.
ee eee eee
Savannah, Georgia’s City Manager, Don Mendonsa has contracted out
city services on a selected basis. He states, "If you are manag~-
ing the way you should be managing, then you look at the alterna-
tives and determine what is most productive." According to the
article, Savannah’s system emphasizes performance improvements
‘through effective management, rather than assuming public em-
ployees are less productive than private-sector employees.
The article points to several criticisms of privatiza-—
tion. These are that privatization:
. Masks hidden costs to government, including the
expenses of contract preparation and monitoring of
contractor performance.
. Emphasizes the profit motive, making contracted
services neither cheaper than publicly provided
services nor of comparable quality.
. Locks public officials into inflexible contracts
that prevent responses to unforeseen circumstances.
. Increases opportunities for corruption.
. Diminishes government accountability to citizens.
The critics of privatization emphasize the importance of govern-
ment maintaining accountability for public-sector services. It
is their view that government must maintain the responsibility
for the effective provision of the service. "Some observers of
privatization argue that efforts to contract out services reflect
an abrogation of responsibility based on the inability of munici-
palities to manage their own services."
The purchasing agent for Arlington, Virginia, Donald
Harvey, points to three reasons for successful privatization:
. The ability of private contractors to complete jobs
faster with fewer employees,
10
. Cost advantages the private sector obtains by pur-
chasing more effective equipment better suited to
performing specific tasks, and
. Use of cost-management techniques more effectively
and with greater frequency than the public sector.
Harvey attributes failures in public-sector delivery of services
to public managers who lack appropriate training and intransigent
bureaucracies that hinder application of innovative cost- and
task-management techniques.
The article also raises the concern that privatization
may lead to a shift from public-sector monopolies to private-
sector monopolies. Darr points to the experience of the Common-
wealth of Massachusetts where privatization of some human ser-
vices has been attempted. According to Susanne Tompkins, Vice
President of the Massachusetts Taypayers Foundation, Inc., “In
many cases, the service providers were created in response to the
state’s need for services. They were private, but not really
private because their only client was the commonwealth. That
doesn’t create competition if the state is the sole service
purchaser." The article concludes that in this case, the state
and providers of service have overemphasized administrative
matters (such as payment rates) and placed too little emphasis on
provider performance.
Darr reports on a survey of 20 cities around Los
Angeles comparing costs of privatized and public-sector services.
Of the eight services contracted, seven were found to be less
expensive in the private sector with no essential difference in
the quality of services.
Suggestions contained in the article for improving
privatization efforts include:
. Request bids from both private firms and from what-
ever in-house group is currently performing the
service.
a1
Preserve some in-house service capacity and never
sole-source a contract for all of the required
services.
Consider service quality, not just price.
12
REFERENCES
Pack, Janet Rothenberg, "Privatization of Public Sector Ser-
vices in Theory and Practice," Journal of Policy Analysis and
Management, Vol. 6, No. 4, 523-540 (1987).
Darr, Thomas B., "Pondering Privatization May Be Good For
Your Government," Governing, November 1987, 42-50.
13
APPENDIX C: AIR AMBULANCE CONFERENCE ATTENDANCE LIST
Robert Borlund
RAE Systems
616 Hurst Drive
Bedford, TX 76022-7424
705/872-2937 (to 9/1/88)
817/282-2618
John L. Chew, Jr.
NHTSA NTS-42
400 7th Street S.W.
Washington, DC 20590
202/366-5440
George W. Falter
Arizona Department of Public Safety
2615 East Airlane
Phoenix, AZ 85034
602/223-2535
Michael Gilbertson
NYS Department Of Health
Corning Tower, 729
Albany, NY 12237
518/474-2219
Charles J. Glass
NHTSA NTS-42
400 7th Street S.W.
Washington, DC 20590
202/366-4297
Louis Grosso
NYS Police
PO Box 3068, Sicker Road
Latham, NY 12110
518/457-5688
518/869-9812
Sam M. Hewitt
Tracor Aviation
Santa Barbara Airport
495 South Fairview Avenue
Santa Barbara, CA 93117
805/967-1122 X297
Marty Ingram
FAA-AEA~210
Fitgerald Federal Building
JFK International Airport
Jamaica, NY 11478
718/917-1864
AIR AMBULANCE CONFERENCE
June 23-24, 1988
Attendance List
William McKenna, Jr.
US Jet Aviation
General Aviation Terminal
Washington National Airport
Washington, DC 20001
703/892-6200
Commander Dennis McLean
US Coast Guard Headquarters
2100 2nd Street S.W.
Washington DC 20593
202/267-2971
Edward L. McNeil, MD
St. Agnes Hospital
305 North Street
White Plains, NY 10605
914/681-4520
Nicholas Nehrbauer, Jr., MD
Memorial Hospital
600 Northern Boulevard
Albany, NY 12204
518/471-3266
Lt. Col. Gary Preston
NYS Police
State Campus, Building 22
Albany, NY 12226
518/457-5929
Carl Soderstrum, MD
MIEMS
22 South Greene Street
Baltimore, MD 21201
301/328-5832
Major Warner I. Sumpter
Maryland State Police
3023 Strawberry Point Road
Baltimore, MD 21220
301/391-0700
Carol Wichman, RN, CCP
St. Francis Health Care Systems
East Pikes Peak at Prospect
Colorado Springs, CO 80903
303/636-8850
Steve Woods
Dade County, Air Rescue Division
14739 SW 128 Street
Miami, FL 33196
305/233-5000
APPENDIX D: OTHER ISSUES
D. OTHER AIR AMBULANCE ISSUES IDENTIFIED AT THE CONFERENCE
In addition to the highest ranked issues presented in the report,
each work group at the air embulance conference identified
numerous other issues that a national study could address. This
appendix summarizes the additional results of each of the work
groups, listing other issues that were identified in each of the
four categories.
Patient Care
. Physician direction of air ambulance responders (on-line
medical control), including protocols, training, and
interstate jurisdictional issues.
7 Triage of patient (selection/rejection) based on financial
class.
° Air ambulance personnel cedicated to emergency medical
services (EMS) versus multi-use personnel (public safety,
EMS, etc.).
- Radio communications between medical crews and hospital
personnel and for flight following.
‘ Specific air medical training of helicopter medical crew
members.
‘ Patient and crew safety (prevention and aircraft survival),
including loading and unioading of patients, packaging of
patients for transport, etc. ;
‘i Minimum standards and criteria for medical equipment to be
carried on air ambulance services (minimum equipment list and
type of equipment).
7 Aircraft cabin configuration requirements (accessibility and
uniform placement of medical equipment).
. Guidelines for prioritizing helicopter missions (among EMS
missions and between EMS and other public safety missions).
@ Access to air ambulance services -- uniform geographic
coverage.
m Response time (from time of air ambulance request to patient
admission to the appropriate hospital).
Initial and recurrent training of medical crews.
Requirements for EMS helicopter response directly to the
scene of the incident versus requirements for inter-facility
transfer of hospital patients.
Impact on patient care of air ambulance sponsorship (hospital
based, hospital affiliated, independent fixed base).
Interface of ground and air ambulance services.
Criteria for use of helicopter vs. fixed wing air ambulance
service.
Personnel dedicated to emergency medical services vs.
personnel engaged in emergency medical services as a
secondary career.
Development of all-weather capabilities.
Avoiding technological imperatives.
Means of central direction for public and private air
ambulance services.
Hospital helipads.
Public expectations and awareness.
Cost effectiveness and cost benefit of air ambulance
services.
Back-up network in event of aircraft emergency.
Interaction of medical and flight crew.
Recruitment and availability of appropriate personnel.
Flight Safety
The existence and content of comprehensive flight safety
procrams.
Requirements for the number and type of flight and air
medical crew members.
‘ "Go/No-go" guidelines (risk assessment vs. patient
condition).
é Minimum equipment list (MEL); appropriate flight equipment to
promote maximum flight safety.
Communication between the Federal Aviation Administration
(FAA) and air ambulance crew members.
. Crew apparel.
. Quality assurance; incident recordkeeping.
s Ground crew training (securing landing sites, safety, ete... «
Rest and duty cycle and crew rest facilities.
” Transport and handling of hazardous materials (eg. medical
gases).
‘ Recurrent pilot training programs (orientation, simulation
training).
‘ Crew survival equipment.
‘i Standards for landing zones and landing spots and
distribution of landing facilities.
Multiple provider responses (call jumping).
Operational control and operations manuals.
Minimum maintenance requirements (aircraft inspection,
airworthiness).
: Flight following requirements.
. Air-to-scene communications.
P Mission priority (categorization of mission urgency).
. Compatability of medical equipment with aircraft.
Pilot knowledge of patient condition.
Minimum mission planning time (safe dispatch procedures, pre-
flight checklists).
Standardization of scene management procedures.
Protocols on prohibited patients, family, animals, etc.
Low level IFR standardized routes specifically for
helicopters.
Operation guidelines suited to the geographic environment.
Minimum safety standards for air ambulance service operators.
Jurisdiction -- responsibility for regulation (federal,
state, local).
Matching aircraft to mission length.
Financial Issues
Guidelines for appropriate use of air ambulance services and
utilization review criteria.
Funding for a national center for the study of aircraft,
crew, medical services, equipment and safety issues.
Appropriate equipment and the skill level of personnel to
provide air ambulance services (minimum standards).
Effectiveness o= seed funding and low interest loans.
‘ Accessibility te air ambulance services and hospital
destination based on the patient's ability to pay (financial
triage).
‘ Exploration of existing statutes to identify models for
funding and/or reimbursement.
‘ "Financial fitness" of air ambulance carriers.
‘ Mechanisms to deploy funds to most efficient system(s).
. Non-traditional funding sources (subscriptions, memberships,
clubs).
. Standardization of insurance funding (Medicare and other
insurance).
° Cap on liability/malpractice (protection against frivolous
lawsuits).
. Spending limit on health care related to the Gross National
Product (GNP).
- Marketing/education strategies to increase funding for air
ambulance services.
P Funding for quality assurance (QA) studies.
. Indigent patient care reimbursement.
‘ Assessment of need for a "middle-man" operator (helicopter
contractor/vendor).
s Compensation ana benefits (eg. life insurance) for medical
transport teams.
# Examination of public and private programs (eg. cost
effectiveness comparisons).
‘ Budget compliance of air ambulance services.
Air ambulance patients' personal liability for the cause of
injury or illness.
Regulatory and Manacement Issues
Levels of compliance by public and private providers with
federal aviation regulations pertaining to air ambulance
services; should public sector providers of air ambulance
services comply with the same standards as private providers?
Enabling legislation for air ambulance services.
Should there be an industry self-inspection and review board?
(Effectiveness of voluntary standards for air ambulance
services)
. Uniform federal inspection of air EMS providers.
7 Quality feedback inspection system; national mandatory
malfunction reporting system (aircraft and medical issues).
The need for and role of the flight operations manager and
the medical director of air ambulance services (coordination
between flight operations and medical program operations).
Curriculum, training, certification and continuing education
of air medical personnel.
F Liability.
Public and private air ambulance interface.
Location and content of dispatch centers (centralized vs.
decentralized).
Need for operations/resources manual; directory of air
ambulance operations, capabilities and equipment.
. Deviation control (granting of exceptions).
Mission statement definition by air ambulance operators.
P Relationship between system size and management
qualifications (contract management systems).
Clarification of patients who would benefit and patients who
would be aggravated by flight.
‘ Budget.
Realignment of present regulatory structure with business
structure.
Availability and cost of capable management personnel.
Contracts.
Jurisdiction protocols of air ambulance services.
Training and educational programs for air ambulance managers.
International cooperation for the procurement of instant
visas.
Safety.
Span of control.
Use of medications outside of jurisdiction (inter-
continental).
Aircraft design.
The number of services in an area.
Research and national trauma registry.
Interstate regulation.
Differences between hospital-based and rescue services.
Universal access applied to the private sector.
Coordinating services based on seasonal changes in
population.
Minimum staffing (MD, RN, EMT) for on-scene and inter-
facility EMS air transports.
Definitions of air ambulance jurisdictions (EMS
districts/regions); jurisdictional agreements.
Consumer access,
Regulatory facets of need/duplication of air ambulance
services.
Certification of medical dispatch program.
Regulatory incentives for appropriate use; dis-incentives for
inappropriate use.
FCC/RF/EMS communications and the availability of radio
frequencies.
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