WINTON – Which came first, the chicken or the egg?

That ages-old analogy was used by the Hertford County Board of Commissioners here on Monday morning where, following a 98-minute closed session, they addressed the county’s existing ordinance regulating the granting of franchises for ambulance providers.

As adopted in 2002, the ordinance prevents a newly established provider from gaining a franchise in Hertford County. That fact was the main concern of the commissioners in re-wording the ordinance.

“It’s the chicken and the egg scenario…you can’t get a state permit (mandatory of all providers in the business of offering non-emergency medical transport) without being granted a franchise in the county that company wishes to conduct business and you can’t get a county franchise without a state permit,” said Chuck Revelle, a Murfreesboro attorney who serves the commissioners as their legal counsel.

As stated in Section 2.1 of the ordinance: “No person either as owner, agent or otherwise, shall furnish, operate, conduct, maintain, advertise, or otherwise be engaged in or profess to be engaged in the service of transportation of patients within the County of Hertford unless the person holds a valid permit for each ambulance used in such business or service issued by the North Carolina Department of Human Resources, Office of Emergency Medical Services, and has been granted a franchise for the operation of such business or service by the County of Hertford pursuant to the Ordinance.”

That portion of the ordinance remains in effect, but to open the door to potential new providers, county officials have written in a “good faith” clause into the ordinance. Section 3.2 (a) reads as follows:

“For applicants that are not currently operating ambulance services because applicant does not hold a license, permit, or certificate required by the N.C. Office of Emergency Medical Services, the applicant shall specify a proposed timetable for obtaining all necessary state approvals, for meeting all county requirements and standards, and to make the service or equipment available or to complete the project, and the timetable to be followed.

“The applicant shall submit such periodic reports on his progress in meeting the timetable as may be required by County. If no progress report is provided or, after reviewing the progress, the County determines that the applicant is not meeting the timetable and the applicant cannot demonstrate that it is making good faith efforts to meet the timetable, the County may terminate the franchise.

“Absent unusual circumstances not due to the fault of the applicant, all necessary state licenses, permits, and certificates shall be obtained within 90 days of the granting of a franchise, and all County requirements and standards shall be met within 150 days of the granting of a franchise. If the County determines that the applicant is making a good faith effort to meet the timetable, the County may, at the request of applicant, extend the timetable for a specified period.”

In layman’s terms, Revelle said this part of the ordinance allows a business wishing to provide non-emergency transport a chance to, “reasonably show they can meet the county requirements which allows them to go to the state to receive the necessary licenses and permits and then have up to 150 days to complete the county’s requirements.”

Revelle stressed that a provider is prohibited from transporting patients until all state and county regulations are met.

He also reminded the commissioners that their involvement in this effort was restricted to re-wording the ordinance, not as to who can apply for a franchise.

“That will come at a later time after you formally approve the revised ordinance,” Revelle said, referencing the possibility of the county allowing for additional providers.

Currently, only Hertford County Emergency Medical Services and Bertie Ambulance Service have franchises to provide non-emergency medical transport in the county.

“I feel the decision we reached on this was based largely upon (offering more) choices,” Commissioner William “Bill” Mitchell said.

Mitchell represents the board of commissioners on the county’s Medical Service Transportation Advisory Council. He said that group agreed to the revised ordinance.

“If our citizens have more (transport) choices, I feel this will cause those providing these types of services to tighten up in an effort to offer better services,” Commission Chair Johnny Ray Farmer said.

Other changes in the ordinance include:

Those holding a county franchise are required annually to provide a financial statement that shows strength and stability of the provider.

All currently franchised ambulance service providers and any additional franchises granted prior to June 30, 2010 are hereby continued as franchisees until June 30, 2011, provided said franchisees remain in compliance with this ordinance. Thereafter, all franchises shall run from July 1 to June 30 of the following year. It is anticipated that a review of all franchisees shall occur in April of each year.

The term “patient” means an individual who is sick, injured, wounded, or otherwise incapacitated or helpless such that the need for some medial assistance might be anticipated while being transported to or from a medical facility; provided that a person being transported in a vehicle equipped to handle a wheelchair, or being transported for routine dialysis, when there is not a reasonable expectation that medical assistance might be anticipated while being transported, shall not be considered a patient.

No franchise is required for any entity transporting patients who are picked up beyond the limits of the County of Hertford, for transportation to facilities located within the County of Hertford.

As required by law, an ordinance (in this case, a revised ordinance) must be approved during two readings at separate meetings. The commissioners are scheduled to read the ordinance into public record for the first time at their Monday, Feb. 1 meeting (9 a.m.). The second reading may occur as early as their Feb. 15 meeting (7 p.m.).