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HomeMy WebLinkAboutbocc.ord.003.2023AN EMERGENCY ORDINANCE OF THE BOARD OF COUNTY COMMISSIONERS OF PITKIN COUNTY, COLORADO, ADOPTING TITLE 6.05 OF THE PITKIN COUNTY CODE, SECURE TRANSPORTATION SERVICES ORDINANCE NO. 003-2023 RECITALS WHEREAS, Pursuant to 30-35-301 C.R.S., the Board of County Commissioners ("BOCC") of Home Rule Counties is authorized to make and publish ordinances for carrying into effect or discharging the powers and duties conferred upon such counties by law and as seems necessary, and; WHEREAS, Pursuant to Section 2.8.2 of the Home Rule Charter ("HRC"), the Board of County Commissioners is authorized to take official action by Emergency Ordinance for certain matters where action is prescribed pursuant to the Colorado Revised Statutes as amended, and; WHEREAS, House Bill 21-1085 ("the Bill"), adopted in June 2021, created a regulatory and service system to provide public or private secure transportation services to individuals experiencing a behavioral health crisis; and, WHEREAS, the Bill identified the State of Colorado counties as the licensing authority for Secure Transportation Services; and, WHEREAS, the Bill directed each county's Board of County Commissioners to set forth requirements for issuing licenses, vehicle permits for such transports, operations and processing complaints and enforcement of the rules associated with the program in order to ensure high - quality behavioral health transportation within Pitkin County; and WHEREAS, the Bill directed each county to have such a program in place by January 1, 2023; and, WHEREAS, The BOCC finds that adoption of this ordinance is necessary for the immediate preservation of the public health, safety and welfare of the citizens of Pitkin County and therefore declares this ordinance and legislation to be effective immediately pursuant to HRC Section 2.8.2. NOW, THEREFORE, BE IT ORDAINED by the Board of County Commissioners of Pitkin County, Colorado that it hereby adopts TITLE 6.05 OF THE PITKIN COUNTY CODE, SECURE TRANSPORTATION SERVICES and authorizes the Chair or the Chair's designee to sign the Ordinance and upon the satisfaction of the County Attorney as to form, execute any other associated documents necessary to complete this matter. INTRODUCED, READ AND ADOPTED AS AN EMERGENCY ORDINANCE ON THE 11TH DAY OF JANUARY 2023 AND SET FOR CONFIRMATORY PUBLIC HEARING ON THE 25TH DAY OF JANUARY, 2023. NOTICE OF CONFIRMATORY PUBLIC HEARING AND TITLE AND SHORT SUMMARY OF THE EMERGENCY ORDINANCE PUBLISHED IN THE ASPEN DAILY NEWS ON THE 12TH DAY OF JANUARY 2023. NOTICE OF CONFIRMATORY PUBLIC HEARING AND THE FULL TEXT OF THE EMERGENCY ORDINANCE POSTED ON THE OFFICIAL PITKIN COUNTY WEBSITE www.pitkincounty.com ON THE 12TH DAY OF JANUARY 2023. CONFIRMED AT A PUBLIC HEARING ON THE 25TH DAY OF JANUARY 2023. POSTED BY TITLE AND SHORT SUMMARY ON THE OFFICIAL PITKIN COUNTY WEBSITE www.pitkincounty.com ON THE 26TH DAY OF JANUARY 2023. PUBLISHED BY TITLE AND SHORT SUMMARY, AFTER CONFIRMATORY PUBLIC HEARING, IN THE ASPEN DAILY NEWS ON THE 2ND DAY OF FEBRUARY, 2023. ATTEST: BOARD OF COUNTY COMMISSIONERS By By: FVratn.fit, iatokr Julia Ely Francie Jacober, Chair Deputy County Clerk Date: Jan-12-2023 APPROVED AS TO FORM: MANAGER APPROVAL 5oati �1Y puffs A.aifiu. John Ely, County Attorney Phylis Mattice for Jon Peacock, County Manager Form Revised 01/01/2023 TITLE 6: HEALTH AND SAFETY 6.05: SECURE TRANSPORTATION SERVICES SECTIONS: TITLE 6: HEALTH AND SAFETY 6.05: SECURE TRANSPORTATION SERVICES 6.05.010: AUTHORITY AND PURPOSE 6.05.020: DEFINITIONS 1 1 1 2 6.05.030: SECURE TRANSPORTATION SERVICES LICENSE AND VEHICLE PERMIT(S) 3 6.05.040: LICENSE AND PERMIT APPLICATION PROCESS 4 6.05.050: COMPLAINT AND INVESTIGATION 6 6.05.060: DENIAL, REVOCATION OR SUSPENSION of licensure and/or vehicle permits 7 6.05.070: DATA COLLECTION AND REPORTING 8 6.05.080: STAFFING REQUIREMENTS 9 6.05.090: CLINICAL, MEDICAL AND OPERATING STANDARDS AND PROCEDURES 12 6.05.100: CLIENT RIGHTS 14 6.05.110: QUALITY MANAGEMENT PROGRAM (QMP) 15 6.05.010: AUTHORITY AND PURPOSE It is the policy of the Pitkin County Board of County Commissioners that all providers of secure transportation services and the vehicles used for secure transportation services comply with local and state laws and regulations including but not limited to Code of Colorado Regulations (CCR) 6 CCR 1011-4, Standards for Secure Transportation Services. A. Purpose. The purpose of these Rules and Regulations is to set forth the requirements for the licensing and permitting of secure transportation services and the vehicles used for such services. B. Applicability. These rules and regulations apply to all public or private businesses within Pitkin County who provide transportation services within the boundaries of Pitkin County, with the exception of ambulance agencies, transportation services provided by the state or county department of human services, emergency service patrols established pursuant to C.R.S. *27-81-115, and law enforcement. C. Amendments. The Board reserves the right to amend these Rules and Page 1 Created on 12/28/22 Regulations, and any other individual conditions of licensing as applied to any particular license, as needed in keeping with its legislative function and in order to implement the policy of the State of Colorado that the regulation and control of secure transportation licenses and permits are in the exclusive purview of the Board. D. Variances. A variance from the terms of these Rules and Regulations may be granted if the Board finds such action is necessary to protect the public health, safety, or welfare. Such action may include the issuance of temporary secure transportation licenses. Such variance shall remain in effect for the period specified by the Board. 6.05.020: DEFINITIONS The definitions contained in 6 CCR 1011-4, as may be amended from time to time, shall apply to these rules and regulations, unless the context clearly requires a different meaning. A. "Secure transportation" or "secure transportation services:" Urgent transportation services provided to individuals experiencing a behavioral health crisis and includes: 1. An individual being transported from the community to a facility designated for treatment and evaluation; 2. An individual in need of services from any location to an approved treatment facility, or to a walk-in crisis center that is operating as part of a behavioral health crisis response system; or 3. An individual who is receiving transportation across levels of care or to a higher level or lower of care. Secure transportation" does not include urgent transportation services provided by law enforcement or personnel employed by or contracted with a law enforcement agency. 6.05.030: SECURE TRANSPORTATION SERVICES LICENSE AND VEHICLE PERMIT(S) A. License Required. Applicable secure transportation service businesses based in Pitkin County are required to have a valid County -issued license for their business beginning January I, 2023. Owners of new secure transportation service businesses must obtain a secure transportation license and vehicle permit(s) prior to beginning operations and upon change of ownership of a secure transportation service. A secure transportation service license or vehicle permit may not be assigned, sold, or otherwise transferred. The County may enter into reciprocal licensing and permitting agreements with other counties and neighboring states. Any reciprocal agreements will be managed by the Licensing Coordinator. B. License and Permit Renewal. Renewal applications are processed in the same manner as new applications. A completed renewal application should be submitted to the Licensing Coordinator no less than 30 days before the date of license or permit expiration. Page 2 Created on 12/28/22 C. Secure Transportation Service Licensure. 1. Classifications/ Categories. have the following two licensing options: a. Class A — services that may use physical restraint during secure transport; or b. Class B — services that shall not use physical restraint during secure transport. 2. Licensure Period. Licenses for all secure transportation services are valid for three (3) years 3. Exemptions to Licensing Requirements. a. The following entities may provide secure transportation services to an individual experiencing a behavioral health crisis without a secure transportation license: i. Ground ambulance agencies ii. Transportation provided by the Office of Behavioral Health iii. Emergency service patrols iv. Law enforcement b. In the event that licensed secure transportation services are unavailable, the County may allow an unlicensed service to provide temporary secure transportation services to an individual experiencing a behavioral health crisis through a review of the situation by the Licensing Coordinator. D. Secure Transportation Vehicle Permitting. To be permitted as a Secure Transportation vehicle, the vehicle must be in compliance with the requirements for vehicle design and safety standards in accordance with 6 CCR 1011-4, Part 3.3 (A) (10). The County shall verify that each vehicle is inspected annually by an EMTAC representative to ensure compliance with the vehicle requirements. The County shall renew each vehicle permit on an annual basis. 1. Type of Vehicle Permit. The type of permit issued will be determined by the type of vehicle that secure transportation services and their appropriate staff utilize when providing secure transportation services to clients. Secure transportation vehicles have the following two (2) permit options: a. Type 1 — vehicle with a safety partition that separates the driver from the passenger compartment, or b. Type 2 — non -partitioned vehicle. 6.05.040: LICENSE AND PERMIT APPLICATION PROCESS Page 3 Created on 12/28/22 A. Application for Secure Transportation Service License and Permit. All applications, whether for a secure transportation service license, a secure transportation vehicle permit, or both can be downloaded from the County website at: www.Pitkincounty.com. Questions related to the applications can be directed to the Licensing Coordinator at licensing@Pitkincounty.com. B. Secure Transportation Service License Application Requirements. For secure transportation service licenses, applicants must provide: 1. Completed license application. 2. Proof of a minimum level of worker's compensation consistent with the Colorado Workers' Compensation Act. 3. Copy of a written policy and procedure manual, operational protocols, medical protocols (if applicable), training procedures, or other relevant documents. 4. Policies and procedures must follow national best practice guidelines where available that address, at a minimum: a. Appropriate procedures to assess initially whether the client requires a higher level of transport than the service can provide; b. Appropriate procedures to follow when, during a secure transport, it becomes apparent that a client needs medical attention or a higher level of transport than the service can provide; c. Appropriate procedures to confirm the receiving facility's acceptance of the client prior to initiation of the secure transport; d. Criteria used for pickup and drop-off, including the circumstances that determine a secure transport client's eligibility; e. The level of support and protection needed for both client and staff safety; f. Compliance with vehicle safety standards and procedures; g. Proper evacuation of the vehicle during emergencies if the windows and/or exits of the vehicle are blocked or inaccessible; h. Infection protection and control, including the decontamination of the vehicle after each transport; i. Parental and/or guardian level of support and involvement; Page 4 Created on 12/28/22 j. Meeting client needs on extended transports including meals, water and bathroom breaks; and k. Documentation of all steps in the process from initial pickup request to drop-off, including but not limited to documenting all stops made during the secure transportation service. I. Payment of Secure Transportation Service license fee C. Secure Transportation Vehicle Permit Application Requirements. For secure transportation service vehicle permits, applicants must provide: 1. Completed permit application (one for each vehicle). 2. Certificate of Mechanical Inspection (to be completed by a qualified motor vehicle mechanic) (one for each vehicle). 3. Proof of motor vehicle insurance coverage with Pitkin County identified as certificate holder. 4. Proof of general liability and applicable professional liability insurance coverage, at a minimum: a. Liability insurance for injuries in the amount of $2,000,000 for each individual claim; b. Liability insurance in the amount of $5,000,000 for all claims made against the secure transportation service or against its personnel from an insurance company authorized to write liability insurance in Colorado; c. Liability insurance coverage to the maximum extent required by Section 2410-114, C.R.S., as applicable, if the secure transportation service is granted qualified immunity under the Colorado Governmental Immunity Act, Section 24-10-101, et.seq., C.R.S.; and d. Proof of any additional insurance as identified in county regulations. 5. Payment of Secure Transportation Service Vehicle permit fee 6. Completed Vehicle Inspection. The applicant shall schedule an appointment for a vehicle(s) inspection. D. Application Review. Once all documentation is completed and the vehicle inspections have been done, the applicant shall contact the Licensing Coordinator to schedule the application review. Upon completion of the application review, applications will be placed on the next available agenda for the Board of County Commissioners' (the "Board") final review and approval. Page 5 Created on 12/28/22 Upon Board review, the Licensing Coordinator will notify the applicant of the Board's findings and when/if the approved license and permit(s) will be available for pick-up. E. Fees. Pitkin County charges a non-refundable flat fee for the review and processing of secure transportation services licenses and vehicle permits, as set forth in the Pitkin County Fee Schedule, as amended from time to time. Payment of the total fee is required at the time of submitting the application(s). 6.05.050: COMPLAINT AND INVESTIGATION A. Origination of Complaints. Alleged violation of these rules by a licensed secure transportation service or of a secure transportation service operating in the County without a license, may be made in writing by any party and addressed to the Board, or by the Board on its own initiative. Any individual bringing a matter of medical competency to the Board shall waive the right of patient confidentiality as a condition of complaint submission and subsequent investigation. If any legal action is filed against a licensed secure transportation service in a court of the United States, the State of Colorado or any of its political subdivisions, the licensee shall notify the Board within ten (10) business days. A violation of these rules shall not be presumed based on the allegation. In the event that a judgment is entered against the licensee, the licensee shall file a copy of the findings of fact, conclusions of law and order of the court with the Board within ten (10) business days. If an action against a secure transportation service license is undertaken by another jurisdiction, the licensee shall notify the Board within ten (10) business days. A violation of these rules shall not be presumed based on the action. If the action results in a suspension or revocation of the secure transportation service license by another jurisdiction, the licensee shall file a copy of the record of the adverse action with the Board within ten (10) business days. B. Validation of Complaints. The Board, or its designee, shall complete an initial review of the complaint, judgment or adverse action within five (5) business days to determine if it constitutes a violation of these rules and has sufficient foundation to warrant a complete investigation. Any apparent violation of these rules having sufficient factual basis shall be fully investigated by the Board. Allegations of violations outside the purview of the Board shall be returned to the complainant for referral to the appropriate authority or jurisdiction. The Board shall notify the complainant in writing if the allegation lacks sufficient basis to warrant investigation. The Board shall notify the licensee in writing if a judgment or adverse action filed with the Board does not constitute a violation of these rules. C. Investigation of Complaints. The Board shall notify the complainant in writing that the allegation is sufficient to warrant a full investigation. Upon initiation of a full investigation, the Board shall notify the secure transportation service of the alleged violation in writing. The Board shall commence action against the secure transportation service or unlicensed secure transportation service if the allegation is determined to be a violation of these rules or, at its discretion, may provide a reasonable period for the licensee to cure any violation or to implement corrective measures to bring the licensee's business activities into conformance Page 6 Created on 12/28/22 with these rules before commencing action to suspend or revoke a license or permit. The Board may forego further hearing or action against the license or permit upon confirmation that the licensee has cured the violation and satisfied any conditions reasonably imposed by the Board. The Board shall notify the complainant in writing if an investigation determines that the allegation fails to constitute a violation of these rules or that the licensee has cured the violation. D. Notification: The County shall notify the Medical Director of the secure transportation service, in writing, of a violation of the licensing regulations by the secure transportation service or alleged complaints or violations by individual providers operating on a secure transportation service. If violations are found, the County shall enforce the Denial, Revocation or Suspension Procedures outlined in Section 6.05.060 of these rules. 6.05.060: DENIAL, REVOCATION OR SUSPENSION of licensure and/or vehicle permits A. Authority. The Board may, on its own initiative or upon written complaint made by any party temporarily suspend, suspend for a definite period, or revoke any license or permit issued pursuant to these rules upon a determination that a violation of these rules by a licensed secure transportation service has occurred. B. Temporary Suspension. Without prior notice to the licensee and upon determination that a violation that poses immediate threat to the public health, safety and welfare has occurred, the Board may temporarily suspend any license or permit. Such temporary suspension shall be effective upon delivery of written notice to the licensed secure transportation service by the Board. No temporary suspension shall be valid for more than thirty (30) days or until a final decision by the Board concerning suspension or revocation, whichever period is longer. Any written notice of temporary suspension shall also provide notice of the time, date and place of a hearing before the Board to consider the suspension or revocation of the license. Except upon written consent of the licensee, the hearing shall be held not more than ten (10) business days following the effective date of the temporary suspension. C. Suspension for Definite Period or Revocation of License. Following notice to the licensee and a public hearing at which the licensee shall be afforded an opportunity to be heard, the Board may suspend or revoke any license or permit. Any suspension or revocation shall require a finding by the Board of a violation of these rules based upon the evidence presented at the hearing. Suspension shall be for a specific and definite period of time not to exceed any remaining current license period. The County shall bear the burden of proof of a violation justifying any suspension or revocation of a license or permit. Issuance of a temporary suspension shall not be a prerequisite to the conduct of a hearing to consider the suspension or revocation of a license or permit. D. Hearings: All suspension or revocation hearings shall be open to the public and shall be conducted in accordance with the Colorado Open Meetings Act. The Board shall be authorized to administer oaths and issue subpoenas to require the attendance of witnesses and the production of papers, books, and records necessary to the determination of any issue at any hearing. Page 7 Created on 12/28/22 E. Notices. Any notice issued pursuant to these rules shall be made in writing and provided to the licensee at the address listed in the application for license. The Board shall use its best efforts to immediately notify in writing any communications center and notify within three (3) business days any first response agencies, local law enforcement agencies and medical facilities of any suspension or revocation. The Board may send notice to other counties, the Colorado Department of Public Health and Environment, Colorado Department of Regulatory Agencies, Colorado Department of Health Care Policy and Financing or other interested parties; provided, however, that such notice shall not entitle these parties to a right to participate in any hearing concerning suspension or revocation of a license. F. Surrender of License or Permit. Following receipt of a written notice of suspension or revocation, the licensee shall surrender and deliver its license and all secure transportation vehicle permits to the Board within forty-eight (48) hours. G. Application after Revocation. If a license is revoked, the secure transportation service licensee may not make a new application for a period of two (2) years from the date of revocation. 6.05.070: DATA COLLECTION AND REPORTING A. Data Collection Reporting. In accordance with 6 CCR 1011-4 Part (6), all secure transportation services in Colorado shall provide the Colorado Department of Public Health and Environment (CDPHE, the "Department") the required data and information in a form and manner determined by the Department. In addition, copies of data submitted to the Department for Pitkin County transports shall also be provided to the Licensing Coordinator in the same form and manner as submitted to the Department. B. Data Required. Beginning in 2024, all secure transportation services shall submit the specific data identified in 6 CCR 1011-4 Part (6.2) no later than March 1 for the previous calendar year. C. Reporting Serious Injury, Illness of Death. Any secure transport resulting in the serious injury, illness or death of a client or staff member during transport or resulting in injury to the client as a result of the use of physical restraint during transport shall be reported to the receiving facility immediately and to the County Licensing Coordinator (by phone or email) within twenty four (24) hours of the incident. Each report shall identify and describe the circumstances leading to the serious injury, illness or death of a client or staff member during transport. D. Secure Transportation Service Profile. The secure transportation service shall complete and submit to the Department a secure transportation service profile The profile content is identified in 6 CCR 1011-4 Part (6.4). 1. Secure transportation services shall update the profile data whenever changes occur and at least annually. 2. As part of the profile, a licensed ground ambulance agency shall notify the Department if it is providing secure transportation services under its ground ambulance license. If a secure transportation service fails to comply with the Page 8 Created on 12/28/22 Department's rules, the Department may report this lack of compliance to Pitkin County. 3. The Department may establish procedures to allow outside agencies, institutions, or individuals to obtain information from the secure transportation data system. 6.05.080: STAFFING REQUIREMENTS A. Manager and Administrator Qualification. Each applicable secure transportation service operating within Pitkin County must have a manager and administrator who meets the following minimum requirements: 1. Be at least twenty-one (21) years of age, possess a high school diploma or GED; and; a. Have at least one (1) year documented supervisory experience in the provision of secure transportation services; or b. Be qualified by education, knowledge, and experience to oversee the secure transportation services provided; 2. Be able to communicate, understand, and respond effectively to the client, family representatives, and other providers and be able to use appropriate translator services as needed; 3. Be familiar with all applicable local, state and federal laws and regulations concerning the operation and provision of secure transportation services; 4. Be in good standing with any state regulatory agency if the manager or administrator is licensed or certified with the Colorado Department of Regulatory Agencies or the Colorado Department of Public Health and Environment; and 5. Have passed a background check that was performed by the secure transportation service or owner prior to the assumption of responsibilities. The manager or administrator shall not conduct their own background check or any required follow-up. B. Administrator and Manager Responsibilities. Responsibilities for each position are identified in 6 CCR 1011 Part (7.2) and (7.3). The Administrator and the Manager may be the same person. Any changes regarding the manager or administrator of record must be provided to the Licensing Coordinator within fourteen (14) business days of the change. C. Staffing. Every secure transportation service's staffing requirement must include, at a minimum: Page 9 Created on 12/28/22 1. All drivers must possess a current and valid driver's license. 2. If a Type 1 (partitioned) vehicle is being used for the secure transport, then the following shall apply: a. A ratio of client to staff member shall be maintained during the transport; this staff member may also be the driver. If one (1) client is being transported, then one (I) staff member with a current and valid certification for all training topics is required to staff a vehicle permitted for each secure transport. If more than one client is being transported, then one (I) staff member who possesses a current and valid certification for all training topics is required to accompany each individual client during transport. 3. If a Type 2 (non -partitioned) vehicle is being used for the secure transport, then the following shall apply: a. A 1:1 ratio of client to staff member shall be maintained during the transport, in addition to the driver who is not included in this staffing ratio requirement. If one (1) client is being transported, then two (2) staff members are required to staff the vehicle. At minimum, the staff member who is not the driver will have a current and valid certification for all training topics. D. Background Check. Each secure transportation service must have a policy in - place related to background checks for all staff members. Such background checks shall take place prior to an individual providing secure transportation services. The policy shall include, at a minimum: 1. The secure transportation service's responsibility to conduct a background check on every existing and prospective staff member. a. If any background check reveals prior convictions of a violent, fraudulent, or abusive nature, the manager or administrator shall inquire further to determine the potential impact on client safety in accordance with the policies developed by the secure transportation service. 2. If an individual is hired despite a background check that reveals a prior conviction of a violent, fraudulent, or abusive nature, the manager or administrator shall document the reasons for hire and plans for supervision. E. Staff Training. All staff must be complete the minimum training requirements prior to providing secure transportation services, and annually thereafter, or as recommended by the relevant training organizations. The secure transport service shall record and document each staff member's compliance with these orientation and annual training requirements and shall make them available to the county(ies) upon request. The minimum staff training requirements include: 1. Cultural competencies including, but not limited to, supporting persons with Page 10 Created on 12/28/22 physical or cognitive disabilities, language accessibility, and accessing interpretive services; 2. In -person or online verbal de-escalation training sessions that prioritize client and staff safety and inform restraint requirements set forth in 6 CCR 1011-4 Part (8.3); 3. Trauma -informed care principles; 4. Evade and escape violent encounter strategies; 5. Internal policies and procedures applicable to the secure transportation service and staff, including, but not limited to the staff disciplinary policy; 6. Client rights; and 7. Compliance with applicable privacy laws. 8. Each secure transportation service must have additional training for staff with direct client contact and achieve core competencies in the following: a. Adult and Youth Mental Health First Aid as offered by educational institutions or by professional organizations such as mentalhealthfirstaid.org, or the equivalent; b. Basic First Aid and CPR: and; c. Care of clients with substance use disorders. 9. Staff members who may utilize physical restraint must also complete training and achieve core competencies in the following: a. Circumstances and protocols governing the permissible application of individual physical restraint during secure transport; and b. Safe application of individual physical restraint on clients during secure transport. 6.05.090: CLINICAL, MEDICAL AND OPERATING STANDARDS AND PROCEDURES A. Parameters for Secure Transportation. Secure transport clients shall only be transported under the following circumstances: 1. The client is experiencing a behavioral health crisis. 2. The client is in need of urgent transportation to a facility that is defined in 6 CCR 101 1-4 Part (2.22)(C). Page 11 Created on 12/28/22 3. The client does not and will not need either: a. Medical treatment during transport, or b. Active or ongoing medical monitoring. 4. The client does not and will not need to be chemically restrained during secure transport as a behavioral intervention. B. Policies and Procedures. 1. The County requires all secure transportation services have policies and procedures that follow national best practice guidelines where available, that address, at a minimum, the items listed in 4 CCR 1101 Part (8.2) (A). 2. In addition, the County requires all Class A secure transportation services have the following: a. The circumstances under which staff who provide direct client support may apply individual physical restraint during the course of the secure transportation service, given the parameters outlined in the section on Restraint (below), and b. The application of individual physical restraint, including training protocols and safety precautions, to ensure the restraints do not restrict the client's airway or breathing ability. C. Restraint. 1. Chemical Restraint. No chemical restraint shall be administered during a secure transport. If chemical restraint is needed to ensure client safety, then the client shall receive an ambulance transport. 2. Physical restraint. Physical restraint as defined in 6 CCR 1011-4 Part (2.21), shall only be utilized for health and safety purposes under the following conditions: a. In cases of emergency, when the client is at risk of causing serious, probable and imminent threat of bodily harm to themselves or to others and when there is the present ability to affect such bodily harm; and b. After the failure of less restrictive alternatives, including verbal de- escalation; or c. After a determination that such alternatives would be inappropriate or ineffective under the circumstances. Page 12 Created on 12/28/22 3. If physical restraint is utilized during a transport, the service shall document the time at which the physical restraint was applied and removed (if applicable) and the type of physical restraint used. D. Transportation Procedures: 1. Transport Protocols. The secure transportation service shall transport one (1) client per vehicle transport, except under the following circumstances: a. Each client has received behavioral health clearance from the treating provider at the sending facility, no physical restraint is needed, and there is a low probability of behavioral destabilization; b. Each client has received medical clearance from the treating provider at the sending facility, is medically stabilized, and has a low probability of medical destabilization; c. Each client has received an assessment from the treating provider at the sending facility that the client is an appropriate candidate for a transport with one or more individuals; d. The transport is an inter -facility transport as defined at 6 CCR 1011-4 Part (2.22)(C); and e. Each client has given their consent to be transported with another individual. 2. Records and Logs. The secure transportation service shall create and maintain accurate and detailed logs of client transports, including professional incident reports. 3. After-hours Contact. To ensure the needs of clients are met, secure transportation services that do not provide 24/7 services shall provide the client with their after-hours contact information and with contract information for the secure transportation service's back-up providers. 6.05.100: CLIENT RIGHTS A. Client Rights Requirements. Every secure transportation service must have written client rights that assure a client has the right to be treated with consideration, respect, and full recognition of human dignity and individuality, and that includes, at a minimum: 1. The right of the client and their property to be treated with respect. 2. The right of the client to have access to basic comfort items and their personal mobile phone provided the direct client support staff member establishes and documents that those items do not pose a danger to the client or staff member. Page 13 Created on 12/28/22 3. The right of the client to wear their own clothes provided the direct client support staff member establishes and documents that those items do not pose a danger to the client or staff member. 4. The right of the client to receive secure transportation services by the least restrictive means necessary to assure the safety of the client. 5. The right of the client to be free from discrimination in the provision of services. 6. The right of the client to be free from neglect; financial exploitation; and verbal, physical, and psychological abuse, including humiliation, intimidation, or punishment. 7. For clients who request voluntary transport, the right of the client to discontinue secure transportation services. 8. The right of the client to receive disclosure about any video and/or audio recording that occurs during the delivery of service in accordance with applicable privacy laws. 9. The right of the client to have personally identifying health information protected from unnecessary disclosure. 10. The right of the client or their representative to file a complaint against the secure transportation service with the secure transportation service and County concerning services or care that is or is not furnished and receive documentation of the existence of the investigation and resolution of the complaint, including providing the complainant with the results of the investigation, and the secure transportation service's plan to resolve any identified issues. 11. The right of the client to file a complaint with the secure transportation service and County without fear of discrimination or retaliation by the secure transportation service's owner, manager, administrator or any staff member. B. Policies and Procedures. Every secure transportation service must have client's rights policies and procedures, that include, at a minimum: 1. Procedures for identifying, reporting, reviewing, and investigating all allegations of abuse, mistreatment, neglect and exploitation. 2. Procedures for timely communicating all investigation results to the client and County in which the secure transportation service is licensed. 3. Procedures for timely and appropriate disciplinary action up to and including termination of staff and appropriate legal recourse against any staff member who has engaged in abuse, mistreatment, neglect or exploitation of a client. Page 14 Created on 12/28/22 4. Procedures that direct client support staff members must follow, to document their decision to withhold any basic comfort items and/or the client's personal mobile phone or prohibit a client from wearing their own clothes. C. Delivery of Client's Rights and Policies and Procedures. Every secure transportation service shall provide written documentation of client rights and client rights' policies and procedures, including the right to file a complaint with the county, to clients at the initiation of the secure transportation service. If the client is unable to read the rights, they shall be read the rights in a language they understand. 6.05.110: QUALITY MANAGEMENT PROGRAM (QMP) Each secure transportation service operating within Pitkin County must have an ongoing Quality Management Program ("QMP") that is appropriate to the size and type of the service. The secure transportation service shall make available the QMP program to Pitkin County during the initial and renewal license applications. A. QMP Program Requirements: The QMP program shall incorporate a plan that evaluates the quality of client care and safety and has the following policies and procedures including, at a minimum, the items identified in 6 CCR 1011-4 Part (10.1). B. Regulatory Agency Access. Pitkin County, the Colorado Department of Public Health and Environment (the "Department"), or any other appropriate regulatory agency having jurisdiction for disciplinary or licensing sanctions shall have access to any records, reports, and other information of the quality management program. Page 15 Created on 12/28/22