I'm not suggesting that laws should be passed that work this way within a framework that assumes they don't. The solution to a mountain of bad code is not to add another layer that tries to make huge changes; it's to rearchitect. I also understand that this isn't going to happen in a large existing system like the US; I think it's a better way, but there's no easy, incremental path from here to there.

As for your hypothetical: In this system, since the vast majority of penalties would be monetary, or have monetary equivalents, and since the entire damage is (supposed to be) captured by the penalty, ambulance companies would come up with their own rules under which they would pay fines on behalf of their drivers, contractually. The market could then correct via abuse of those rules by the driver, or refusal of drivers to work for that ambulance company, depending on which way the rules erred.