BILL NUMBER: AB 210 AMENDED
BILL TEXT
AMENDED IN SENATE JUNE 29, 2011
AMENDED IN ASSEMBLY JUNE 1, 2011
AMENDED IN ASSEMBLY MAY 27, 2011
AMENDED IN ASSEMBLY APRIL 4, 2011
INTRODUCED BY Assembly Member Solorio
JANUARY 31, 2011
An act to amend Sections 1797.224 and 1797.270 of, to add
Sections 1797.95 and 1797.225 to, and to repeal Section 1797.201 of,
the Health 1797.85, 1797.224, 1797.270, 1797.274, and
1797.276 of, and to repeal and add Section 1797.201 of, the Health
and Safety Code, relating to emergency medical services.
LEGISLATIVE COUNSEL'S DIGEST
AB 210, as amended, Solorio. Emergency medical services.
(1) Existing law establishes the Emergency Medical Services System
and the Prehospital Emergency Medical Care Personnel Act, which
governs local emergency medical service systems and establishes the
Emergency Medical Services Authority, which is responsible for the
coordination and integration of all state activities concerning
emergency medical services. The act requires a county to enter into a
written agreement with a city or fire district that contracted for,
or provided, as of June 1, 1980, prehospital emergency medical
services regarding the provision of these services for the city or
fire district, as specified. The act requires, until an agreement is
reached, prehospital emergency medical services to be continued at
not less than the existing level, unless reduced by the city council
or the governing body of the fire district, as specified.
This bill would repeal these requirements
continue the authorization of a city or fire district that had
continuously contracted for or provided prehospital emergency medical
services (EMS) since June 1, 1980, to contract for or pr
ovide, with operational control, the same category of prehospital EMS
that it has continuously provided during that time, within the
geographical service area that it continuously served during that
time, if the city or fire district makes a formal written request to
the local EMS agency prior to January 1, 2014, and if specified
conditions are met . The bill would revise the definition
of exclusive operating area for this purpose to delete providers of
limited advanced life support on advanced life support.
(2) The act authorizes a local EMS agency to create one or more
exclusive operating areas in the development of a local plan, as
specified, and requires a local EMS agency that creates an exclusive
operating area in its local plan to develop and submit the local EMS
agency's competitive process for selecting providers and determining
the scope of their operations to the authority.
This bill would require authorize a
local EMS agency to grant an one or more
exclusive operating area or authorization to provide
the same prehospital emergency medical services to a city, county,
fire district, or other governmental entity that has continuously
contracted for, or provided, these services since June 1, 1980, if
this prehospital EMS provider has not entered into an agreement with
the local EMS agency to provide prehospital emergency medical
services for a city, county, or fire district. It would require a
prehospital EMS provider, as defined, granted an exclusive operating
area or authorization to provide prehospital emergency medical
services to enter into a written agreement with the local EMS agency
by December 31, 2013. It would also require prehospital EMS providers
to be subject to the medical control of the local EMS agency and
comply with local EMS agency policies and procedures regarding
administration of the local EMS system areas for
emergency ambulance services, interfacility transport, or both, in
the development of the local plan .
(3) The EMS act authorizes the establishment of an emergency
medical care committee in each county and requires the committee to
annually review ambulance services operating within the county,
emergency medical care offered within the county, and first aid
practices in the county. The act also requires the committee to
report its observations and recommendations relative to this review
to the authority and the local EMS agency.
This bill would , instead, require the committee to review
the county's emergency medical system. The bill would require
the membership of an emergency medical care committee in each county
to be representative of the EMS system participants.
(4) By increasing the duties of local officials, this bill would
impose a state-mandated local program.
(5) The California Constitution requires the state to reimburse
local agencies and school districts for certain costs mandated by the
state. Statutory provisions establish procedures for making that
reimbursement.
This bill would provide that, if the Commission on State Mandates
determines that the bill contains costs mandated by the state,
reimbursement for those costs shall be made pursuant to these
statutory provisions.
Vote: majority. Appropriation: no. Fiscal committee: yes.
State-mandated local program: yes.
THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:
SECTION 1. The Legislature finds and declares all of the
following:
(a) Emergency medical services (EMS) system coordination remains
the key factor in efficiently delivering the highest level of
prehospital patient care and emergency medical transport.
(b) All providers and stakeholders
prehospital EMS providers in the EMS delivery system must be
guided by consistent, clear standards regarding their rights,
responsibilities, and duties arising out of the provision of
prehospital emergency medical care services
to their respective communities.
(c) Agencies Local EMS agencies
responsible for developing and maintaining a local emergency medical
services plan must be guided by and responsive to reasonable and
consistent standards for evaluating and determining the scope,
manner, and types of services provided within their respective
jurisdictions, particularly when making determinations regarding
exclusive operating areas , as set forth in Sections 1797.85 and
1797.224, and the concomitant rights of cities and fire
districts that have provided prehospital emergency medical services
at not less than the existing level since June 1, 1980.
(d) As of January 1, 2012, all emergency medical services
personnel, regardless of local agency or private employer, are
subject to the same training, certification, and licensing standards,
and coordinate in the same manner with the base hospital in the
provision of prehospital EMS services.
(d) It is the intent of the act adding this subdivision to
preserve the rights of cities and fire districts as set forth in
Section 1797.201, as that section read on December 31, 2011, and the
authority of the local EMS agencies to grant exclusive operating
areas pursuant to Section 1797.224 as that section read on December
31, 2011, and to align those rights and authority.
(e) Cities, fire districts, private providers, and local EMS
agencies are vital partners in the delivery of prehospital EMS
services , partners that contribute to a rapid
deployment of highly trained EMS personnel.
(f) Cities and fire districts remain a fundamental partner in
assisting the county in its duty to provide emergency ambulance
services for all residents of that county.
(g) A city or fire district that retains and carries out
prehospital emergency medical service is a reflection of the will of
that jurisdiction's constituents, as it is the local taxpayers who
must pay to maintain the chosen level of service or any increase in
the level of that service.
(h)
(f) It is in the public interest to ensure that all
agencies providing prehospital EMS services do so
within a coordinated EMS system that provides clear standards for
training, certification, and licensure of personnel, as well as for
administration, medical control , and clinical
oversight.
(i) Guided by findings of the courts over the past two decades,
without altering or otherwise affecting the status of a city or fire
district that has historically provided prehospital emergency medical
services, it is further the intent of the Legislature to lend
greater clarity to the rights and responsibilities of a city, county,
fire district, private provider, and local EMS agency with respect
to their respective emergency response duties to their constituents.
(j) Establishing an agreement between a city or fire district and
its respective local EMS agency to codify the existing authority of
that city or fire district to continue the administration of its own
prehospital emergency medical services as part of a coordinated EMS
system, rather than relying on the absence of an agreement, best
serves all agencies that seek to work cooperatively to provide
quality patient care at the highest level.
(k) It is imperative that those cities and fire districts
providing, as of January 1, 2012, services in the categories of
dispatch of their own resources, first responder, or transport at a
level not less than what they provided continuously within the same
category since June 1, 1980, be recognized through a written
agreement with the local emergency medical services agency (LEMSA) as
an authorized service provider within the local EMS system.
(l) Over 20 years of litigation magnifies the need for further
statutory guidance to ensure that the California EMS community
continues its focus on its primary mission, providing excellent care
to the citizens they serve.
SEC. 2. Section 1797.95 is added to the Health
and Safety Code, to read:
1797.95. "Prehospital EMS provider" means a city, county, fire
district, or other governmental entity or private entity that
provides first response services at the limited advanced life support
or advanced life support level or provides emergency ambulance
services or dispatches EMS resources.
SEC. 2. Section 1797.85 of the Health
and Safety Code is amended to read:
1797.85. "Exclusive operating area" means an EMS area or subarea
defined by the emergency medical services plan for which a local EMS
agency, upon the recommendation of a county, restricts operations to
one or more emergency ambulance services or providers of
limited advanced life support or advanced life support .
SEC. 3. Section 1797.201 of the Health and Safety Code is
repealed.
SEC. 4. Section 1797.201 is added to the
Health and Safety Code , to read:
1797.201. (a) A city or fire district that has continuously
contracted for or provided prehospital emergency medical services
(EMS) since June 1, 1980, shall have continuing authorization to
contract for or provide, with operational control, the same category
of prehospital EMS that is has continuously provided during that
time, within the geographical service area that it continuously
served during that time, if the city or fire district makes a formal
written request for recognition to the local EMS agency prior to
January 1, 2014, and if the following conditions are met:
(1) The city or fire district has not previously entered into a
prehospital EMS administration agreement. A "prehospital EMS
administration agreement" means an agreement entered into between a
city or fire district and a local EMS agency in which the city or
fire district agreed to have their prehospital EMS administered by
the local EMS agency. An agreement, other than an agreement described
in this paragraph, previously entered into between a local EMS
agency and a city or fire district where the city or fire district
agreed to adhere to that local EMS agency's medical control policies
and procedures shall not constitute a prehospital EMS administration
agreement.
(2) The city or fire district enters into a written agreement with
the local EMS agency, in a form specified by the local EMS agency,
addressing only the following:
(A) Medical control including policies, protocols, emergency
medical dispatch protocols, and quality improvement.
(B) Coordination of EMS resources.
(C) Recognition of the category of prehospital EMS that the city
or fire district is authorized to perform.
(D) Designation of the geographical service area for which
authorization is granted.
(b) If the city or fire district fails to enter into an agreement
with the local EMS agency by January 1, 2014, or has failed to
commence an appeal, then the city or fire district shall not perform
or contract for that category of prehospital EMS unless formally
authorized to do so by the local EMS agency in accordance with the
requirements of this division. Appeals shall proceed in the following
order: local Emergency Medical Care Committee or its equivalent, the
governing body of the local EMS agency, and then judicial review.
The standard of review on the appeal shall be de novo.
(c) A city or fire district that has not continuously performed,
or contracted for, a category of prehospital EMS since June 1, 1980,
shall not perform or contract for that category or prehospital EMS
unless formally authorized to do so by the local EMS agency in
accordance with the requirements of this division.
(d) A local EMS agency shall include all prehospital EMS providers
who comply with the requirements of this division in its local
emergency medical services plan.
(e) For purposes of this division, "category of prehospital EMS"
shall include only one or more of the following:
(1) First response, which means the delivery of prehospital EMS
without patient transport.
(2) Dispatch, which means dispatch of a provider's own or
contracted prehospital EMS resources.
(3) 911 ambulance transport service, which means ambulance service
provided in response to a 911 call or, as determined by the local
EMS agency, an emergency call to a 7 digit number.
(4) Interfacility ambulance service, which means ambulance
transport, other than 911 ambulance service, between health
facilities or between a patient's residence and a health facility.
(f) All prehospital EMS providers shall be subject to medical
control by the local EMS agency, including, but not limited to, those
pursuant to Chapter 5 (commencing with Section 1798), and shall
comply with local EMS agency policies and procedures regarding the
delivery of prehospital emergency medical services.
(g) Nothing in this section shall preclude a prehospital EMS
provider from increasing the level of service it provides within a
category for which it has continuously provided service since June 1,
1980.
(h) Nothing in this section shall be construed as permitting a
prehospital EMS provider from adding a new category of service that
it has not provided continuously since June 1, 1980.
SEC. 4. SEC. 5. Section 1797.224 of
the Health and Safety Code is amended to read:
1797.224. A local EMS agency may create one or more exclusive
operating areas for emergency ambulance services or
interfacility transport, or both, in the development of a local
plan, if a competitive process is utilized to select the provider or
providers of the services pursuant to the plan. No competitive
process is required if the local EMS agency develops or implements a
local plan that continues the use of existing providers operating
within a local EMS area in the manner and scope in which the services
have been provided without interruption since January 1, 1981. A
local EMS agency which elects to create one or more exclusive
operating areas in the development of a local plan shall develop and
submit for approval to the authority, as part of the local EMS plan,
its competitive process for selecting providers and determining the
scope of their operations. This plan shall include provisions for a
competitive process held at periodic intervals as determined by
the local EMS agency .
SEC. 5. Section 1797.225 is added to the Health
and Safety Code, to read:
1797.225. (a) A local EMS agency shall grant to a city, county,
fire district, or other governmental entity that has continuously
contracted for, or provided prehospital emergency medical services
since June 1, 1980, an exclusive operating area or authorization to
provide the same prehospital emergency medical services if this
prehospital EMS provider has not already entered into an agreement
with the local EMS agency to provide prehospital emergency medical
services for a city, county, or fire district. The prehospital EMS
provider granted an exclusive operating area or authorization to
provide prehospital emergency medical services shall enter into a
written agreement with the local EMS agency by December 31, 2013.
(b) A local EMS agency shall include all prehospital EMS providers
in its local emergency medical services plans.
(c) Prehospital EMS providers shall be subject to medical control
by the local EMS agency, including, but not limited to, pursuant to
Chapter 5 (commencing with Section 1798), and shall comply with local
EMS agency policies and procedures regarding the administration of
the local EMS system.
SEC. 6. Section 1797.270 of the Health and Safety Code is amended
to read:
1797.270. An emergency medical care committee may be established
in each county in this state. The committee membership shall be
representative of the EMS system participants. Nothing in this
division should be construed to prevent two or more adjacent counties
from establishing a single committee for review of emergency medical
care in these counties.
SEC. 7. Section 1797.274 of the Health
and Safety Code is amended to read:
1797.274. The emergency medical care committee shall, at least
annually, review the operations of each of the following:
county's emergency medical system.
(a) Ambulance services operating within the county.
(b) Emergency medical care offered within the county, including
programs for training large numbers of people in cardiopulmonary
resuscitation and lifesaving first aid techniques.
(c) First aid practices in the county.
SEC. 8. Section 1797.276 of the Health
and Safety Code is amended to read:
1797.276. Every emergency medical care committee shall, at least
annually, report to the authority, and the local EMS agency its
observations and recommendations relative to its review of the
ambulance services, emergency medical care, and first aid
practices, and programs for training people in cardiopulmonary
resuscitation and lifesaving first aid techniques, and public
participation in such programs in that county county's
emergency medical system . The emergency medical care
committee shall submit its observations and recommendations to the
county board or boards of supervisors which it serves and
shall act in an advisory capacity to the county board or boards of
supervisors which it serves, and to the local EMS agency,
on all matters relating to emergency medical services as
directed by the board or boards of supervisors .
SEC. 7. SEC. 9. This act, which
adds Section 1797.225 to, and repeals repeals
and adds Section 1797.201 of , the Health
and Safety Code, shall not be construed to affect, limit, or
otherwise invalidate any decision by a court of competent
jurisdiction that interprets and applies Section 1797.201
Division 2.5 (commencing with Section 1797) of
the Health and Safety Code, as that section
division read on December 31, 2011.
SEC. 8. SEC. 10. If the Commission
on State Mandates determines that this act contains costs mandated by
the state, reimbursement to local agencies and school districts for
those costs shall be made pursuant to Part 7 (commencing with Section
17500) of Division 4 of Title 2 of the Government Code.