BILL ANALYSIS Ó
AB 210
Page 1
ASSEMBLY THIRD READING
AB 210 (Solorio)
As Amended May 27, 2011
Majority vote
HEALTH 14-5 APPROPRIATIONS 12-5
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|Ayes:|Monning, Ammiano, Atkins, |Ayes:|Fuentes, Blumenfield, |
| |Bonilla, Eng, Gordon, | |Bradford, Charles |
| |Hayashi, | |Calderon, Campos, Davis, |
| |Roger Hernández, Bonnie | |Gatto, Hall, Hill, Lara, |
| |Lowenthal, Mitchell, | |Mitchell, Solorio |
| |Nestande, Pan, | | |
| |V. Manuel Pérez, Williams | | |
| | | | |
|-----+--------------------------+-----+--------------------------|
|Nays:|Logue, Garrick, Mansoor, |Nays:|Harkey, Donnelly, |
| |Silva, Smyth | |Nielsen, Norby, Wagner |
| | | | |
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SUMMARY : Revises existing statute relating to the role of city,
county or fire districts with regard to prehospital emergency
medical services (EMS). Specifically, this bill :
1)Requires that a local emergency medical services agency
(LEMSA) grant to a city, county or fire district that has been
continuously providing prehospital EMS since June 1, 1980, and
has not entered into an agreement with the LEMSA,
authorization to provide the same services or an exclusive
operating area.
2)Repeals the existing provision similar to 1) above and
requires the EMS provider granted exclusive rights to enter
into an agreement by December 31, 2013. Provides that this
bill shall not be construed to affect, limit, or otherwise
invalidate any decision by any court that has interpreted the
section.
3)Defines "prehospital EMS provider" as 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.
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4)Requires a LEMSA to include all prehospital EMS providers in
its local EMS plans.
5)Requires all prehospital EMS providers to be subject to the
medical control of the LEMSA and to comply with LEMSA policies
and procedures regarding administration of the local EMS
system.
6)Requires the membership of a county-established emergency
medical care committee to be representative of the EMS
participants.
7)States legislative findings with regard to EMS system
coordination as follows:
a) That all providers must be guided by consistent, clear
standards regarding their rights, responsibilities, and
duties arising out of the provision of prehospital
emergency medical care;
b) Local agencies must be guided by and responsive to
reasonable and consistent standards for evaluating the
scope, manner and types of services within their respective
jurisdictions, particularly with respect to exclusive
operating areas and states that over 20 years of litigation
magnifies the need for further statutory guidance;
c) 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) Cities, fire districts, private providers and local EMS
agencies are vital partners in the delivery of prehospital
EMS services, partners that all contribute to a rapid
deployment of highly trained EMS personnel, that 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, that a city or
fire district that retains and carries out prehospital
emergency medical service is a reflection of the will of
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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;
e) It is in the public interest to ensure that all agencies
providing pre-hospital EMS services do so within a
coordinated EMS system that provides clear standards for
training, certification, and licensure of personnel as well
as for medical control and clinical oversight;
f) 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 EMS, 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
emergency response duties to their constituents;
g) 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 their own prehosptial
emergency medical services as part of a coordinated EMS
system, rather than relying on the absence of an agreement,
best serves all agencies who seek to work cooperatively to
provide quality patient care at the highest level; and,
h) Those cities and fire districts currently providing
emergency medical dispatch, first responder or transport
services at a level not less then what they provided since
June 1, 1980, shall be recognized through a written
agreement with the LEMSA as an authorized service provider
within the local EMS system. Said services must be
acknowledged as part of any agreement with the LEMSA and
this authorization shall be in perpetuity and not be
subject to a competitive bidding process that would
otherwise be impacted in a manner that reduces or increases
the recognized service area. Recognized providers will
participate in medical control and adhere to standardized
licensure, certification and training standards, while also
serving as EMS system participants working in a coordinated
manner as part of the EMS plan.
AB 210
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FISCAL EFFECT : According to the Assembly Appropriations
Committee, negligible direct state impact.
COMMENTS : According to the author, in the last three decades
since the enactment of the EMS Act and particularly the
enactment of the provisions relating to prehospital EMS
agreements that allow for exclusive operating areas, the
practice of prehospital medicine has witnessed significant
changes and growth, thereby making it increasingly more
important for a coordinated EMS system that worked to provide
the best possible emergency medical care. The author states
that it has become more common for EMS transportation providers
to function without entering into a written agreement with their
respective LEMSA. The author argues that this has created
confusion in determining which EMS providers are required to
maintain services in certain areas.
The Emergency Medical Services System and Prehospital Emergency
Care Personnel Act ÝSB 125 (Garamendi), Chapter 1260, Statutes
of 1980] creates a two-tiered system of regulation. At the
state level, the California Emergency Medical Services Authority
(EMSA) performs a number of different functions relating to the
coordination of EMS throughout the state including leadership
for the planning, development, and implementation of local EMS
systems. These include assessing each EMS area to determine the
need for additional services, coordination and effectiveness of
EMS. EMSA also reviews EMS plans submitted by a LEMSA to
determine whether the plan effectively meets the needs of the
persons served and are consistent with coordinating activities
in the geographical area served as well as with the guidelines
and regulations established by EMSA. LEMSAs occupy the second
tier of governance under the EMS Act. California has 31 local
EMS systems that are providing EMS for California's 58 counties.
Seven regional EMS systems comprised of 34 counties and 24
single county agencies provide the services. Regional systems
are usually comprised of small, more rural, less-populated
counties and single-county systems generally exist in the larger
and more urban counties. LEMSAs are required to develop a
formal plan for the system in accordance with the EMSA's
guidelines and submit the plan to EMSA annually. The EMS Act
also provides that medical direction and management of an EMS
system is under the medical control of the Medical Director of
the LEMSA.
AB 210
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The EMS Act included a provision that "grandfathered" the
administration of prehospital EMS by cities and fire districts
as of June 1, 1980, and required these rights to be retained
until there is a written agreement regarding the provision of
the services between the LEMSA and the city or fire district,
(referred to as Section 201 rights or administrative control).
This bill repeals and recasts these provisions. In 1984, the
EMS Act was amended for the purpose of authorizing LEMSAs to
grant exclusive operating areas (EOAs) to private EMS providers
such as ambulance companies (referred to as Section 224).
According to the California Supreme Court, ÝCounty of San
Bernardino v. City of San Bernardino (1997) 15 Cal. 4th 909]
such authorization was necessary to immunize the agencies from
liability under a then recent United States Supreme Court's
decision holding that local governments granting monopolies
would not be exempt from federal antitrust laws unless they
acted pursuant to clearly articulated and affirmatively
expressed state policy. AB 3153 (Bronzan), Chapter 1349,
Statutes of 1984, provides that a LEMSA which elects to create
one or more exclusive operating areas must develop and submit to
EMSA for approval, as part of the local plan, its competitive
process for selecting providers. AB 210 (Solorio) deletes the
provision that was included in AB 3153 (Bronzan) stating that it
was not intended to supersede the Section 201 rights.
Section 201 and Section 224 have been the source of friction
between the fire-based providers and LEMSAs, at times resulting
in litigation. The California Supreme Court first ruled on the
respective roles of counties, the LEMSAs, cities and fire
districts in the 1997 San Bernardino case. That case arose from
a dispute between the City of San Bernardino and the LEMSA over
who controlled the dispatch of prehospital emergency paramedics
and ambulance services. The court ruled that the City had
Section 201 rights to continue to administer its own prehospital
EMS, but not to provide ambulance services that it was not
providing prior to the June 1980 "grandfather" date. The Court
also ruled that even the City's administrative control was
limited by the LEMSAs medical control authority which included
the power to issue protocols regarding dispatch and patient
management. In order to resolve this dispute, the Court
conducted an extensive review of the legislative history as well
as a detailed analysis of the meaning of nearly every phrase.
To help resolve the longstanding disputes regarding these
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issues, EMSA hosted a one-day stakeholder workshop in May 2010.
The Commission on EMS also established a subcommittee to
evaluate these issues. In December 2010, the subcommittee
submitted a report and recommendations which were intended to
serve as a road map for further action for EMSA and the EMS
community at large. In response, EMSA convened a task force
consisting of EMS constituents with knowledge of these issues.
The task force has been meeting on a bi-weekly basis since late
January 2011, and is developing a draft set of regulations and
possible statutory changes to address the same issues this bill
is seeking to address. According to the December 2010
subcommittee report, the regulatory package and recommended
statutory framework were to be considered at the June 2011
Commission meeting, but has been delayed to September 2011. The
language in this bill reflects the stakeholder input, however
not all of the stakeholders are in agreement.
Analysis Prepared by : Marjorie Swartz / HEALTH / (916)
319-2097
FN: 0001076