BILL ANALYSIS Ó
AB 412
Page 1
Date of Hearing: April 26, 2011
ASSEMBLY COMMITTEE ON HEALTH
William W. Monning, Chair
AB 412 (Williams) - As Amended: March 14, 2011
SUBJECT : Emergency medical services.
SUMMARY : Enacts, for the County of Santa Barbara only, a
penalty of $5 for every $10 in base fines imposed on criminal
offenses and certain vehicle code offenses and provides that the
amount collected is to be deposited in a county established
Maddy Emergency Medical Services (EMS) Fund. Specifically, this
bill :
1)Establishes, in Santa Barbara County, a penalty of $5 for
every $10 to be imposed on fines, penalties, and forfeitures
collected for all criminal offenses and those vehicle code
offenses related to driving under the influence.
2)Requires the proceeds of the penalty assessment to be payable
in the same manner as funds in a county Maddy EMS Fund.
3)Conditions implementation of this bill upon adoption of a
resolution of necessity by the County Board of Supervisors.
4)Requires the Santa Barbara Board of Supervisors to report to
the Legislature on the actions taken to implement alternative
local sources of funding.
5)Exempts restitution fines, specified penalties, and parking
offenses from imposition of the additional penalty
calculation.
EXISTING LAW :
1)Authorizes a county to establish a Maddy EMS Fund and
specifies a distribution formula for the penalty assessment
funds money deposited into a Maddy EMS Fund including
reimbursement to physicians and hospitals for patients who do
not make payment for services, pediatric trauma centers,
administrative expenses and other local EMS purposes.
2)Establishes a State Penalty Assessment of $10 for every $10 on
every fine, penalty, or forfeiture. Of the funds collected,
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70% goes to the state and 30% remains with the county. The
state portion is distributed to the Fish and Game Preservation
Fund, the Restitution Fund, the Peace Officers Training Fund,
the Driver Training Penalty Assessment Fund, the Corrections
Training Fund, the Local Public Prosecutors and Public
Defenders Fund, the Victim-Witness Assistance Fund, and the
Traumatic Brain Injury Fund.
3)Establishes a County Penalty Assessment (CPA) of $7 for every
$10 on every fine, penalty, or forfeiture imposed and
collected. The proceeds are distributed to funds established
by the county board of supervisors: including a Courthouse
Construction Fund, Criminal Justice Facilities Construction
Fund, Automated Fingerprint Identification Fund, Maddy EMS
Fund, and, DNA Fund.
4)Establishes a State Surcharge of 20% on every base fine
collected by the court, deposited in the General Fund.
5)Establishes a State Court Facilities Construction Penalty
Assessment of up to $5 for every $10 or fraction thereof, upon
every fine, penalty or forfeiture collected by the courts for
criminal offenses.
6)Establishes a Court Security Fee of $40 on every conviction
for a criminal offense for court security.
7)Establishes a levy of a $4 penalty assessment on every $10 in
fines and forfeitures resulting from criminal and traffic
offenses for state and local governments for DNA databank
implementation purposes.
8)Establishes an additional $35 Conviction Assessment for the
existing State Court Facilities Construction Fund on every
criminal infraction, including traffic offenses,
9)Establishes an additional EMS Penalty Assessment of $2 for
every $10 on every fine, penalty, forfeiture or criminal
offenses and all offenses dealing with the Vehicle Code except
parking offenses for local Maddy EMS Funds.
10)Establishes a $4 Emergency Medical Services Penalty
Assessment to fund Emergency Air Medical Transportation
Services.
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FISCAL EFFECT : This bill has not been analyzed by a fiscal
committee.
COMMENTS :
1)PURPOSE OF THIS BILL . According to the author, this bill is
necessary to reenact the authorization for Santa Barbara
County to impose an additional penalty of $5 for every $10 in
base fines collected for all criminal offenses and five
specific vehicle code violations relating to driving under the
influence that expired on January 1, 2011 to provide funding
to the Maddy EMS Fund. The author points out that this bill
reestablishes this source of funding that aided Santa Barbara
to expand access to the uninsured and underinsured who seek
care through emergency rooms and trauma centers. The author
argues that in 2005, there were 61,500 emergency department
(ED) visits in Santa Barbara County, and of those, 62% of
patients were uninsured or underinsured. According to the
author, the number of uninsured individuals in Santa Barbara
County tripled between 1981 and 2009 (from 7% to 28%). The
author states that at the time of the enactment of the penalty
assessment intended as the Maddy EMS Fund, Santa Barbara did
not have a trauma center and elected to use the funding for
the aging court system. The author further argues that
counties do not have the authority to raise penalty
assessments at the local level and it is necessary to ask the
state for such authority.
2)MADDY FUNDS . SB 12 (Maddy), Chapter 1240, Statutes of 1987,
authorized counties to establish a fund to reimburse
physicians for the uncompensated costs of emergency care and
other county emergency services through a $1 penalty
assessment on fines, forfeitures, and penalties. The Maddy
fund was part of a comprehensive scheme regulating the
treatment of uninsured patients in hospital EDs. In 1991,
various state and local funds and program responsibilities
were realigned. At that time, AB 544 (Isenberg), Chapter 189,
Statutes of 1991, consolidated various county optional penalty
assessments, including the $2 for the Maddy Fund, into the
combined PA. AB 544 also required any county that had
established a Maddy EMS Fund continue to use the penalty
revenue in the amount originally authorized plus a growth
factor. Counties that had not established a Maddy EMS Fund by
June 1, 1991 were authorized to set aside up to 28% of the
newly consolidated PA, using up to $2 of the $7 fee collected.
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According to a California State Auditor Report on County Maddy
EMS Funds, issued in March 2004, as of November 2003, 49
counties had established EMS Funds and those counties financed
these through several revenue sources. According to the
report, of the 49 counties with Maddy EMS funds, 40
established the funds prior to June 1, 1991. Other funding
sources included:
a) Penalty assessments on certain criminal and traffic
violations;
b) A portion of the fees from people attending traffic
violator schools;
c) Revenues from taxes on tobacco products deposited in the
State's cigarette and tobacco products surtax fund; and,
d) Redirected money from the State's cigarette and tobacco
products surtax fund through an annual EMS Appropriation.
SB 1773 ( Alarcon), Chapter 841, Statutes of 2006, authorized
counties, until January 1, 2009, to elect to levy an
additional $2 for every $10 in base fines for purposes of
supporting EMS, and required the additional assessment to be
deposited in the local Maddy EMS Funds, with 15% to be
directed to pediatric trauma services. SB 1236 (Padilla),
Chapter 60, Statutes of 2008, extended the sunset until
January 1, 2014. Thirty-two counties have implemented this
supplemental assessment.
3)SANTA BARBARA . The Santa Barbara County Board of Supervisors,
in November of 1991, allocated all county penalty assessments
evenly between the Courthouse Construction Fund and the
Criminal Justice Facilities Construction Fund. In 2001, the
Santa Barbara County Board of Supervisors issued a Certificate
of Participation for $40 million for construction of
courthouse and criminal justice facilities. This debt is
serviced by the Criminal Justice Facilities Construction Fund
and the Courthouse Construction Fund until 2021 including the
penalty assessments that would otherwise be used to establish
a Maddy EMS Fund.
a) SB 635 (Dunn), Chapter 524, Statutes of 2004 . In the
2003-04 legislative session, the county of Santa Barbara
sought state authority to impose and collect an additional
penalty of $5 for every $10 of base fine on every criminal
penalty and $2.50 on every parking penalty, through SB 635.
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SB 635 included a January 1, 2007 sunset and a requirement
that the Board of Supervisors of the County of Santa
Barbara report to the Legislature whether, and to the
extent that, actions are taken by the County of Santa
Barbara to implement alternative local sources of funding.
b) Legislative Intent . Senator Dunn submitted a letter to
the Senate Journal since it was not possible to amend the
bill while on concurrence. The letter to the Senate
Journal dated August 26, 2004, in pertinent part reads:
"I respectfully request permission to clarify the intent
of Sec. 4 subdivision (b) contained in Senate Bill 635.
This is in response to an issue raised in the Senate
Public Safety Committee when the bill returned to the
Senate for concurrence. The bill requires the Board of
Supervisors of Santa Barbara County to report to the
Legislature whether, and to what extent that, actions are
taken by the county to implement alternative local
sources of funding for emergency medical services.
It is the intent of the author of SB 635, Senator Joseph
Dunn, that the Board of Supervisors of Santa Barbara
County place a measure on the Santa Barbara County ballot
as soon as possible, but no later than November 2006,
that will raise funds for emergency medical services."
c) Santa Barbara Report to the Legislature on SB 635 Maddy
EMS Fund Activities, April 3, 2006 . The County of Santa
Barbara stated in the 2006 report to the Legislature
required by SB 635 that they could not put funding for the
Maddy EMS Fund on the ballot for November 2006 because of
competing interests including an extension of a sales tax
for transportation funding that expired in April of 2010
and a construction fund to deal with jail overcrowding.
According to the 2006 Report, an extension of the sunset
would give them time to increase critical awareness of the
need for emergency room/trauma center funding without
decreasing the chance of the other competing measures
passing by placing too many on the ballot at once.
According to this 2006 report, there was an increased need
for a Maddy EMS Fund in Santa Barbara. This was due to a
dramatic rise in the in the rates of uninsured in the local
EDs, decreasing payment in government programs such as
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Medicare, the costs of seismic retrofit and nurse staffing
ratio requirements. According to the 2006 Report, Santa
Barbara was the only county in the state with a Level II
Trauma Center that did not receive Maddy EMS funds. The
2006 report stated that the revenue from the fund that was
due to sunset was anticipated to be $137,000 monthly or
$1.6 million annually. The report also argued that
contrary to the assertion of opponents, the increase in the
fines had not led to diminishing revenues to the other PA
funds in Santa Barbara. Although, the 2006 Report admitted
that the promised tax had not been placed on the ballot,
the County identified other actions taken to implement
alternative sources of funding as follows:
i) Establishment of a local Maddy Committee to
strategize for securing permanent funding;
ii) Seeking increased Medicare reimbursement at the
federal level;
iii) Public opinion polling in anticipation of a
local sales tax increase on the ballot;
iv) Public education;
v) Committing tobacco settlement funds;
vi) Efforts to reduce inappropriate use of the ED;
vii) Improved ability to identify sources of
reimbursement;
viii) Efficiencies and cost savings in the emergency
medical system; and,
ix) Injury prevention and reduction.
d) Subsequent Sunset Extensions . Santa Barbara
successfully sought another extension upon submission of
the 2006 report. AB 2265 (Nava), Chapter 768, Statutes of
2006, extended the sunset date for the additional $5 for
every $10 in base fines for all criminal offenses,
including all vehicle code offenses and the $2.50
additional penalty on all parking penalties for the Maddy
EMS Fund in Santa Barbara County from January 1, 2007, to
January 1, 2009. AB 2265 also made legislative findings
that the county required additional time to develop an
appropriate local measure and that the Legislature expects
the county to place a proposed county tax ordinance on the
November 2008 ballot.
The county argued at that time that local hospitals were
losing an estimated $8 million annually for provision of
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uncompensated emergency and trauma care. Furthermore, two
hospitals had closed in the past seven years, leaving five
hospitals to serve the area and that Santa Barbara County
was home to the only Level II trauma center between Los
Angeles and San Jose, Cottage Hospital. According to the
county, Cottage had the only around-the-clock physician
on-call panel on the Central Coast, the only pediatric ICU
on the Central Coast, and supported facilities throughout
the tri-counties region.
AB 1900 (Nava), Chapter 323, Statutes of 2008, extended the
sunset date again, until January 1, 2011 and has therefore
expired. AB 1900 covered all criminal offenses, but
limited the vehicle code violations to those relating to
driving under the influence and excluded parking penalties.
AB 1900 also required The Board of Supervisors of the
County of Santa Barbara to report to the Legislature
whether, and to the extent that, any actions are taken by
the County of Santa Barbara to implement alternative local
sources of funding.
e) AB 1900 Report, November 2010 . According to the 2010 AB
1900 report, the County Board of Supervisors voted to place
a parcel tax measure on the ballot to fund emergency
medical and trauma care services in 2008. The measure
received 46% of the voters, failing the required 2/3
majority vote to pass.
The loss of revenue due to the sunset is estimated to be
approximately $700,000 per year. The 2010 AB 1900 Report
identifies additional measures taken to provide alternative
funding. These include utilization of the SB 1236 penalty
assessment to fund pediatric trauma care. The loss may be
partially mitigated through the use of Intergovernmental
Transfers to match local funds with federal funds in the
Medi-Cal Program. The 2010 AB 1900 Report states that this
funding will be doubled to $400,000 for Medi-Cal patients.
The 2010 AB 1900 Report concluded that even with this
additional revenue there is still a shortfall at least
until comprehensive coverage is implemented through the
Patient Protection and Affordable Care Act in 2014.
4)PENALTY ASSESSMENTS . The Legislature has increasingly turned
to penalty assessments on criminal and traffic offenses as a
method of raising revenue for various projects. Currently,
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the amounts of assessments on individuals who commit traffic
violations are almost quadruple the base fine. A study
conducted by the California Research Bureau (CRB) in February
2006 disclosed that in counties in which the data was
available, the majority of penalties and assessments collected
were from Vehicle Code violations. Many criminal defendants
who committed more serious offenses under the Penal Code are
unlikely to have the ability to pay any fines assessed in
addition to other punishments such as county jail or state
prison sentences.
Judges do have the discretion to reduce the base fine, which
then reduces revenue to state and local governments, as well
as to assessments. As current penalty assessments can almost
quadruple the base fine, increasing fines and assessments may
have the unintended consequence of reduced fine collections.
Indigent defendants facing ever-increasing fees may simply
choose to spend time in jail in lieu of paying the fine,
causing taxpayers to pay the jail costs while state and local
government receive fewer penalty funds. Moreover, county jail
population caps may provide additional incentives to opt for
jail time over fines, as the time served for nonviolent
offenders may be minimal. As noted by the CRB in its 2006
review of penalty assessments, "High penalty assessments may
result in higher rates of default by the guilty parties. Some
offenders may spend time in jail, or plea for community
service, rather than pay the fine and penalty assessment. The
end result may be that a substantial amount of fines, fees,
and revenue is not collected."
5)SUPPORT . The sponsors of this bill, California Chapter of the
American College of Emergency Physicians state that Santa
Barbara is home to five hospitals to serve the large Central
Coast area. According to the sponsors, the number of ED
visits from these five hospitals has doubled form 61, 5000
visits in 2005 to over 131, 000 visits in 2009. The sponsors
further argue in support that California's emergency rooms
have become the health care safety net are the front line of
any public health emergency. The sponsors also assert that
while the Maddy EMS funds only reimburse a small portion of
the cost of care; they are nevertheless a critical source of
funding helping to preserve the emergency care safety net.
The County of Santa Barbara, in support of this bill states
that enabling Santa Barbara County to continue its Maddy EMS
Fund will maintain some relief for physicians and hospitals
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locally. In addition, according to the supporters, this
funding will benefit residents of other counties because
Cottage Hospital, a Level II trauma center, serves as a
tertiary care hospital for some of the most seriously injured
patient in the region.
6)DOUBLE REFERRAL . This bill is double referred. Should it
pass out of this committee, it will be referred to the
Assembly Committee on Local Government.
7)POLICY ISSUES .
a) Santa Barbara only extension . AB 1900 included
legislative findings and declarations that it was the third
time that the County of Santa Barbara has sought
extraordinary assistance from the Legislature in obtaining
Maddy EMS funding and that the county was the only county
in the state that is receiving this unique funding and
further stated that it is the intent of the Legislature in
passing another extension on this penalty assessment that
the County of Santa Barbara secure a permanent local
funding mechanism to ensure the continuation of trauma care
in the region before the repeal of Section 76104.1 of the
Government Code. Given this should this assessment be
continued for Santa Barbara County only?
b) Budget interaction . The Budget Conference Committee
applied the SB 1773(Alarcon) $2 for $10 penalty assessment
statewide and redirected $55 million into a new State EMS
Fund that would be matched in the Medi-Cal Program. The
allocation for pediatric trauma services would be
unchanged. However, the implementing legislation was
deleted from the AB 97 (Committee on Budget), Chapter 3,
Statutes of 2011, the Budget Trailer Bill implementing the
health-related provisions. The sponsors of this bill,
American College of Emergency Physicians, State Chapter of
California, have proposed an alternative that would
eliminate local Maddy EMS funding from the CPA and enact a
new statewide penalty assessment that would be allocated
the same as the budget proposal except that the funding for
hospitals for unreimbursed care would be eliminated and all
of it would be allocated to physicians. Even though the
budget proposal potentially eliminates the Maddy fund
distributions, the author has requested this bill to be
allowed to proceed in a timely fashion until the resolution
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of the budget issue.
REGISTERED SUPPORT / OPPOSITION :
Support
American College of Emergency Physicians, State Chapter of
California (sponsor)
California Medical Association
County of Santa Barbara
Opposition
None on file.
Analysis Prepared by : Marjorie Swartz / HEALTH / (916)
319-2097