BILL ANALYSIS Ó
AB 412
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Date of Hearing: May 4, 2011
ASSEMBLY COMMITTEE ON LOCAL GOVERNMENT
Cameron Smyth, Chair
AB 412 (Williams) - As Amended: April 28, 2011
SUBJECT : Emergency medical services.
SUMMARY : Reenacts, 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 requires the amount collected be deposited in
a county-established Maddy Emergency Medical Services (EMS)
Fund. Specifically, this bill :
1)Establishes, in the County of Santa Barbara only, 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 these provisions upon adoption of
a resolution of necessity by the County of Santa Barbara Board
of Supervisors (BOS).
4)Requires BOS 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 the imposition of the additional penalty
calculation.
6)Repeals these provisions as of January 1, 2016, unless a later
enacted statute deletes or extends that date.
EXISTING LAW :
1)Authorizes any 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.
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2)Establishes a state penalty assessment of $10 for every $10 on
every fine, penalty, or forfeiture. Of the funds collected,
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 (PA) 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.
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10)Establishes a $4 Emergency Medical Services Penalty
Assessment to fund Emergency Air Medical Transportation
Services.
FISCAL EFFECT : None
COMMENTS :
1)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 AB 412 reestablishes this source of
funding that helped Santa Barbara 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 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)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 EMS 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 EMS 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
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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.
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)The BOS, in November of 1991, allocated all PAs evenly between
the Courthouse Construction Fund and the Criminal Justice
Facilities Construction Fund. In 2001, BOS 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.
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4)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 (Dunn), Chapter 524, Statutes of 2004. SB 635 included
a January 1, 2007, sunset and a requirement that BOS 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.
Senator Dunn submitted a letter to the Senate Journal because 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."
5)The County of Santa Barbara stated in its 2006 report to the
Legislature required by SB 635 that it 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 it
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
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rise in the rates of uninsured in the local EDs, decreasing
payment in government programs, such as 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 the promised tax had not been placed on the
ballot, the county identified other actions taken to implement
alternative sources of funding, as follows:
a) Establishment of a local Maddy Committee to strategize for
securing permanent funding;
b) Seeking increased Medicare reimbursement at the federal
level;
c) Public opinion polling in anticipation of a local sales
tax increase on the ballot;
d) Public education;
e) Committing tobacco settlement funds;
f) Efforts to reduce inappropriate use of the ED;
g) Improved ability to identify sources of reimbursement;
h) Efficiencies and cost savings in the emergency medical
system; and,
i) Injury prevention and reduction.
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 the
County of Santa Barbara from January 1, 2007, to January 1,
2009. AB 2265 also made legislative findings that the county
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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, local hospitals were losing
an estimated $8 million annually for the provision of
uncompensated emergency and trauma care. Furthermore, at that
time, two hospitals had closed in the past seven years,
leaving five hospitals to serve the area and Santa Barbara
County was home to the only Level II trauma center between Los
Angeles and San Jose. According to the county, Cottage
Hospital 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. 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 BOS 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.
According to the 2010 AB 1900 report, BOS 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 two-thirds 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 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.
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6)The Legislature has increasingly turned to penalty assessments
on criminal and traffic offenses as a method of raising
revenue for various projects. Currently, 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,
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 and
assessments, which then reduces revenue to state and local
governments. 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.
7)Prior bills authorizing the County of Santa Barbara to levy an
additional assessment for purposes of the Maddy EMS Fund
contained legislative findings and declarations that it was
not the first time the County of Santa Barbara had sought
extraordinary assistance from the Legislature in obtaining
Maddy EMS funding and the county was the only one in the state
receiving this unique funding. Prior bills also further
stated it was the intent of the
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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.
Voters rejected the proposal to secure permanent local funding
for unreimbursed emergency medical services in 2008. The
Committee may wish to consider whether this assessment should
be continued given the fact the county has been unable to
secure permanent local funding because local voters do not
want it.
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. The
sponsors of AB 412, 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 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 be allowed to proceed in a
timely fashion until the resolution of the budget issue.
8)Support arguments: Supporters, 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 locally.
Opposition arguments: Opposition might argue the voters of the
County of Santa Barbara already have rejected a parcel tax to
fund the Maddy EMS Fund so the Legislature should not be
stepping in to give the county yet another opportunity.
9)This bill was heard by the Assembly Health Committee on April
26, 2011, where it passed with a 15-0 vote.
REGISTERED SUPPORT / OPPOSITION :
Support
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American College of Emergency Physicians, California Chapter
ÝSPONSOR]
CA Medical Association
County of Santa Barbara
Opposition
None on file
Analysis Prepared by : Jennifer Klein Baldwin / L. GOV. /
(916) 319-3958