BILL ANALYSIS �
SENATE COMMITTEE ON HEALTH
Senator Ed Hernandez, O.D., Chair
BILL NO: SB 191
AUTHOR: Padilla
INTRODUCED: February 7, 2013
HEARING DATE: April 10, 2013
CONSULTANT: Marchand
SUBJECT : Emergency Medical Services.
SUMMARY : Deletes the January 1, 2014, sunset date on provisions
of existing law authorizing counties to assess an additional $2
on every $10 of certain fines and penalties, including vehicle
code violations, to supplement revenues for county Maddy
Emergency Medical Services Funds (Maddy Funds), and that require
15 percent of these additional funds to be used for pediatric
trauma care.
Existing law:
1.Permits each county to establish an emergency medical services
fund, known as the Maddy Fund, and specifies how these funds
are to be used, including limiting administrative costs to no
more than 10 percent of the amount in the fund, with 58
percent of the balance of the fund distributed to physicians
for emergency services in hospitals, 25 percent distributed
only to hospitals providing disproportionate trauma and
emergency medical care services, and 17 percent distributed
for other emergency medical services as determined by each
county, including funding regional poison control centers.
2.Assesses additional penalties on every fine and penalty
imposed and collected by the courts for all criminal offenses,
including all offenses involving a violation of the Vehicle
Code, and requires funds from these additional penalties to be
deposited into a county Maddy Fund, if the county has
established a Maddy Fund, to pay for emergency medical
services as specified.
3.Requires each county establishing a Maddy Fund to report to
the Legislature annually on the implementation and status of
the fund.
4.Permits a county board of supervisors to levy an additional
penalty, in addition to the additional penalties already
assessed under number 2) above, in the amount of $2 for every
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$10 upon every fine and penalty imposed and collected by the
courts for all criminal offenses, in order to supplement
county Maddy Funds. Sunsets this provision on January 1, 2014.
5.Permits the additional fines authorized in number 3) above to
only be collected if the county board of supervisors provides
that the increased penalties do not offset or reduce the
funding of other programs from other sources, but that these
additional revenues result in increased funding to those
programs. Sunsets this provision on January 1, 2014.
6.Requires that of the additional money deposited into county
Maddy Funds pursuant to number 3) above, 15 percent be used to
provide funding for pediatric trauma centers, as specified.
This separate allocation for pediatric trauma is known as
Richie's Funds. Requires counties that do not maintain a
pediatric trauma center to utilize the money to improve access
to, and coordination of, pediatric trauma and emergency
services in the county, with preference for funding given to
hospitals that specialize in services to children. Sunsets
this provision on January 1, 2014.
This bill:
1.Deletes the January 1, 2014, sunset date on existing law
permitting an additional $2 on every $10 fine or penalty
imposed by a county for purposes of supplementing county Maddy
Funds.
2.Deletes the January 1, 2014, sunset dates on existing law
requiring that 15 percent of the additional penalty revenue be
used for pediatric trauma services, and that no more than 10
percent of the additional penalty revenue be used for
administrative costs of these additional funds.
FISCAL EFFECT : This bill is keyed non-fiscal.
COMMENTS :
1.Author's statement. Californians, regardless of geographic
location, income or ethnicity, continue to face either
increased emergency wait time, being rerouted to other
hospitals, or both. Additionally, pediatric trauma care is
still not widely available in California. There are only 14
pediatric trauma care centers in our state of 38 million
people. Too often, pediatric trauma patients must be
transported by helicopter to trauma centers and the time that
elapses during transport can impact survival and recovery
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rates.
In 2006, legislation was signed into law authorizing counties to
supplement their local Maddy Fund by collecting an additional
$2 penalty on every $10 assessment on certain criminal and
vehicle code violations, 15 percent of which is allocated to
pediatric trauma care. This is the only dedicated source of
funding for pediatric trauma care.
More than 20 counties throughout the state have elected to
collect the additional revenue. Because of the sunset
provision, as of January 1, 2014, counties will no longer be
able to collect these additional revenues to fund emergency
medical services and pediatric trauma care.
2.Double referral. This bill is double referred. Should it pass
out of this committee, it will be referred to the Senate
Committee on Public Safety.
3.Prior legislation. SB 1236 (Padilla), Chapter 60, Statutes of
2008, extended the sunset dates, from January 1, 2009, to
January 1, 2014, on provisions of law authorizing counties to
assess an additional $2 on every $10 in fines to supplement
Maddy Funds, with 15 percent of these additional funds
allocated to pediatric trauma care. These are the sunset dates
that this bill is proposing to delete.
SB 1773 (Alarcon), Chapter 841, Statutes of 2006, enacted the
provisions of law that authorized counties to assess an
additional $2 on every $10 in fines to supplement Maddy Funds,
with 15 percent of these additional funds allocated to
pediatric trauma care. These are the provisions of law that
this bill is seeking to make permanent.
4.Support. This bill is sponsored by the California Chapter of
the American College of Emergency Physicians (California
ACEP), which states that emergency care is California is in
crisis. California ACEP states that in the past decade, more
than 65 emergency departments have closed, ED visits are up,
wait times continue to increase, and hospital diversion is on
the rise. California ACEP states that in response to these
challenges, in 2006 SB 1773 (Alarcon) was signed into law to
raise approximately $50 million to augment county Maddy Funds.
The Maddy Fund is intended to mitigate the losses for
treating the uninsured, particularly in rural and urban
emergency departments. California ACEP points out that a
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recent study by the UCLA Center for Health Policy Research
indicates that despite the implementation of the Affordable
Care Act, three to four million Californians will still remain
uninsured, and that this bill is critical to maintaining
access to high quality emergency services.
The Los Angeles County Board of Supervisors states that since
the inception of the funding of the pediatric trauma
component, also known as Richie's Funds, $11.6 million in
these funds have been allocated to implement and to expand
pediatric trauma care and emergency services at both County
and non-County facilities. Los Angeles County states that it
will continue to provide emergency care for the thousands of
persons in the County who will remain without insurance cove
rage even after the implementation of the Affordable Care Act.
Retaining the availability of Richie's Funds is critical to
maintaining the County's fragile trauma and emergency care
system. Numerous other counties have written in support with
similar arguments.
The California Hospital Association also supports this bill,
stating that it is estimated that through the optional
implementation of both the original Maddy Fund and the
supplemental assessment funds, counties, physicians,
hospitals, local emergency medical services providers, and the
Richie Fund for pediatric trauma, receive approximately $94
million annually statewide.
5.Opposition. The Automobile Club of Southern California (Auto
Club) states in opposition that according to the Uniform Bail
and Penalty Schedule, published by the Judicial Council of
California, current penalty assessments are in excess of about
380 percent of the base fine. This means that for every $10,
about $38 is added, with a share going to the state and
counties. The Auto Club states that about 70 percent - 80
percent of penalty assessment revenue is generated from
Vehicle Code moving violations. The Auto Club states that
penalty assessments were originally established in the 1950s
to fund drivers training in public schools, but over time, the
amount of assessments has increased exponentially and today
they fund a plethora of programs largely unrelated to traffic
safety.
The Auto Club asserts that although some people involved in
vehicular collisions utilize emergency room services, many
arrive in emergency rooms due to causes or circumstances
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unrelated to driving or traffic crashes, including violent
crimes, sporting activities, or general illness. The Auto Club
argues that while emergency room services are a necessary and
laudable effort to support, funding the program through
assessments on Vehicle Code tickets places a disproportionate
burden upon the motoring public to achieve this goal.
SUPPORT AND OPPOSITION :
Support: California Chapter of the American College of
Emergency Physicians (sponsor)
Los Angeles County Board of Supervisors (co-sponsor)
Emergency Medical Services Administrators Association
California Children's Hospital Association
California Hospital Association
California State Association of Counties
Children's Hospital & Research Center Oakland
Contra Costa County Board of Supervisors
County of San Diego
Santa Clara County Board of Supervisors
Stanislaus County Board of Supervisors
Ventura County Board of Supervisors
Oppose: Automobile Club of Southern California
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