BILL ANALYSIS �
SB 535
Page 1
Date of Hearing: July 2, 2013
ASSEMBLY COMMITTEE ON HEALTH
Richard Pan, Chair
SB 535 (Nielsen) - As Amended: April 17, 2013
SENATE VOTE : 37-2
SUBJECT : Commission on Emergency Medical Services.
SUMMARY : Revises the membership of the Commission on Emergency
Medical Services (EMS) by adding one representative from a
public agency that provides air rescue and transport to be
appointed by the Speaker of the Assembly and one air ambulance
representative appointed by the Senate Committee on Rules from a
list of three names submitted by the California Association of
Air Medical Services (CAAMS).
EXISTING LAW :
1)Establishes an 18-member Commission on EMS, within the
California Health and Human Services Agency (HHSA).
Authorizes the Commission members to serve two three-year
terms and requires the Commission to meet at least on a
quarterly basis. Allows members of the Commission to receive
reimbursement for travel and other expenses, but does not
authorize the members to receive compensation for serving on
the Commission.
2)Defines the duties of the Commission to include reviewing
regulations, standards, and guidelines developed by the
California Emergency Medical Services Authority (EMSA);
advising EMSA on a data collection system; advise on emergency
facilities and services, emergency communications, medical
equipment, personnel training, and various aspects of the EMS
system; and, to make recommendations for further development
of the EMS system.
3)Provides a process for a local emergency services agency
(LEMSA) to appeal to the Commission if there is a
determination by EMSA that a local EMS and trauma care system
plan does not effectively meet the needs of residents and is
not consistent with coordinating activities and can therefore
not be implemented.
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FISCAL EFFECT : According to the Senate Appropriations
Committee, pursuant to Senate Rule 28.8, negligible state costs.
COMMENTS :
1)PURPOSE OF THIS BILL . According to the author, this bill is
to add two more members to the Commission on EMS which was
created in HHSA, effective January 1, 1981. One of the new
members would be a private air ambulance member and one would
be a representative from a public agency that does air rescue
and transport. The Commission currently consists of 18
members, including physicians, paramedics, nurses,
firefighters, law enforcement, hospitals, county health
officers, local EMS officials, and ground ambulance providers.
Air ambulance providers do not currently have representation
on the Commission. The author argues that air ambulance
providers throughout the State are increasingly concerned that
they are not adequately represented on the EMS Commission.
The author points out that as the Commission reviews various
regulations that affect emergency services providers, there
are times when air services are included in these discussions.
The author further argues that because air ambulance
providers are regulated by multiple federal, state, and local
agencies it is important that these providers are able to
clarify how a proposed regulation will affect the provision of
air services. This bill adds an appointment by the Speaker of
the Assembly and one by the Senate Rules Committee, from a
list provided by CAAMS. According to the sponsor, CAAMS,
established in 2005, is a chapter of the Association of Air
Medical Services, an international association serving
providers of air and surface medical transport systems and is
a voluntary non-profit organization
2)BACKGROUND . According to EMSA, the Commission was originally
created to ensure that stakeholders have a voice in decisions
affecting the EMS system in California. In 1984 its original
advisory and regulatory role was expanded to allow a LEMSA to
appeal decisions made by EMSA prohibiting implementation of a
proposed local EMS and trauma care system plan. The
Commission may sustain the determination of EMSA or overrule
it and permit local implementation of the plan. In 2008, the
Commission was expanded from 16 to 18 members as part of a
two-bill package requiring the EMSA to establish a statewide
EMT registry, to develop standards, guidelines, and
regulations for the certification, discipline and criminal
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background check investigations of emergency medical
technicians (EMTs). The legislation also included legislative
findings and declarations regarding the Commission's role in
ensuring a consistent statewide certification and licensure
process, standardized enforcement provisions, and due process
for disciplinary actions regarding prehospital personnel. The
current composition has 12 gubernatorial appointees, three by
the Speaker of the Assembly, and three by the Senate Rules
Committee.
Under existing law, the EMS Commission is composed of the
following appointments:
---------------------------------------------------------------
| Type |
| Representing Appointed |
|by: |
---------------------------------------------------------------
|--------------------------+------------------------------+------|
|Physician whose practice |California Chapter of the |Senate|
|is emergency medicine |American College of Emergency | |
| |Physicians | |
|--------------------------+------------------------------+------|
|Physician who is board |American Board of Emergency |Assemb|
|certified in emergency |Medicine |ly |
|medicine | | |
|--------------------------+------------------------------+------|
|Physician who is a trauma |American College of Surgeons |Assemb|
|surgeon | |ly |
|--------------------------+------------------------------+------|
|Physician |California Medical |Senate|
| |Association | |
|--------------------------+------------------------------+------|
|County Health Officer |California Conference of |Govern|
| |Local Health Officers |or |
|--------------------------+------------------------------+------|
|Registered nurse who is a |Emergency Nurses Association |Govern|
|mobile intensive care | |or |
|nurse | | |
|--------------------------+------------------------------+------|
|Paramedic or EMT-II, who |California Rescue and |Senate|
|is not a peace officer |Paramedic Association (CRPA) | |
|--------------------------+------------------------------+------|
|Private emergency |California Ambulance |Assemb|
|services provider |Association |ly |
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|--------------------------+------------------------------+------|
|Fire management |California Fire Chiefs |Govern|
| |Association |or |
|--------------------------+------------------------------+------|
|Hospital administrator |California Hospital |Govern|
| |Association |or |
|--------------------------+------------------------------+------|
|Paramedic or EMT-II who |California Peace Officers' |Govern|
|is also a full time peace |Association |or |
|officer | | |
|--------------------------+------------------------------+------|
|Public member |Rural area |Govern|
| | |or |
|--------------------------+------------------------------+------|
|Public member |Non-specific |Govern|
| | |or |
----------------------------------------------------------------
---------------------------------------------------------------
| Type |
| Representing Appointed |
|by: |
---------------------------------------------------------------
----------------------------------------------------------------
|LEMSA administrator |Emergency Medical Services |Govern|
| |Administrators' Association |or |
| |of California | |
----------------------------------------------------------------
|Medical director of a |Emergency Medical Directors |Govern|
|LEMSA |Association of California |or |
| | | |
----------------------------------------------------------------
|Firefighter |California State |Govern|
| |Firefighters' Association |or |
----------------------------------------------------------------
|Employee of CAL-FIRE |California Professional |Govern|
| |Firefighters (CPF) |or |
|--------------------------+------------------------------+------|
|Employee of a city, |CPF |Govern|
|county, or special | |or |
|district providing fire | | |
|protection | | |
----------------------------------------------------------------
In May 2011, Governor Brown's May Revision to the proposed
2011-12 Budget included elimination of this Commission as part
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of a package of savings to be achieved through department
consolidations, eliminations of boards and commissions, and
other operational efficiencies. The savings attributed to the
elimination of this Commission was $38,000 ($9,000 General
Fund). Although a number of other health-related commissions,
such as the California Medical Assistance Commission, were
eliminated, the EMS Commission was not.
3)SUPPORT . CAAMS, sponsor of this bill, and other supporters
such as CALSTAR, AirMethods, REACH Air Medical Services, and
PHI Air Medical write in support that the addition of an air
medical representative and one from a public agency that
provides air rescue and transport will provide an opportunity
for air medical providers to provide their prospective when
regulations are developed and comments provided.
4)OPPOSITION . The Emergency Medical Services Administrators
Association (EMSAAC) writes in opposition that the current 18
member Commission on EMS adequately represents the interests
of prehospital EMS providers including air ambulance services.
Creating two additional positions to be filled specifically
by air ambulance representatives is disproportionate to their
role within the EMS system. Air ambulance transport accounts
for a small fraction of the overall call volume of the EMS
system. EMSAAC believes the existing Commission membership
which includes seven prehospital members and six physician
members is sufficient to provide oversight and representation
for the operational and clinical aspects of air ambulance
service in California.
5)PREVIOUS LEGISLATION .
a) AB 2394 (Nielsen) of 2012 would have required the
Speaker of the Assembly to appoint one air ambulance
representative from a list of the three names submitted by
CAAMS. AB 2394 was referred to Assembly Health Committee,
but did not have a hearing.
b) AB 2173 (Beall), Chapter 547, Statutes of 2010,
establishes the Emergency Medical Air Transportation Act,
which imposes an additional $4 on every Vehicle Code
violation to augment Medi-Cal reimbursement rates for
medical air transportation services. These penalty
provisions sunsets on July 1, 2016, and the entire bill
sunsets on January 1, 2018.
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c) SB 997 (Ridley-Thomas), Chapter 275, Statutes of 2008,
adds to the Commission two members to be appointed by the
Governor, one who is an employee of Cal-FIRE and one who is
an employee of a city, county, or special district that
provides fire protection, each appointed by the Governor
from lists of three names provided by CPF. Revises the
requirement that one of the other 16 Commission members is
a person appointed by the Governor is an active member of
the California State Firemen's Association or the CPF by
deleting CPF from the list of two organizations from which
one Commission member must be selected.
d) AB 1898 (Nakano) of 2004 would have required the Senate
Rules Committee to appoint a representative from the
California State Firefighters Association instead of a
representative from CRPA, would have required the Governor
to appoint a representative recommended by CPF, would have
created an additional seat and required the Governor to
appoint a paramedic, EMT-I or EMT-II who is employed in the
private sector from a list provided by the California Labor
Federation. AB 1898 was vetoed by Governor Schwarzenegger
stating that the report on the reorganization of state
government by the California Performance Review (CPR)
recommended the elimination of the Commission. If after
review and vetting of the CPR's recommendations the work of
the Commission is deemed to be vital to the emergency
medical services system of California, then the decision
will be made of whether its composition should be changed."
REGISTERED SUPPORT / OPPOSITION :
Support
CAAMS, sponsor
AirMethods
CALSTAR
PHI Air Medical
REACH Air Medical Services
Opposition
Emergency Medical Services Administrators Association
Analysis Prepared by : Marjorie Swartz / HEALTH / (916)
SB 535
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319-2097