BILL ANALYSIS Ó
AB 430
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Date of Hearing: May 6, 2015
ASSEMBLY COMMITTEE ON APPROPRIATIONS
Jimmy Gomez, Chair
AB
430 (Roger Hernández) - As Amended April 20, 2015
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Urgency: No State Mandated Local Program: NoReimbursable: No
SUMMARY:
This bill:
1)Requires the Emergency Medical Services Authority (EMSA) to
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develop a statewide trauma plan that addresses specified
threats by March 2016.
2)Requires local emergency medical services agency implementing
a trauma care system to commission an independent regional
assessment of equitability and access to its trauma system.
FISCAL EFFECT:
1)Costs to EMSA to contract for a consultant to modify their
recently completed statewide trauma plan to address threats
specified in the bill, estimated at $250,000 (GF).
2)Potential state-reimbursable mandate costs of more than $2
million GF every five years associated with a new requirement
on local EMS agencies for comprehensive regional assessments.
Additional staff costs in the same range may be incurred by
local EMS agencies to support such assessments, but it is
unclear whether these costs will be reimbursable.
COMMENTS:
1)Purpose. According to the author, this bill would create a new
state standard for EMSA certification by requiring local EMSAs
to commission a comprehensive assessment of their regional
trauma system. The author states that this bill is a
necessary response to the recent State Auditor report
suggesting the need for better oversight in the spending and
allocation of Los Angeles (L.A.) County's Measure B funds, and
also suggests independent assessment would benefit EMS systems
statewide.
2)Responsibilities for Trauma Care Systems. EMSA provides
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statewide coordination and leadership for the planning,
development, and implementation of local trauma care systems.
EMSA's responsibilities include the development of statewide
standards for trauma care systems and trauma centers, the
provision of technical assistance to local agencies
developing, implementing or evaluating components of a trauma
care system, and the review and approval of local trauma care
system plans to ensure compliance with minimum standards set
by EMSA.
California has 33 local EMS agencies: seven regional
multi-county systems and 25 single-county agencies. Local EMS
agencies are responsible for planning, implementing, and
managing local trauma care systems, including assessing needs,
developing the system design, designating trauma care centers,
collecting trauma care data, and providing quality assurance.
3)RTCCs. In 2008, EMSA defined five regions and created
corresponding RTCCs composed of trauma system providers, local
EMS agency staff, and trauma system stakeholders from within
each region. The RTCCs serve in an advisory capacity to
promote regional cooperation, enhance and develop best
practices, assist with the analysis of regional data, and work
collaboratively with the state and local EMS agencies to
develop regional policies and protocols in support of the
state trauma system.
4)L.A. County's Measure B. In order to maintain, expand, and
improve the trauma system countywide, L.A. County approved
Measure B in 2002. In recent years, concerns have been raised
about the expenditure of Measure B funds and whether they are
being equitably allocated throughout the county. A February
2014 State Auditor report recommended the L.A. County Board of
Supervisors reinstate a defunct oversight committee, and that
Measure B funds be used to engage the American College of
Surgeons (ACS) to perform a comprehensive assessment of the
trauma system.
5)Opposition. Local EMS agencies and counties oppose this bill,
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they indicate the current framework governing trauma care is
transparent, accountable, and has served to support robust
local EMS systems for decades. They believe this bill would
upend this system by requiring local EMS agencies to
incorporate RTCC recommendations into their trauma care plans
while imposing additional mandates and costs. They argue that
while they collaborate through RTCCs, local EMS agencies
should not be forced to cede authority over system planning
and design to these committees. They further explain that
RTCCs are informal, voluntary committees that serve as a forum
to share best practices for trauma care, but lack a standard
structure or any function established in regulations.
6) Related Legislation. AB 70 (Waldron), pending in Assembly
Health, changes the reporting requirement that EMSA report
annually to the Legislature on the effectiveness of the
statewide trauma system to once every five years.
7)Prior Legislation. AB 1975 (Hernández) of 2014 was similar to
this bill, but also contained an appropriation for EMSA to
create a data system, and was held on the Suspense File of
this committee.
Analysis Prepared by:Lisa Murawski / APPR. / (916)
319-2081