BILL ANALYSIS Ó
SENATE COMMITTEE ON HEALTH
Senator Ed Hernandez, O.D., Chair
BILL NO: AB 1931
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|AUTHOR: |Rodriguez |
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|VERSION: |April 25, 2016 |
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|HEARING DATE: |June 8, 2016 | | |
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|CONSULTANT: |Vince Marchand |
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SUBJECT : Emergency medical services: paramedics: discipline
SUMMARY : Adds Emergency Medical Technician-Paramedics to the provisions
of law governing the procedures for investigations and
disciplinary actions that are current law for Emergency Medical
Technician-Is and IIs.
Existing law:
1)Establishes the Emergency Medical Services Authority (EMSA)
within the California Health and Human Services Agency, and
requires the director of EMSA to be a physician appointed by
the Governor.
2)Requires EMSA, among other things, to develop planning and
implementation guidelines for emergency medical services
systems which address specified components, including manpower
and training, communications, transportation, system
organization and management, data collection and evaluation,
and disaster response.
3)Establishes the EMS Commission within the California Health
and Human Services Agency, composed of 18 members appointed by
the Governor, the Speaker of the Assembly, and the Senate
Committee on Rules to represent specified entities,
professions and associations.
4)Requires the EMS Commission to review and approve regulations,
standards and guidelines to be developed by EMSA for
implementation of the EMS System and the Prehospital Emergency
Medical Care Personnel Act.
5)Defines "Emergency Medical Technician-I" or "EMT-I" as an
individual trained in all facets of basic life support, as
AB 1931 (Rodriguez) Page 2 of ?
specified. Defines an "Emergency Medical Technician-II,"
"EMT-II," "Advanced Emergency Medical Technician," or
"Advanced EMT" as an EMT-I with additional training in limited
advanced life support according to specified standards. Both
EMT-Is and EMT-IIs are certified at the local level.
6)Defines "Emergency Medical Technician-Paramedic," "EMT-P,"
"paramedic" or "mobile intensive care paramedic" means an
individual whose scope of practice includes the ability to
provide advanced life support, as specified, including
administering specified medications. EMT-Ps are licensed and
regulated at the state level through EMSA.
This bill:
1)Requires EMSA to develop and adopt guidelines for disciplinary
orders, temporary suspensions, and conditions of probation for
EMT-P license holders, in addition to the existing requirement
that they develop and adopt these guidelines for EMT-I and
EMT-II certificate holders (when referring to EMT-Is, EMT-IIs
and EMT-Ps collectively, "EMTs").
2)Adds EMT-Ps to the provisions of law governing the procedures
for investigations and disciplinary actions that currently
exist for EMT-Is and EMT-IIs. Specifically, this bill adds
EMT-Ps to laws that do the following:
a) Permit an employer of an EMT to conduct
investigations, and take disciplinary action, against
an EMT for specified conduct violations, and require
the employer to notify the regulating entity of the
EMT within three days when an allegation has been
validated as a potential conduct violation.
b) Require each employer of an EMT to notify the
regulating entity within three days after the EMT is
terminated or suspended for a disciplinary cause, the
EMT resigns following notification of an impending
investigation, or the EMT is removed from EMT-relat4ed
duties for a disciplinary cause.
c) Require the director of the EMT's regulating
entity to conduct the investigation and take any
necessary disciplinary action against an EMT who is
not employed by an ambulance service or public safety
agency, or if that ambulance service or public safety
AB 1931 (Rodriguez) Page 3 of ?
agency chooses not to conduct an investigation.
d) Permit the director of the EMT's regulating
entity to deny, suspend, or revoke any EMT certificate
or license, or place an EMT on probation, upon a
finding that the EMT employer failed to impose
discipline according to the guidelines for
disciplinary orders.
e) Permit the director of the EMT's regulating
entity, after consultation with the EMT's employer, to
temporarily suspend, prior to a hearing, an EMT
certificate or license upon a determination that the
EMT has engaged in acts or omissions that constitute
grounds for revocation of their certificate or
license, and that permitting the EMT to continue to
practice without restriction would pose an imminent
threat to the public health or safety.
f) Require the regulating entity, if it
temporarily suspends an EMT, to notify the EMT, and
within three working days, to jointly investigate,
with the EMT's employer, the allegation in order to
make a determination of the continuation of the
temporary suspension.
g) Require the regulating entity to refer, for
investigation and discipline, any complaint received
on an EMT to the relevant employer within three days
of receipt of the complaint.
3)Defines "regulating entity," for purposes of the provisions of
law governing investigations and disciplinary actions of EMTs,
as either of the following:
a) For purposes of EMT-I and EMT-II certificate
holders, the LEMSA that has jurisdiction; or,
b) For purposes of EMT-P license-
c) holders, EMSA, and when requiring a report or
notification regarding an EMT-P, "regulating entity"
refers to both the LEMSA and EMSA.
4)Requires proceedings against any EMT-P licenseholder to be
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held in accordance with specified provisions of law governing
administrative adjudication formal hearings.
5)Clarifies that employers of EMTs are required to notify the
regulating entity of the EMT of validated allegations and
disciplinary actions taken, regardless of the county where the
alleged violation occurred.
6)Makes other conforming changes, including deleting provisions
of law requiring EMT-P employers to report disciplinary action
to the LEMSA, which would no longer be necessary with EMT-Ps
being added to the disciplinary provisions applicable to
EMT-Is and IIs, which already require sharing of disciplinary
information between employers and LEMSAs.
FISCAL
EFFECT : According to the Assembly Appropriations Committee:
staff costs of $130,000 GF per year for two years to EMSA to
promulgate regulations.
PRIOR
VOTES :
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|Assembly Floor: |78 - 0 |
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|Assembly Appropriations Committee: |20 - 0 |
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|Assembly Health Committee: |18 - 0 |
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COMMENTS :
1)Author's statement. According to the author, this bill enacts
a disciplinary oversight system for California's paramedics
(EMT-Ps) that is similar to the system currently applicable to
EMT-Is and EMT-IIs, as approved by this Legislature and
Governor in 2007. EMS providers, local EMS agencies and the
state Emergency Medical Services Authority have a cooperative
obligation to maintain the consistency of medical policies and
procedures and the imposition of disciplinary action. This
bill ensures swift and appropriate disciplinary intervention
when necessary, but enacts the appropriate safeguards so our
paramedics, also known as EMT-Ps, won't be reprimanded twice
or more after disciplinary action has been taken against them.
AB 1931 (Rodriguez) Page 5 of ?
Currently, multiple agencies can investigate the actions of
EMT-Ps. However, there is no requirement that these agencies
coordinate or communicate with each other during the course of
the investigation.
2)Background on emergency medical services. EMSA is lead agency
and centralized resource to oversee emergency and disaster
medical services. EMSA is charged with providing leadership
in developing and implementing local emergency medical
services systems (called local EMS agencies, or LEMSAs)
throughout California and setting standards for the training
and scope-of-practice of various levels of EMS personnel.
Day-to-day EMS system management is the responsibility of the
local and regional EMS agency. California has 32 LEMSA systems
that provide EMS for California's 58 counties. Regional
systems are usually comprised of small, more rural,
less-populated counties and single-county systems generally
exist in the larger and more urban counties. There are seven
regional EMS agencies comprised of 33 counties and 25
single-county agencies. Among other responsibilities, EMSA
develops and implements regulations that set training
standards and the scope of practice for emergency medical
personnel: EMT-Is and EMT-IIs, EMT-Ps, mobile intensive care
nurses, firefighters, peace officers, and lifeguards..
3)EMT-Is and IIs. An EMT is a specially trained and certified
or licensed professional who renders immediate medical care in
the pre-hospital setting to seriously ill or injured
individuals. California has three levels of EMTs: EMT-I
(basic), EMT-II (also known as Advanced EMT); and, EMT-P
(paramedic). To be certified as an EMT, an applicant must
successfully complete a training program and pass a written
and skills certifying examination. EMT-Is and EMT-IIs are
certified by a LEMSA or a certifying entity such as a fire or
police department according to guidelines and regulations
developed by EMSA, including criminal background checks. The
responsibility for disciplinary investigations, suspensions,
and revocations is shared by the LEMSA, ambulance service
employers licensed by the California Highway Patrol, and fire
and other public safety agencies. According to EMSA, there are
more than 59,532 EMT-Is certified in California, while there
are 106 EMT-IIs, utilized mostly in rural areas where they may
be the only EMS responder.
4)EMPT-Ps. Paramedics must meet significantly higher training
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requirements compared to EMT-Is and IIs, and have a
significantly broader scope of practice. There are 21,752
EMT-Ps licensed in California. In 1993, EMSA took over the
licensure of paramedics from the LEMSAs. EMSA has the
responsibility to review the license applications to ensure
that licensing requirements are met, including training,
testing, and continuing education, and completion of criminal
background checks for initial EMT-P licensure applicants and
for those whose licenses have lapsed for more than a year.
EMSA also investigates and prosecutes complaints regarding
paramedic pre-hospital care, inappropriate conduct, and other
related issues, including information revealed from the
criminal background checks.
5)Prior legislation. SB 1378 (Hancock of 2012), would have
required the medical director of a LEMSA to evaluate the good
character and rehabilitation of an EMT-I or EMT-II applicant
who has a prior criminal conviction before denying a
certificate. SB 1378 was held on the Senate Appropriations
Suspense File.
AB 1944 (Gatto of 2012), would have revised the process relating
to disciplinary actions for cause against an EMT-P, including
by increasing employer authority over disciplinary
investigations and actions. AB 1944 was held on the Senate
Appropriations Suspense File.
AB 2917 (Torrico, Chapter 274, Statutes of 2007), requires
EMSA to establish a statewide EMT registry and to develop
standards, guidelines, and regulations for certification of
specified EMTs. AB 2917 also establishes rules for EMT
certification and discipline and for investigation of any
conduct which threatens public health and safety, as defined.
AB 1655 (Negrete McLeod, Chapter 513, Statutes of 2004),
provides more flexibility and allows the imposition of
administrative fines instead of suspending an EMT-P if the
violation did not result in actual harm to a patient and if
the paramedic had no record of discipline by EMSA for five
years. AB 1655 also requires employers of EMT-Ps to report
certain disciplinary actions to EMSA and to permit EMSA to
share the results of an investigation into a paramedic's
misconduct with the EMT-P's employer and the LEMSA.
6)Support. This bill is sponsored by the California
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Professional Firefighters (CPF), which states that all
professional firefighters are trained as EMTs and in many - if
not most - cases, as EMT-Ps as a condition of employment. CPF
states that they believe in being held to the highest
standards for training and performance in the protection of
the public's safety, especially in the area of emergency
medical care. According to CPF, EMS providers, LEMSAs and EMSA
have a cooperative obligation to maintain the consistency of
medical policies and procedures and the imposition of
disciplinary action when necessary. While the state issues
licenses to EMT-Ps, CPF notes that multiple agencies and
levels of government - from a fire department employer and
LEMSA to the state EMSA - retain the authority to investigate
the actions of an EMT-P and impose discipline without an
effective system of coordination or communication with each
other during the course of an investigation or when imposing
such discipline. As a result, CPF states that discipline may
be imposed on a paramedic licenseholder by one oversight
agency without regard for any appropriately-administered
discipline already imposed by another oversight agency.
According to CPF, because the coordinated system made
applicable to EMT-Is and IIs nearly a decade ago does not
apply to EMT-Ps, this bill is needed to ensure that any EMT-P
discipline imposed is timely, decisive, and appropriate.
SUPPORT AND OPPOSITION :
Support: California Professional Firefighters (sponsor)
Oppose: None received
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