BILL ANALYSIS Ó SENATE COMMITTEE ON HEALTH Senator Ed Hernandez, O.D., Chair BILL NO: AB 1931 --------------------------------------------------------------- |AUTHOR: |Rodriguez | |---------------+-----------------------------------------------| |VERSION: |April 25, 2016 | --------------------------------------------------------------- --------------------------------------------------------------- |HEARING DATE: |June 8, 2016 | | | --------------------------------------------------------------- --------------------------------------------------------------- |CONSULTANT: |Vince Marchand | --------------------------------------------------------------- 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 AB 1931 (Rodriguez) Page 4 of ? 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 : ----------------------------------------------------------------- |Assembly Floor: |78 - 0 | |------------------------------------+----------------------------| |Assembly Appropriations Committee: |20 - 0 | |------------------------------------+----------------------------| |Assembly Health Committee: |18 - 0 | | | | ----------------------------------------------------------------- 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 AB 1931 (Rodriguez) Page 6 of ? 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 AB 1931 (Rodriguez) Page 7 of ? 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 -- END --