BILL ANALYSIS Ó
SB 867
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Date of Hearing: June 14, 2016
Counsel: David Billingsley
ASSEMBLY COMMITTEE ON PUBLIC SAFETY
Reginald Byron Jones-Sawyer, Sr., Chair
SB
867 (Roth) - As Amended April 12, 2016
SUMMARY: Extends until January 1, 2027, the Maddy Emergency
Medical Services (EMS) Fund, which authorizes each county to
levy an additional $2 for every $10 of criminal fines to
establish an emergency medical services fund for reimbursement
of costs related to emergency medical services based on fees on
criminal convictions.
EXISTING LAW:
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1)States that for the purposes of supporting emergency medical
services as specified, in addition to other specified criminal
penalties, the county board of supervisors may elect to levy
an additional penalty in the amount of two dollars ($2) for
every ten dollars ($10), or part of ten dollars ($10), upon
every fine, penalty, or forfeiture imposed and collected by
the courts for all criminal offenses. (Gov. Code, § 76000.5,
subd., (a)(1).)
2)Specifies that the additional penalty for emergency medical
services does not apply to the restitution fine, parking
violations, the state surcharge and specified penalty
assessments. (Gov. Code, § 76000.5, subd., (a)(2).)
3)Provides that the emergency medical services funds shall be
collected only 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. (Gov. Code, § 76000.5, subd., (b).)
4)States that moneys collected for the emergency medical
services fund shall be taken from fines and forfeitures
deposited with the county treasurer prior to any division.
(Gov. Code, § 76000.5, subd., (c).)
5)Specifies that funds collected pursuant to this section shall
be deposited into the Maddy Emergency Medical Services (EMS)
Fund. (Gov. Code, § 76000.5, subd., (d).)
6)States the EMS Fund will be repealed on January 1, 2017. (Gov.
Code, § 76000.5, subd., (e).)
7)Provides that each county may establish an emergency medical
services fund, upon the adoption of a resolution by the board
of supervisors. (Health & Saf. Code, § 1797.98a, subd.
(b)(1).)
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8)Specifies that the costs of administering the fund shall be
reimbursed by the fund in an amount that does not exceed the
actual administrative costs or 10 percent of the amount of the
fund, whichever amount is lower. (Health & Saf. Code, §
1797.98a, subd. (b)(2).)
9)States that all interest earned on moneys in the fund shall be
deposited in the fund for disbursement as specified in this
section. (Health & Saf. Code, § 1797.98a, subd. (b)(3).)
10)States that the amount in the fund, reduced by the amount for
administration and the reserve, shall be utilized to reimburse
physicians and surgeons and hospitals for patients who do not
make payment for emergency medical services and for other
emergency medical services purposes as determined by each
county according to the following schedule:
a) Fifty-eight percent of the balance of the fund shall be
distributed to physicians and surgeons for emergency
services provided by all physicians and surgeons, except
those physicians and surgeons employed by county hospitals,
in general acute care hospitals that provide basic,
comprehensive, or standby emergency services pursuant to
paragraph (3) or (5) of subdivision (f) of Section 1797.98e
up to the time the patient is stabilized. (Health & Saf.
Code, § 1797.98a, subd. (b)(5)(A).)
b) Twenty-five percent of the fund shall be distributed
only to hospitals providing disproportionate trauma and
emergency medical care services. (Health & Saf. Code, §
1797.98a, subd. (b)(5)(B).)
c) Seventeen percent of the fund shall be distributed for
other emergency medical services purposes as determined by
each county, including, but not limited to, the funding of
regional poison control centers. Funding may be used for
purchasing equipment and for capital projects only to the
extent that these expenditures support the provision of
emergency services and are consistent with the intent of
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this chapter. (Health & Saf. Code, § 1797.98a, subd.
(b)(5)(C).)
11)States that the source of the moneys in the fund shall be the
penalty assessment made for this purpose. (Health & Saf. Code,
§ 1797.98a, subd. (c).)
12)Specifies that of the money deposited into the fund as
specified, 15 percent shall be utilized to provide funding for
all pediatric trauma centers throughout the county, both
publicly and privately owned and operated. (Health & Saf.
Code, § 1797.98a, subd. (e).)
13)States that counties that do not maintain a pediatric trauma
center shall utilize the money deposited into the fund 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,
and physicians and surgeons who provide emergency care for
children. (Health & Saf. Code, § 1797.98a, subd. (e).)
FISCAL EFFECT: Unknown
COMMENTS:
1)Author's Statement: According to the author, "The Maddy
Emergency Medical Services Fund acts as a critical source of
funding to ensure patients have access to high quality
emergency care. Eliminating these funds will lead to a
reduction in emergency physicians staffing. Fewer emergency
physicians per shift are a significant contributor to longer
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wait times, worse outcomes, and poorer access to care for all
patients with emergencies - whether they are insured or
uninsured. California's Emergency Departments are the
healthcare safety net and front line of any public health
emergency. The demand on Emergency Departments is only
increasing. Despite the implementation of the Affordable Care
Act (ACA), Emergency Room visits are up, and millions of
Californians remain uninsured. In fact, a joint report by the
UC Berkeley Labor Center and the UCLA Center for Health Policy
Research, found that between 3.1 and 4 million Californians
will remain uninsured in 2019, even with full implementation
SB 867, and the continuation of the Maddy Fund, is critical to
maintaining access to quality emergency care for all
Californians for the foreseeable future."
2)Maddy EMS Fund: In 1987, the Legislature approved the
establishment of the Maddy EMS Fund, and although counties are
not required to establish EMS Funds, almost all counties have
done so. The Legislature intended the EMS Funds to reimburse
physicians, hospitals, and other providers of emergency
services, specifically for patients who do not have health
insurance coverage for emergency services and care, cannot
afford to pay for those services, and for whom payment will
not be made through any private coverage or by any program
funded in whole or in part by the federal government, as
specified.
Counties have several sources of revenue for their EMS Funds:
Maddy revenues, derived from county penalty assessments on
various criminal offenses and motor vehicle violations;
traffic violator school fees; and, revenues from taxes on
tobacco products deposited in the State's Cigarette and
Tobacco Products Surtax Fund, including the EMS Appropriation.
Current law requires courts to collect the fines, penalties, and
forfeitures for various criminal offenses, motor vehicle and
traffic violations. Currently, the total penalty assessment
is $7 for every $10 of fines and forfeitures, a portion of
which goes to the Maddy EMS Fund. Courts collect the penalty
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assessments and forward them to counties.
SB 1773 (Alarcon), Chapter 841, Statutes of 2006, further
authorized county Boards of Supervisors to levy an additional
penalty in the amount of $2 for every $10, or part of $10 for
criminal offenses, violations relating to the Vehicle Code and
alcohol beverages. Under SB 1773, 15% of the funds collected
must be utilized to fund pediatric trauma centers in the
county, both publicly and privately owned and operated. The
expenditure of money is limited to reimbursement to physicians
and surgeons, and to hospitals for patients who do not make
payment for emergency care services in hospitals up to the
point of stabilization, or to hospitals for expanding the
services provided to pediatric trauma patients at trauma
centers, other hospitals providing care to pediatric trauma
patients, or at pediatric trauma centers, including the
purchase of equipment. The remaining 75% in these funds are
distributed in accordance with the specified formula. SB 1773
was set to originally sunset in 2009, but was extended to
January 1, 2014 under SB 1236 (Padilla), Chapter 60, Statutes
of 2008. SB 191 (Padilla), Chapter 600, Statutes of 2013,
extended the sunset date until January 1, 2017. This bill
deletes that January 1, 2017 sunset date and extends it until
January 1, 2027.
3)Existing Penalty Assessments: There are penalty assessments
and fees added on the base fine the court imposes on a
defendant for a criminal conviction. The penalty for the
Maddy EMS Fund is one of several additional fees added to a
defendant's base fine. Assuming a defendant was fined $1000,
the following penalty assessments would be imposed pursuant to
the Penal Code and the Government Code:
Base Fine:
$ 1,000
Penal Code 1464 state penalty on fines:
1,000 ($10
for every $10)
Penal Code 1465.7 state surcharge:
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200 (20% surcharge)
Penal Code 1465.8 court operation assessment:
40 ($40 fee per offense)
Government Code 70372 court construction penalty:
500 ($5 for every $10)
Government Code 70373 assessment:
30
($30 per felony/misdo)
Government Code 76000 penalty:
700 ($7 for every $10)
Government Code 76000.5 Maddy EMS penalty:
200 ($2 for every $10)
Government Code 76104.6 DNA fund penalty:
100 ($1 for every $10)
Government Code 76104.7 addt'l DNA fund penalty:
500 ($4 for every $10)
Total Fine with Assessments:
$4,270
It should be noted that this figure does not include victim
restitution, or the restitution fine, and that other fines and
fees, such as the jail booking fee, attorney fees, and
probation department fees, may also be applicable.
4)Criminal Fines are Not a Reliable Funding Source: Criminal
fines and penalties have climbed steadily in recent decades.
Government entities tasked with collecting these fines have
realized diminishing returns from collection efforts.
Government resources can be wasted in futile collection
attempts.
A recent San Francisco Daily Journal article noted, "When it
comes to collecting fines, superior court officials in several
counties describe the process as 'very frustrating,' 'crazy
complicated' and 'inefficient.'" (See State Judges Bemoan Fee
Collection Process, San Francisco Daily Journal, 1/5/2015 by
Paul Jones and Saul Sugarman.) The fines applicable to
procuring and abducting minors for purposes of prostitution
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may provide an example of this problem. Simply put, criminal
defendants can generally not produce a substantial flow of
money for fines.
In the same Daily Journal article, the Presiding Judge of San
Bernardino County was quoted as saying "the whole concept is
getting blood out of a turnip." (Daily Journal, supra.)
The article noted in particular that "Felons convicted to
prison time usually can't pay their debts at all. The annual
growth in delinquent debt partly reflects a supply of money
that doesn't exist to be collected." (Ibid.)
5)LAO Report on Criminal Fines and Fees: The Legislative
Analyst's Office (LAO) published a report in January 16, 2016
about California's system of criminal fines and fees. Upon
conviction of a criminal offense (including traffic
violations), individuals are typically required by the court
to pay various fines and fees as part of their punishment.
Collection programs-operated by both courts and
counties-collect payments from individuals and then distribute
them to numerous funds to support various state and local
government programs and services. Distribution occurs in
accordance to a very complex process dictated by state law.
The LAO identified some particular problems related to criminal
fines and fees:
Difficult for Legislature to Control Use of Fine and Fee
Revenues. The existing system distributes fine and fee revenue
based on various statutory formulas, making it difficult for the
Legislature to control how such revenue is used. This is because
the current formula based system limits the information
available to guide legislative decisions, makes it difficult for
the Legislature to reprioritize the use of revenue, and allows
administering entities to maintain significant control over the
use of funds.
Revenue Distributions Generally Not Based on Need. The existing
system distributes revenue in a manner that is generally not
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based on program need-thereby resulting in programs receiving
more or less funding than needed.
Difficult to Distribute Revenue Accurately. The complexity of
the existing system makes it difficult for collection programs
to accurately distribute fine and fee revenue.
Lack of Complete and Accurate Data on Collections and
Distributions. A lack of complete and accurate data on fine and
fee collections and distributions makes it difficult for the
Legislature to conduct fiscal oversight. Improving California's
Fine and Fee System, January, 2016,
http://www.lao.ca.gov/reports/2016/3322/criminal-fine-and-fee-sys
tem-010516.pdf
Given the some of the problems identified by the LAO, the
Legislature should consider whether continuing to use criminal
fines and fees to distribute revenues through statutory
formulas is the best way to fund California's policy
priorities.
6)Argument in Support: According to The Urban Counties of
California, " In 2006, the Maddy Emergency Services Fund (SB
1773) was created in response to long wait times at emergency
rooms and provided $50 million in funds by allowing counties
to collect additional penalties. These funds are used to
reimburse physicians and hospitals that treat uninsured
patients in the emergency departments. That law is set to
expire on January 1, 2017.
"SB 867 extends the sunset date to January 1, 2027 of this
important funding source and allows counties to continue to
collect an additional $2 for every $10 penalty for all
criminal offenses and moving violations. To date, 10 urban
counties have elected to adopt this fee. In addition, the bill
continues to allocate funds to "Richie's Fund," which supports
pediatric trauma centers. Without this bill, there is no
statewide funding source for pediatric trauma.
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"SB 867 preserves California's emergency care safety net by
extending the Maddy Emergency Medical Services Funds and helps
to mitigate the losses for treating the uninsured and keeps
emergency departments open. California's emergency rooms are
the healthcare safety net and the front lines of any public
health emergency. Therefore, this funding option is critical
for urban counties."
7)Prior Legislation:
a) SB 191 (Padilla), Chapter 600, Statutes of 2013,
extended the Maddy EMS fund until January 1, 2017.
b) SB 1236 (Padilla), Chapter 60, Statutes of 2008,
extended from January 1, 2009 to January 1, 2014, existing
provisions allowing a county Board of Supervisors to levy
additional penalties on criminal offenses, for purposes of
the Maddy EMS Fund, and allocate 15% of the funds collected
to pediatric trauma centers, as specified.
c) SB 1773 (Alarcon), Chapter 841, Statutes of 2006,
authorized a county Board of Supervisors, until January 1,
2009, to elect to levy an additional $2 for every $10 in
base funds for purposes of supporting EMS, and requires the
additional assessment to be deposited in local Maddy EMS
Funds, with 15% to be directed to pediatric trauma services
and authorizes up to 10% to be used for administrative
expenses.
d) AB 1475 (Solorio), Chapter 537, Statutes of 2009,
provided that the costs of administering the EMS Fund that
are reimbursed by the fund are not to exceed the actual
costs of administering the fund or 10% of the amount of the
fund, whichever amount is lower.
REGISTERED SUPPORT / OPPOSITION:
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Support
California Hospital Association (Co-Sponsor)
California Chapter of the American College of Emergency
Physicians (Co-Sponsor)
California Medical Association (Co-Sponsor)
Adventist Health
American Academy of Pediatrics
California Academy of PAs
California Ambulance Association
California Children's Hospital Association
California Fire Chiefs Association
California School Nurses Organization
California Society of Industrial Medicine and Surgery
California State Association of Counties
Children's Specialty Care Coalition
Contra Costa County Board of Supervisors
Del Norte County Board of Supervisors
Del Norte Ambulance
Emergency Medical Services Administrators Association
Emergency Medical Services Medical Directors Association of
California
Emergency Nurses Association, California State Council
Fire Districts Association of California
Health Officers Association of California
Humboldt County Board of Supervisors
Lake County Health Services Department
Los Angeles County Board of Supervisors
Local Emergency Medical Services Agency (Counties of Del Norte,
Humbolt, and Lake)
Loma Linda University Health
Marin County
Osteopathic Physicians and Surgeons of California
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Peace Officers Research Association of California
Petaluma Valley Hospital
Private Essential Access Community Hospitals
Providence Health & Services
Riverside County Board of Supervisors
Rural County Representatives of California
San Bernadino County
San Diego County
Santa Barbara County Board of Supervisors
Santa Rosa Memorial Hospital
St. Helena Hospital, Clear Lake
St. Mary Medical Center, Apple Valley
St. Joseph Hospital, Orange
St. Jude Medical Center, Fullerton
Sutter Lakeside Hospital
Urban Counties of California
Opposition
None
Analysis Prepared by:David Billingsley / PUB. S. / (916)
319-3744
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