BILL ANALYSIS
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|SENATE RULES COMMITTEE | AB 2456|
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THIRD READING
Bill No: AB 2456
Author: Torrico (D)
Amended: 8/20/10 in Senate
Vote: 21
SENATE HEALTH COMMITTEE : 5-3, 6/30/10
AYES: Alquist, Cedillo, Leno, Negrete McLeod, Pavley
NOES: Strickland, Aanestad, Romero
NO VOTE RECORDED: Cox
SENATE APPROPRIATIONS COMMITTEE : 7-4, 8/12/10
AYES: Kehoe, Alquist, Corbett, Leno, Price, Wolk, Yee
NOES: Ashburn, Emmerson, Walters, Wyland
ASSEMBLY FLOOR : 53-19, 6/2/10 - See last page for vote
SUBJECT : Emergency medical services: regulation
SOURCE : California Professional Firefighters
DIGEST : This bill requires the Emergency Medical
Services Authority to adopt regulations establishing
standards for policies and procedures applicable to the
functions of emergency medical technicians.
Senate Floor Amendments of 8/20/10 direct the Emergency
Medical Services Authority to adopt the regulations in the
bill, instead of develop or establish them, and requires a
Local Emergency Medical Services Agency to adhere to the
regulations.
CONTINUED
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ANALYSIS :
Existing law
1. Establishes the state Emergency Medical Services
Authority (EMSA), which is responsible for the
coordination and integration of all state activities
concerning emergency medical services (EMS), including
establishing the minimum standards for the policies and
procedures necessary for medical control of the EMS
system.
2. Authorizes counties to develop an EMS program and
designate a Local Emergency Medical Services Agency
(LEMSA) responsible for planning and implementing an EMS
system.
3. Allows EMSA to determine that a LEMSA EMS and trauma
care system plan is not consistent with its applicable
guidelines or established regulations, and allows a
LEMSA to appeal the decision to the EMS Commission. The
EMS Commission may sustain the determination of the
authority or overrule it, and permit local
implementation of a plan. The decision of the commission
is final.
4. Provides for the certification of EMTs through the
issuance of certificates, including EMT I and II
certificates by LEMSAs; public safety agencies, for
public safety personnel; and, the State Board of Fire
Services, for fire safety personnel, for EMT I
certificates.
5. Requires all persons certified to have completed a
training program approved by EMSA or a LEMSA.
6. Requires EMSA to adopt, upon approval of the EMS
Commission, regulations for the training and scope of
practice for EMT I certification and EMT Paramedic
(EMT-P) licensure; guidelines for disciplinary actions
and regulations for disciplinary processes for EMT I and
EMT II certificate holders; and, regulations for issuing
and reissuing EMT I and EMT II certificates.
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7. Requires EMSA to establish and maintain a statewide
registry containing specified publicly available data
elements and the status of all EMT licenses and
certificates, to be used by certifying entities, as
defined.
8. Requires the Medical Director of a LEMSA to investigate
possible EMT I or EMT II misconduct that threatens
public health and safety, and, if necessary, to take
disciplinary action, if the employer of the EMT chooses
not to conduct the investigation, or if the employer is
an ambulance service provider that is not licensed by a
public safety agency, and specifies procedures and
timelines for those investigations and disciplinary
procedures.
9. Establishes an 18-member EMS Commission within the
Health and Human Services Agency.
10. Defines the duties of the EMS Commission to include
reviewing regulations, standards, and guidelines
developed by EMSA, advising EMSA on a data collection
system, advising the EMSA director regarding various
aspects of the EMS system, and making recommendations
for further development of EMS.
This bill:
1. Requires EMSA to adopt regulations establishing
standards for policies and procedures applicable to the
functions, certification and licensure of EMT I, EMT II
and EMT Paramedic personnel, and that all of the
following address components:
Local accreditation
Competency-based written and skills examinations
Demonstration of skills competency
Medical control for the use of the optional skills
Approval of service providers utilizing approved
optional skills
Additional training and maintenance of
accreditation for optional skills
Continued competency in the optional skills, and
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requires these to be monitored through various methods
Field internships
Preceptor evaluation criteria for trainees and,
Approval and evaluation of advanced EMT service
providers.
2. Requires a LEMSA to adhere to the standards developed by
EMSA for policies and procedures applicable to the
functions, certification and licensure of EMT I, EMT II
and EMT Paramedic personnel, as listed above.
3. Requires, upon notification by an EMS service provider,
any policies and procedures applicable to the functions,
certification, and licensure of EMT personnel,
implemented by a LEMSA to that are not in accordance
with EMSA's standards to be subject to approval by the
Director of EMSA.
4. Requires approval to be granted by the Director only if
the policies further the purposes of this division.
5. States that local EMS agency that is notified by the
authority that a policy or procedure is not in
compliance with the regulations developed by the
authority shall stop implementing that policy or
procedure or shall submit a revised policy or procedure
that complies with the regulations developed by the
authority to the director within 90 days of
notification.
6. The authority may assess penalties on a local EMS agency
that fails to respond to a notification as required.
7. States that any policies and procedures adopted or
approved by a local EMS agency are subject to review by
the Director of the EMSA at the discretion of the
director or upon notification by a relevant employer or
a local EMS agency. Approval of policies and procedures
by the director pursuant to this bill shall only be
granted if the policies and procedures implemented by
the local EMS agency further the purposes of this
division and are in accordance with the regulations
developed by the authority.
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8. States that it is the intent of the Legislature to
clarify the law with respect to the EMSA's ability to
adopt regulations and enforce statutes and regulations
for the coordinated delivery of EMS by the many
essential prehospital EMS stakeholders of this state.
9. Requires EMSA to develop, as late than July 1, 2012,and
after approval by the EMS Commission, adopt the
following guidelines and regulations that affect EMT I
and Advanced EMT:
Guidelines for disciplinary orders, temporary
suspensions, and probationary conditions for EMT I and
Advanced EMT certificate holders.
Regulation for the issuance of EMT I and Advances
EMT certificates.
Regulations for the recertification of EMT I and
Advanced EMT certificate holders.
Regulations for disciplinary processes for EMT I
and Advanced EMT certificate holders in accordance
with existing law.
10.Allows EMSA to develop as late as July 1, 2012, and,
after approval by the EMS Commission, adopt a schedule
of fees to be collected in amounts sufficient to support
EMSA's actual additional costs to promulgate the
regulations proposed in this bill.
11.States findings and declarations regarding the statewide
EMS system.
Background
Statewide and local EMS system . California operates a
two-tiered EMS system. EMSA is the state lead agency which
oversees emergency and disaster medical services. EMSA is
charged with providing leadership in developing and
implementing EMS systems throughout California and setting
standards for the training and scope of practice of various
levels of EMS personnel. EMSA also has responsibility for
promoting disaster medical preparedness throughout the
state, and, when required, managing the state's medical
response to major disasters. Among EMSA'a responsibilities
are assessing local EMS systems, technical assistance to
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local agencies; developing, implementing, or evaluating
components of an EMS system; developing statewide standards
and guidelines for EMS systems as well as guidelines for
the assessment of critical care capabilities of hospitals;
and, reviewing and approving local EMS plans to ensure
compliance with the minimum standards set by EMSA
California has 32 LEMSAs that provide EMS for California's
58 counties. Seven regional EMS systems, comprised of 33
counties and 25 single county agencies, provide services.
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.
Prior to 1980, California did not have a central state
agency responsible for ensuring the development and
coordination of EMS services and programs statewide.
According to EMSA, although the many stakeholders in EMS,
including local administrators, fire agencies, ambulance
companies, hospitals, physicians, nurses, and other health
care providers did not agree on many issues, there was a
consensus that a more unified approach to emergency and
disaster medical services was needed. After several years
of effort by EMS constituents and stakeholders to establish
a state lead agency and centralized resource to oversee
emergency and disaster medical services, the EMS System and
Prehospital Emergency Care Personnel Act was passed,
creating EMSA.
In some areas, such as trauma care, EMSA develops statewide
standards, but LEMSAs implement and ensure compliance.
EMSA operates the licensure and discipline program for
paramedics. However, the LEMSAs are responsible for
certifying EMT-Is and EMT-IIs. EMTs employed by public
safety agencies, such as fire departments and law
enforcement agencies, may be certified by their
departments. In other areas, such as EMS system operation,
EMSA's role may be limited to the development of guidelines
which are advisory.
Problems and improvements in the EMS system . In the recent
past, failures in EMT oversight have been the focus of
media scrutiny, with numerous articles questioning the
adequacy of state and local oversight of EMTs. In 2007 the
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Sacramento Bee (Bee) published an investigative series that
reported that paramedics whose licenses had been revoked
for sexual misconduct and patient neglect had been able to
obtain rescue jobs as EMTs. The Bee series also noted that
people with criminal records of patient abuse, who stole
morphine from employers, and who stole money from patients
were able to obtain and keep EMT certificates.
A series of articles in the Los Angeles Times (Times)
reviewed all regulatory actions from 2000 to 2006 statewide
and concluded that there was no coherent system for
reporting problems or processing complaints that could lead
to discipline. The articles found substantial variation
from region to region. The articles noted that, only
through settlement agreements and media reports were cases
brought to the attention of regulators. The articles also
found that very few EMTs were disciplined, even in cases of
serious medical lapses, negligent care, and fraudulent or
counterfeit credentials.
The Times reported that EMTs who were disciplined were able
to find employment with another agency due to the lack of a
statewide registry.
AB 2917 (Torrico), Chapter 274, Statutes of 2008, was
enacted in response to failures in the oversight and
discipline of EMTs. AB 2917 requires EMSA to establish a
statewide EMT registry and to develop standards,
guidelines, and regulations for certification of EMTs. AB
2917 also establishes rules for EMT certification and
discipline and for the investigation of conduct that
threatens public health and safety.
EMS Commission . The duties of the EMS Commission are
defined to include reviewing regulations, standards, and
guidelines developed by EMSA, advising EMSA on a data
collection system, advising the EMSA director regarding
various aspects of the EMS system, and making
recommendations for further development of EMS.
Regulations and guidelines addressing medical control and
skills, recently promulgated by EMSA and approved by the
EMS Commission, are currently on review at the Office of
Administrative Law as part of the APA process.
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The Governor appoints the following members of the EMS
Commission, based on names submitted by the listed
agencies:
A county health officer - California Conference of
Local Health Officers
A registered nurse - Emergency Nurses Association
A fire protection services manager - California
Fire Chiefs Association
A hospital administrator - California Association
of Hospitals and Health Systems
An EMT II or EMT Paramedic police officer -
California Peace Officers Association
Two public members with experience in local EMS
policy issues, one of which must reside in a rural
area
A LEMSA administrator - Emergency Medical Services
Administrator's Association of California
A LEMSA medical director who is an active member of
the Emergency Medical Directors Association of
California
An active member of the California State Firemen's
Association
A person employed by the Department of Forestry and
Fire Protection - California Professional
Firefighters
A person employed by a city, county, or special
district that provides fire protection - California
Professional Firefighters
The Legislature appoints the following members of the EMS
Commission, based on names submitted by the listed
agencies:
A physician and surgeon - California Medical
Association,
A physician and surgeon who is a trauma surgeon -
California Chapter of the American College of Surgeons
A physician and surgeon whose primary practice is
emergency medicine - California Chapter of the
American College of Emergency Physicians
A physician and surgeon who is certified in the
specialty of emergency medicine by the American Board
of Emergency Medicine
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An EMT II or EMT Paramedic who is not a police
officer - California Rescue and Paramedic Association
A prehospital emergency services provider from the
private sector - California Ambulance Association
FISCAL EFFECT : Appropriation: No Fiscal Com.: Yes
Local: Yes
According to the Senate Appropriations Committee analysis:
Fiscal Impact (in thousands)
Major Provisions 2010-11 2011-12
2012-13 Fund
EMSA EMT regulations $128 $255 $153
Special*
and ongoing review
*Emergency Medical Services Personnel Fund. EMSA may charge
a fee for the promulgation of regulations to cover costs.
SUPPORT : (Verified 8/23/10)
California Professional Firefighters (source)
CDF Firefighters Local 2881
OPPOSITION : (Verified 8/23/10)
American Medical Response
California Ambulance Association
California State Association of Counties
City of Eureka
County of Fresno
County of Orange Board of Supervisors
County of Humboldt Board of Supervisors
County of San Bernardino
Emergency Medical Services Administrators' Association of
California
Emergency Medical Directors Association of California
Emergency Medical Services Authority (unless amended)
Emergency Nurses Association
Health Officers Association of California
Health Officers of California
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Los Angeles County Board of Supervisors
Regional Council of Rural Counties
San Bernardino County Sheriff's Office
San Joaquin County Board of Supervisors
Santa Clara County Board of Supervisors
Urban Counties Caucus
ARGUMENTS IN SUPPORT : The California Professional
Firefighters (CPF), the sponsor of this bill, argue that
this bill simply clarifies existing law with respect to
EMSA's current ability to establish guidelines that direct
LEMSAs and other essential EMS stakeholders in their
operations. CPF adds that EMS personnel must fulfill
certain requirements to attain certifications and licenses,
which can differ by county, mandating EMS personnel who
operate in multiple counties to perform additional, varied,
or sometimes disparate activities in order to serve as an
EMT in more than one county. CPF contends that in order to
streamline this process, policies must be driven by
research and consensus, applied broadly across the EMS
delivery system, and supports the statewide mutual aid
process by providing a minimum level of service delivery as
defined by the EMS community.
ARGUMENTS IN OPPOSITION : According to EMSAAC, adopting
standardized medical guidelines applicable to EMT
personnel, on behalf of all counties is inherently
problematic due to the diversity of settings and available
resources. According to EMSAAC, this was demonstrated when
EMSA previously attempted to create universal paramedic
treatment guidelines for LEMSAs. EMSAAC cites as an
example the difference in delivery of prehospital care in
rural counties where ambulance transport times may exceed
one hour as compared to an urban setting with a short
transport time. EMSAAC further argues that EMSA may, under
existing statute, adopt regulations that set or revise the
minimum standards which LEMSAs must follow. EMSAAC further
argues that fees that may be assigned to fulfill the
requirements of this bill will disproportionately effect
EMT personnel in rural areas. Finally, EMSAAC contends
that this bill not only takes medical control away from
LEMSA medical directors, but also from the EMSA Director.
ASSEMBLY FLOOR :
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AYES: Ammiano, Arambula, Bass, Beall, Blakeslee, Block,
Blumenfield, Bradford, Brownley, Buchanan, Caballero,
Charles Calderon, Carter, Conway, Cook, Coto, Davis, De
La Torre, De Leon, Eng, Evans, Feuer, Fletcher, Fong,
Fuentes, Furutani, Gilmore, Hall, Hayashi, Hernandez,
Hill, Huffman, Jeffries, Jones, Bonnie Lowenthal, Ma,
Mendoza, Miller, Monning, Nava, V. Manuel Perez,
Portantino, Ruskin, Salas, Saldana, Skinner, Solorio,
Swanson, Torlakson, Torres, Torrico, Yamada, John A.
Perez
NOES: Adams, Anderson, Bill Berryhill, DeVore, Emmerson,
Fuller, Gaines, Garrick, Hagman, Harkey, Huber, Knight,
Logue, Nestande, Niello, Nielsen, Silva, Smyth, Villines
NO VOTE RECORDED: T om Berryhill, Chesbro, Galgiani, Lieu,
Norby, Audra Strickland, Tran, Vacancy
CTW:do 8/23/10 Senate Floor Analyses
SUPPORT/OPPOSITION: SEE ABOVE
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