BILL ANALYSIS �
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|SENATE RULES COMMITTEE | AB 1387|
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THIRD READING
Bill No: AB 1387
Author: Solorio (D)
Amended: 9/2/11 in Senate
Vote: 21
PRIOR VOTES NOT RELEVANT
SUBJECT : Emergency medical services
SOURCE : Author
DIGEST : This bill revises existing statute pertaining to
the role of city, county, and fire districts in the
provision of prehospital emergency medical services (EMS).
NOTE: This bill contains the provisions of the August 15,
2011 version of AB 210 (R. Hernandez), which was
subsequently amended to address a different subject
matter.
ANALYSIS : Existing law:
1. Establishes the EMS Act for the purpose of
providing the state with a statewide EMS system.
2. Establishes the EMS Authority, within the Health
and Human Services Agency, responsible for the
coordination and integration of all state activities
concerning EMS including establishing the minimum
standards for the policies and procedures necessary
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for medical control of the EMS system.
3. Establishes a 16-member EMS Commission within the
Health and Human Services Agency, and defines duties
and criteria for its members. Ten commissioners are
appointed by the Governor, three by the Senate, and
three by the Speaker of the Assembly.
4. Authorizes counties to develop an EMS program and
designate a local EMS agency (LEMSA) responsible for
planning and implementing an EMS system.
5. Requires the Authority to authorize LEMSAs, review
and approve LEMSA plans for implementation of EMS and
trauma care systems, and provide for a LEMSA to appeal
a negative determination to the EMS Commission.
6. Allows a LEMSA to create an exclusive operating
area (EOA) in the development of a local plan if a
competitive process is utilized to select the
provider.
7. Defines an EOA to mean an EMS area or subarea
defined by the EMS plan for which a LEMSA restricts
operations to one or more emergency ambulance services
or providers of advanced life support (ALS) or limited
advanced life support.
8. Does not require a competitive process if the LEMSA
develops or implements a local plan that continues the
use of existing providers that have continuously
provided services without interruption since January
1, 1981.
9. Requires a LEMSA which elects to develop an EOA to
submit a plan to the Authority for approval.
10. Requires this plan to include provisions for a
competitive process held at periodic intervals.
11. Provides that nothing in the provisions pertaining
to the creation of an EOA supersedes the provisions
pertaining to the grandfathering of administration of
pre-hospital EMS by cities and fire districts as of
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June 1, 1980.
12. Allows an emergency medical care committee to be
established in each county.
13. Requires every emergency medical care committee to
report its observations and recommendations at least
annually to the Authority.
This bill:
1.Continues the authorization of a city or fire district to
provide prehospital EMS that it had continuously
contracted for or provided since June 1, 1980, within the
geographical service area that it continuously served
during that time, if the city or fire district makes a
formal written request to the LEMSA prior to January 1,
2014, as specified. If the city or fire district fails
to enter into an agreement by January 1, 2014, it would
be prohibited from performing prehospital EMS for that
type of service unless formally authorized to so by the
LEMSA. It may appeal to first the local emergency
medical care committee, or its equivalent, then the
LEMSA, and then to the courts.
2.Authorizes a city or fire district to increase its
geographical area and increase or decrease its level of
service, as specified.
3.Prohibits a LEMSA from creating an exclusive operating
area for a type of prehospital EMS provided or contracted
for by a city or fire district that is providing
continuing prehospital EMS.
4.Prohibits a city or fire district that has not
continuously provided or contracted for a type of
prehospital EMS since June 1, 1980, from providing or
contracting for that type of prehospital EMS unless it is
formally authorized to do so by a LEMSA. A LEMSA would be
required to include all cities and fire districts that
comply with these provisions in its local EMS plan.
5.Requires the local emergency medical care committees,
authorized by the EMS Act and currently required to
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annually review ambulance services operating within the
county, to review the county's EMS system and to act in
an advisory capacity to the county board or boards of
supervisors.
6.States that these provisions should not be construed to
affect, limit, or otherwise invalidate any decision by a
court. This body of law has a 30 year history of
litigation. For example, in its most recent case, County
of Butte v. California Emergency Medical Services
Authority , 3rd Appellate Court (2009), EMSA paid $75,000
in legal costs to the Attorney General's Office.
Background
The EMS system in California began its development with the
passage of the Wedworth-Townsend Pilot Paramedic Act SB 772
(Wedworth), Chapter 1188, Statutes of 1974). Paramedic
programs began forming throughout the state without regard
to EMS system planning. The first paramedic program was
formed in 1970 in the county of Los Angeles. California
was seen as a leader in EMS, with the utilization of
paramedics in the EMS system. Although most EMS systems
that developed nationwide have been structured with state
involvement and/or standardization, the EMS system in
California evolved at the local level.
Prior to 1981, California did not have a central state
agency responsible for ensuring the development and
coordination of EMS services and programs statewide.
Because of the manner in which EMS evolved in California,
system management and operation developed independently
from county to county throughout the state. Each county
established its own EMS system (including protocols, scope
of practice, training standards, etc.) and tailored it to
meet the specific needs of its geography, economy, and
client population. Though fragmented, these individual
systems worked well as long as EMS calls were confined
within the local jurisdiction. However, when the services
of one county were required across county lines (e.g., for
multi-casualty incidents, patient transport, or mutual
aid), the absence of common operating procedures and
methodologies often resulted in inconsistency of care.
Questions regarding scope of practice and specific
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protocols, created indecision and confusion among
responders at the scene.
The EMS Act created the Authority, effective January 1,
1981, and now provides the foundation for EMS in the state.
As the lead agency and centralized resource to oversee
emergency and disaster medical services, the Authority is
charged with providing leadership in developing and
implementing local EMS systems throughout California, and
setting standards for the training and scope of practice of
various levels of EMS personnel. This includes assessing
each EMS area to determine the need for additional
services, coordination and effectiveness of EMS. The
Authority reviews EMS plans submitted by LEMSAs to
determine whether the plans effectively meet the needs of
the persons in the geographical areas served and are
consistent with local coordinating activities as well as
with the guidelines and regulations established by the
Authority.
LEMSAs occupy the second tier of governance under the EMS
Act. California has 32 local EMS systems that provide EMS
for California's 58 counties. (Seven regional EMS systems
comprised of 33 counties and 25 single-county agencies
provide the services.) Regional systems are usually
comprised of small, rural, less-populated counties, and
single-county systems generally exist in the larger and
more urban counties. LEMSAs are required to develop a
formal plan for the system in accordance with the
Authority's guidelines and to submit the plan to the
Authority annually. The EMS Act also provides that medical
direction and management of an EMS system is under the
medical control of the medical director of the LEMSA.
The EMS Act includes a provision that "grandfathers" the
administration of pre-hospital EMS by cities and fire
districts as of June 1, 1980, and requires those rights to
be retained until there is a written agreement regarding
the provision of these services between the LEMSA and the
city or fire district (referred to as Section 201 rights or
administrative control). A city or fire district must
provide pre-hospital EMS during the transitional period of
time before an agreement is reached to integrate into the
local EMS system. In 1984, the EMS Act was amended for the
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purpose of authorizing LEMSAs to grant EOAs to private EMS
providers such as ambulance companies (referred to as
Section 224).
FISCAL EFFECT : Appropriation: No Fiscal Com.: Yes
Local: No
SUPPORT : (Verified 9/7/11)
California Professional Firefighters (source)
American Federation of State, County and Municipal
Employees
California Fire Chiefs Association
California Senior Legislature
OPPOSITION : (Verified 9/7/11)
American Medical Response
California Ambulance Association
Mono County Board of Supervisors
San Joaquin County Board of Supervisors
Tulare County Board of Supervisors
ARGUMENTS IN SUPPORT : The California Professional
Firefighters (CPF) states that agencies with Section 201
rights have frequently functioned without entering into
written agreements with their respective LEMSAs to
coordinate, participate in the local EMS plan, and abide by
standard field protocols. CPF adds that while this
approach may work in some jurisdictions, in others it has
not and this is what has led to expensive litigation over
the proper provision of pre-hospital EMS. CPF contends
that it is appropriate to statutorily clarify the need for
a written agreement, as well as to clarify exactly what
should be contained in that agreement to recognize a city
or fire district's continuing authorization to provide
pre-hospital EMS in its jurisdiction, manage its own EMS
resources and be subject to LEMSA medical control.
Understanding that pre-hospital patient care treatment
protocols and policies regarding emergency medical services
vary by county, and, in order to promote an efficient
delivery of the highest level of patient care and
transport, CPF states that each county should establish and
maintain an Emergency Medical Care Committee representative
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of local EMS system participants so that collaboration
among stakeholders is streamlined and coordinated.
ARGUMENTS IN OPPOSITION : The California Ambulance
Association (CAA) states that the Authority is hosting a
task force which is developing regulations on the very
issues AB 210 addresses, and it is critical that this work
be allowed to continue and be completed before additional
statutory changes to the EMS act are made. CAA contends
that the best approach is to defer statutory changes and
allow the regulatory process to continue.
The county of Tulare states that this bill changes EMS
systems in every county even though there have been
problems in only a few jurisdictions. The county of Tulare
contends that this bill attempts to overturn longstanding
legal precedent which currently provides clarity and
consistency to the EMS planning process in counties. The
county of Tulare adds that this bill unnecessarily removes
Section 201 and re-creates it in another form, inviting
more legal challenges to counties.
CTW:do 9/7/11 Senate Floor Analyses
SUPPORT/OPPOSITION: SEE ABOVE
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