BILL NUMBER: AB 1944 AMENDED
BILL TEXT
AMENDED IN SENATE JUNE 28, 2012
AMENDED IN ASSEMBLY MAY 25, 2012
AMENDED IN ASSEMBLY APRIL 30, 2012
AMENDED IN ASSEMBLY APRIL 11, 2012
INTRODUCED BY Assembly Member Gatto
FEBRUARY 23, 2012
An act to amend Sections 1798.200, 1798.201, 1798.202,1798.211,
and 1799.112 of the Health and Safety Code, relating to emergency
medical services.
LEGISLATIVE COUNSEL'S DIGEST
AB 1944, as amended, Gatto. Emergency medical services: EMT-P
discipline.
Under existing law, the Emergency Medical Services System and the
Prehospital Emergency Medical Care Personnel Act, the Emergency
Medical Services Authority is responsible for establishing minimum
standards and promulgating regulations for the training and scope of
practice for an emergency medical technicians-paramedic (EMT-P) who
is licensed under the act.
Existing law provides that the Emergency Medical Services
Authority may deny, suspend, or revoke licenses issued under these
provisions, or may place a licenseholder on probation, upon the
occurrence of any of specified events. Existing law also authorizes
the director of the authority and the medical director of a local
emergency medical service (EMS) agency to temporarily suspend a
license upon a determination that specified conditions have been met.
This bill would revise the procedures and requirements for
discipline of an EMT-P to require , among other things,
require a decision by an employer to decline an
investigation or an investigation, as specified, and
certain determinations by the authority or an investigation by the
EMT-P employer, as specified, and a determination of
disciplinary cause , before the authority may deny,
suspend, or revoke a license. This bill would permit only an
employer with physician oversight, including by contract,
to conduct an investigation. The bill would
authorize the medical director of a local EMS agency to refer
information regarding conduct that appears to constitute disciplinary
cause to the authority or and the
EMT-P's employer, as specified. The bill would further require, in
specified instances, if an EMT-P is unemployed, that the authority
conduct an investigation and take disciplinary action, as necessary.
By imposing new duties upon local officials, this bill would
create a state-mandated local program.
The California Constitution requires the state to reimburse local
agencies and school districts for certain costs mandated by the
state. Statutory provisions establish procedures for making that
reimbursement.
This bill would provide that, if the Commission on State Mandates
determines that the bill contains costs mandated by the state,
reimbursement for those costs shall be made pursuant to these
statutory provisions.
Vote: majority. Appropriation: no. Fiscal committee: yes.
State-mandated local program: yes.
THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:
SECTION 1. The Legislature finds and declares all of the
following:
(a) The health and safety of Californians often depends on the
timely response and competent care of emergency medical service (EMS)
personnel.
(b) Whether it is an automobile accident, heart attack, near
drowning, unscheduled childbirth, gunshot wound, or other life
critical incident, emergency medical technicians (EMTs) provide
vital, lifesaving, prehospital attention to the public and assist in
transporting the sick or injured to an appropriate medical facility.
(c) Effective monitoring and supervision of an EMT's activity
performed under the authority of the certificate or license is an
integral component of ensuring the safe and efficient delivery of
lifesaving services to the public.
(d) While the state issues licenses to EMT-Paramedics (EMT-Ps),
multiple agencies and levels of government, from the employer and the
local emergency medical services agency to the state's Emergency
Medical Services Authority and its EMS Commission, retain authority
to impose EMT-P discipline with no required coordination and often
without regard for any appropriately administered discipline imposed
by those multiple oversight agencies.
(e) The public's health and safety is best protected when policies
and procedures relative to EMT oversight are enforced in a
consistent and equitable manner and the public's interest is best
served when government works closest to the people.
(f) Recognizing this, in 2007, California adopted a system for
coordinated oversight of EMT-Is and EMT-IIs when the Legislature
enacted and the Governor signed Assembly Bill 2917 into law.
Consistent with that policy, California's EMS community and the
public they protect would be further served by adopting that same
system of coordinated oversight for EMT-Ps.
SEC. 2. Section 1798.200 of the Health and Safety Code is amended
to read:
1798.200. (a) (1) (A) Except as provided in paragraph (2), an
employer of an EMT-I or EMT-II may conduct investigations, as
necessary, and take disciplinary action against an EMT-I or EMT-II
who is employed by that employer for conduct in violation of
subdivision (c). The employer shall notify the medical director of
the local EMS agency that has jurisdiction in the county in which the
alleged violation occurred within three days when an allegation has
been validated as a potential violation of subdivision (c).
(B) Each employer of an EMT-I or EMT-II employee shall notify the
medical director of the local EMS agency that has jurisdiction in the
county in which a violation related to subdivision (c) occurred
within three days after the EMT-I or EMT-II is terminated or
suspended for a disciplinary cause, the EMT-I or EMT-II resigns
following notification of an impending investigation based upon
evidence that would indicate the existence of a disciplinary cause,
or the EMT-I or EMT-II is removed from EMT-related duties for a
disciplinary cause after the completion of the employer's
investigation.
(C) At the conclusion of an investigation, the employer of an
EMT-I or EMT-II may develop and implement, in accordance with the
guidelines for disciplinary orders, temporary suspensions, and
conditions of probation adopted pursuant to Section 1797.184, a
disciplinary plan for the EMT-I or EMT-II. Upon adoption of the
disciplinary plan, the employer shall submit that plan to the local
EMS agency within three working days. The employer's disciplinary
plan may include a recommendation that the medical director of the
local EMS agency consider taking action against the holder's
certificate pursuant to paragraph (3).
(2) If an EMT-I or EMT-II is not employed by an ambulance service
licensed by the Department of the California Highway Patrol or a
public safety agency or if that ambulance service or public safety
agency chooses not to conduct an investigation pursuant to paragraph
(1) for conduct in violation of subdivision (c), the medical director
of a local EMS agency shall conduct the investigations, and, upon a
determination of disciplinary cause, take disciplinary action as
necessary against the EMT-I or EMT-II. At the conclusion of these
investigations, the medical director shall develop and implement, in
accordance with the recommended guidelines for disciplinary orders,
temporary orders, and conditions of probation adopted pursuant to
Section 1797.184, a disciplinary plan for the EMT-I or EMT-II. The
medical director's disciplinary plan may include action against the
holder's certificate pursuant to paragraph (3).
(3) The medical director of the local EMS agency may, upon a
determination of disciplinary cause and in accordance with
regulations for disciplinary processes adopted pursuant to Section
1797.184, deny, suspend, or revoke any EMT-I or EMT-II certificate
issued under this division, or may place any EMT-I or EMT-II
certificate holder on probation, upon the finding by that medical
director of the occurrence of any of the actions listed in
subdivision (c) and the occurrence of one of the following:
(A) The EMT-I or EMT-II employer, after conducting an
investigation, failed to impose discipline for the conduct under
investigation, or the medical director makes a determination that the
discipline imposed was not according to the guidelines for
disciplinary orders and conditions of probation and the conduct of
the EMT-I or EMT-II certificate holder constitutes grounds for
disciplinary action against the certificate.
(B) Either the employer of an EMT-I or EMT-II further determines,
after an investigation conducted under paragraph (1), or the medical
director determines after an investigation conducted under paragraph
(2), that the conduct requires disciplinary action against the
certificate.
(4) The medical director of the local EMS agency, after
consultation with the employer of an EMT-I or EMT-II, may temporarily
suspend, prior to a hearing, any EMT-I or EMT-II certificate or both
EMT-I and EMT-II certificates upon a determination that both of the
following conditions have been met:
(A) The certificate holder has engaged in acts or omissions that
constitute grounds for revocation of the EMT-I or EMT-II certificate.
(B) Permitting the certificate holder to continue to engage in the
certified activity without restriction would pose an imminent threat
to the public health or safety.
(5) If the medical director of the local EMS agency temporarily
suspends a certificate, the local EMS agency shall notify the
certificate holder that his or her EMT-I or EMT-II certificate is
suspended and shall identify the reasons therefor. Within three
working days of the initiation of the suspension by the local EMS
agency, the agency and employer shall jointly investigate the
allegation in order for the agency to make a determination of the
continuation of the temporary suspension. All investigatory
information not otherwise protected by law held by the agency and
employer shall be shared between the parties via facsimile
transmission or overnight mail relative to the decision to
temporarily suspend. The local EMS agency shall decide, within 15
calendar days, whether to serve the certificate holder with an
accusation pursuant to Chapter 5 (commencing with Section 11500) of
Part 1 of Division 3 of Title 2 of the Government Code. If the
certificate holder files a notice of defense, the hearing shall be
held within 30 days of the local EMS agency's receipt of the notice
of defense. The temporary suspension order shall be deemed vacated if
the local EMS agency fails to make a final determination on the
merits within 15 days after the administrative law judge renders the
proposed decision.
(6) The medical director of the local EMS agency shall refer, for
investigation and discipline, any complaint received on an EMT-I or
EMT-II to the relevant employer within three days of receipt of the
complaint, pursuant to subparagraph (A) of paragraph (1) of
subdivision (a).
(b) (1) The authority may, upon determination of disciplinary
cause, deny, suspend, or revoke any EMT-P license issued under this
division, or may place any EMT-P license issued under this division,
or may place any EMT-P licenseholder on probation upon the finding by
the director of the occurrence of any of the actions listed in
subdivision (c) subsequent to either one of the following:
(A) An employer of an EMT-P declines to conduct an investigation
or, after conducting an investigation pursuant to subdivision (b) of
Section 1798.201, fails to impose discipline for the conduct under
investigation, or the authority makes a determination that the
discipline imposed was not according to the guidelines for
disciplinary orders, temporary suspensions, and conditions of
probation and the conduct of the EMT-P constitutes grounds for
disciplinary action against the license.
(B) Either the employer of an EMT-P determines, after an
investigation conducted pursuant to subdivision (b) of Section
1798.201, or the authority determines after an investigation
conducted pursuant to subdivision (c) of Section 1798.201, that the
conduct requires disciplinary action against the license.
(2) Proceedings against any EMT-P license or licenseholder shall
be held in accordance with Chapter 5 (commencing with Section 11500)
of Part 1 of Division 3 of Title 2 of the Government Code.
(c) Any of the following actions shall be considered evidence of a
threat to the public health and safety and may result in the denial,
suspension, or revocation of a certificate or license issued under
this division, or in the placement on probation of a certificate
holder or licenseholder under this division:
(1) Fraud in the procurement of any certificate or license under
this division.
(2) Gross negligence.
(3) Repeated negligent acts.
(4) Incompetence.
(5) The commission of any fraudulent, dishonest, or corrupt act
that is substantially related to the qualifications, functions, and
duties of prehospital personnel.
(6) Conviction of any crime which is substantially related to the
qualifications, functions, and duties of prehospital personnel. The
record of conviction or a certified copy of the record shall be
conclusive evidence of the conviction.
(7) Violating or attempting to violate directly or indirectly, or
assisting in or abetting the violation of, or conspiring to violate,
any provision of this division or the regulations adopted by the
authority pertaining to prehospital personnel.
(8) Violating or attempting to violate any federal or state
statute or regulation that regulates narcotics, dangerous drugs, or
controlled substances.
(9) Addiction to, the excessive use of, or the misuse of,
alcoholic beverages, narcotics, dangerous drugs, or controlled
substances.
(10) Functioning outside the supervision of medical control in the
field care system operating at the local level, except as authorized
by any other license or certification.
(11) Demonstration of irrational behavior or occurrence of a
physical disability to the extent that a reasonable and prudent
person would have reasonable cause to believe that the ability to
perform the duties normally expected may be impaired.
(12) Unprofessional conduct exhibited by any of the following:
(A) The mistreatment or physical abuse of any patient resulting
from force in excess of what a reasonable and prudent person trained
and acting in a similar capacity while engaged in the performance of
his or her duties would use if confronted with a similar
circumstance. Nothing in this section shall be deemed to prohibit an
EMT-I, EMT-II, or EMT-P from assisting a peace officer, or a peace
officer who is acting in the dual capacity of peace officer and
EMT-I, EMT-II, or EMT-P, from using that force that is reasonably
necessary to effect a lawful arrest or detention.
(B) The failure to maintain confidentiality of patient medical
information, except as disclosure is otherwise permitted or required
by law in Part 2.6 (commencing with Section 56) of Division 1 of the
Civil Code.
(C) The commission of any sexually related offense specified under
Section 290 of the Penal Code.
(d) The information shared among EMT-I, EMT-II, and EMT-P
employers, medical directors of local EMS agencies, the authority,
and EMT-I and EMT-II certifying entities shall be deemed to be an
investigative communication that is exempt from public disclosure as
a public record pursuant to subdivision (f) of Section 6254 of the
Government Code. A formal disciplinary action against an EMT-I,
EMT-II, or EMT-P shall be considered a public record available to the
public, unless otherwise protected from disclosure pursuant to state
or federal law.
(e) For purposes of this section, "disciplinary cause" means an
act that is substantially related to the qualifications, functions,
and duties of an EMT-I, EMT-II, or EMT-P and is evidence of a threat
to the public health and safety described in subdivision (c).
SEC. 3. Section 1798.201 of the Health and Safety Code is amended
to read:
1798.201. (a) When information comes to the attention of the
medical director of the local EMS agency that an EMT-P licenseholder
has committed any act or omission that appears to constitute
disciplinary cause as defined in subdivision (e) of Section 1798.200,
the medical director of the local EMS agency may, if he or she
determines that disciplinary action may be necessary, refer any
information received regarding the conduct of the EMT-P licenseholder
to the relevant employer or, and to the
authority, or if the licenseholder is unemployed, to the
authority within three days of receipt of the information so the
employer or the authority may conduct an investigation pursuant to
this section.
(1) If the act or omission occurred while the EMT-P licenseholder
was off duty, the medical director of the local EMS agency shall
refer the information directly to the authority for investigation.
The medical director of the local EMS agency shall also notify the
relevant employer.
(2) If the act or omission is a potentially criminal act, the
medical director of the local EMS agency shall refer the information
directly to the authority and to the employer who shall jointly
conduct an investigation.
(b) An employer of an EMT-P may conduct an investigation, as
necessary, and take disciplinary action against an EMT-P who is
employed by that employer for conduct in violation of subdivision (e)
of Section 1798.200 , and the employer shall conduct an
investigation under the circumstances described in paragraph (2) of
subdivision (a). Only an employer with physician oversight, including
by contract, may conduct an investigation . The employer shall
notify the authority within three days of either the date of a
decision not to conduct an investigation or the date an allegation
has been validated as a potential violation of subdivision (c) of
Section 1798.200 and the employer has made a determination of
disciplinary cause. At the conclusion of an investigation, if
the employer of determines that
disciplinary action against an EMT-P may
is required, the employer shall develop and implement, in
accordance with the guidelines for disciplinary orders, temporary
suspensions, and conditions of probation adopted by the authority, a
disciplinary plan for the EMT-P. Upon adoption of the disciplinary
plan, the employer shall submit that plan to the authority and to the
local EMS agency medical director within three working days. The
employer's disciplinary plan may include a recommendation that the
authority consider taking licensure action pursuant to subdivision
(b) of Section 1798.200. The employer shall notify the authority and
the medical director of the local EMS agency that has jurisdiction in
the county within three days of any action taken by the employer
pursuant to subdivision (a) of Section 1799.112 or within three days
of the conclusion of an investigation that results in a determination
by the employer to not impose discipline.
(1) If an employer conducts an investigation, the employer shall
notify the authority of the status of the investigation every 60 days
and complete the investigation within 120 days.
(2) (A) If the employer is not able to complete the investigation
within 120 days, the employer shall defer the investigation to the
authority.
(B) Any action taken by the employer against an EMT-P in
connection with the investigation of an act or omission shall be
taken into consideration and applied to any licensure action imposed
by the authority.
(c) If an EMT-P is not employed, the authority shall conduct the
investigation, and, upon a determination of disciplinary cause, take
disciplinary action as necessary against the EMT-P pursuant to
subdivision (b) of Section 1798.200.
(d) If the employer of the EMT-P, pursuant to subdivision (b)
sends a recommendation to the authority for further investigation or
discipline of the licenseholder, the recommendation shall include all
documentary evidence collected by the employer in evaluating whether
or not to make that recommendation. This recommendation and
accompanying evidence sent to the authority shall be deemed in the
nature of an investigative communication and be protected by Section
6254 of the Government Code. In deciding what level of disciplinary
action is appropriate in the case and is consistent with subdivision
(b) of Section 1798.200, the authority shall consult with the
employer and medical director of the local EMS agency.
SEC. 4. Section 1798.202 of the Health and Safety Code is amended
to read:
1798.202. (a) The director of the authority or the medical
director of the local EMS agency, after consultation with the
relevant employer, may temporarily suspend, prior to hearing, any
EMT-P license upon a determination that: (1) the licensee has engaged
in acts or omissions that constitute grounds for revocation of the
EMT-P license; and (2) permitting the licensee to continue to engage
in the licensed activity, or permitting the licensee to continue in
the licensed activity without restriction, would present an imminent
threat to the public health or safety. When the suspension is
initiated by the local EMS agency, subdivision (b) shall apply. When
the suspension is initiated by the director of the authority,
subdivision (c) shall apply.
(b) The local EMS agency shall notify the licensee that his or her
EMT-P license is suspended and shall identify the reasons therefor.
Within three working days of the initiation of the suspension by the
local EMS agency, the agency shall transmit to the authority, via
facsimile transmission or overnight mail, all documentary evidence
collected by the local EMS agency relative to the decision to
temporarily suspend. The authority and the relevant employer shall
jointly investigate the allegation to determine disciplinary cause as
defined in subdivision (e) of Section 1798.200. Within two working
days of receipt of the local EMS agency's documentary evidence, the
director of the authority, in consultation with the employer and
consistent with Sections 1798.200 and 1798.201, shall determine the
need for the licensure action. Part of that determination shall
include an evaluation of the need for continuance of the suspension
during the licensure action review process. If the director of the
authority determines that the temporary suspension order should not
continue, the authority shall immediately notify the licensee that
the temporary suspension is lifted. If the director of the authority
determines that the temporary suspension order should continue, the
authority shall immediately notify the licensee of the decision to
continue the temporary suspension and shall, within 15 calendar days
of receipt of the EMS agency's documentary evidence, serve the
licensee with a temporary suspension order and accusation pursuant to
Chapter 5 (commencing with Section 11500) of Part 1 of Division 3 of
Title 2 of the Government Code.
(c) The director of the authority shall initiate a temporary
suspension with the filing of a temporary suspension order and
accusation pursuant to Chapter 5 (commencing with Section 11500) of
Part 1 of Division 3 of Title 2 of the Government Code and shall
notify the director of the local EMS agency, and the relevant
employer.
(d) If the licensee files a notice of defense, the hearing shall
be held within 30 days of the authority's receipt of the notice of
defense. The temporary suspension order shall be deemed vacated if
the authority fails to make a final determination on the merits
within 15 days after the administrative law judge renders the
proposed decision.
SEC. 5. Section 1798.211 of the Health and Safety Code is amended
to read:
1798.211. When making a decision regarding a disciplinary action
pursuant to Section 1798.200, 1798.201, or 1798.210, the authority,
and when applicable the administrative law judge, shall give credit
for discipline imposed by the employer and for any immediate
suspension imposed by the local EMS agency for the same conduct.
SEC. 6. Section 1799.112 of the Health and Safety Code is amended
to read:
1799.112. (a) EMT-P employers shall report in writing to the
local EMS agency medical director and the authority within three
days, and provide all supporting documentation within 30 days, of
whenever any of the following actions are taken:
(1) An EMT-P is terminated or suspended for disciplinary cause or
reason.
(2) An EMT-P resigns following notice of an impending
investigation based upon evidence indicating disciplinary cause or
reason.
(3) An EMT-P is removed from paramedic duties for disciplinary
cause or reason following the completion of an internal
investigation.
(b) The reporting requirements of subdivision (a) do not require
or authorize the release of information or records of an EMT-P who is
also a peace officer protected by Section 832.7 of the Penal Code.
(c) For purposes of this section, "disciplinary cause or reason"
means only an action that is substantially related to the
qualifications, functions, and duties of a paramedic and is
considered evidence of a threat to the public health and safety as
identified in subdivision (c) of Section 1798.200.
(d) Pursuant to subdivision (i) of Section 1798.24 of the Civil
Code, upon notification to the paramedic, the authority may share the
results of its investigation into a paramedic's misconduct with the
paramedic's employer, prospective employer when requested in writing
as part of a preemployment background check, and the local EMS
agency.
(e) The information reported or disclosed in this section shall be
deemed in the nature of an investigative communication and is exempt
from disclosure as a public record by subdivision (f) of Section
6254 of the Government Code.
(f) A paramedic applicant or licensee to whom the information
pertains may view the contents, as set forth in subdivision (a) of
Section 1798.24 of the Civil Code, of a closed investigation file
upon request during the regular business hours of the authority.
SEC. 7. If the Commission on State Mandates determines that this
act contains costs mandated by the state, reimbursement to local
agencies and school districts for those costs shall be made pursuant
to Part 7 (commencing with Section 17500) of Division 4 of Title 2 of
the Government Code.