BILL ANALYSIS �
AB 1944
Page 1
Date of Hearing: April 17, 2012
ASSEMBLY COMMITTEE ON HEALTH
William W. Monning, Chair
AB 1944 (Gatto) - As Amended: April 11, 2012
SUBJECT : Emergency medical services: EMT-P discipline.
SUMMARY : Revises the process relating to disciplinary actions
for cause against an emergency medical technician-paramedic
(EMT-P). Specifically, this bill :
1)Provides that the Emergency Medical Services Authority (EMSA)
may not take action against an EMT-P license or license
holder, except on the grounds of an imminent threat to public
safety, until after one of the following has occurred:
a) The employer of the EMT-P has conducted an investigation
and fails to impose discipline or EMSA determines that the
discipline imposed was not according to its guidelines and
the conduct constitutes grounds for discipline; or,
b) The employer determines, after an investigation, that
the conduct requires action against the license.
2)Deletes the requirement that the medical director of a local
emergency medical services agency (LEMSA) evaluate information
that comes to his/her attention that may constitute grounds
for disciplinary action against an EMT-P and instead requires
it to be referred to the relevant employer of the EMT-P within
three days of receipt so that the employer may conduct an
investigation. Requires, if the EMT-P is unemployed, referral
to EMSA.
3)Authorizes the employer to conduct an investigation and take
disciplinary action against the EMT-P for conduct that may be
considered a threat to public safety, as specified, and if
validated and determined to be disciplinary cause, requires
the employer to notify EMSA within three days of the
determination or within three days of a decision not to
conduct an investigation.
4)Authorizes an employer, at the conclusion of an investigation
in by 3) above, to develop and implement a disciplinary plan
in accordance with EMSA guidelines for disciplinary orders,
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temporary suspensions, and conditions of probation and submit
the plan to the LEMSA medical director and to EMSA within
three working days of adoption, including a recommendation
that EMSA consider taking licensure actions.
5)Requires the employer to notify the EMSA and the LEMSA medical
director within three days if:
a) An EMT-P is terminated or suspended for disciplinary
cause or reason;
b) An EMT-P resigns following notice of an impending
investigation; or,
c) An EMT-P is removed from paramedic duties for
disciplinary cause following an internal investigation.
6)Requires an employer who sends a recommendation to EMSA for
further investigation of discipline to include all documentary
evidence and requires EMSA to consult with the employer in
deciding the level of disciplinary action consistent with
existing authority.
7)Requires EMSA and the relevant employer to jointly investigate
an allegation that has led to a temporary suspension due to a
determination of imminent threat to public health and safety
and requires EMSA to consult with the employer in determining
the need for licensure action.
8)Requires EMSA or an administrative law judge to give credit
for discipline imposed by an employer for the same conduct.
EXISTING LAW :
1)Establishes EMSA, which is responsible for the coordination
and integration of all state activities concerning emergency
medical services (EMS), including the establishment of minimum
standards, policies, and procedures.
2)Authorizes counties to develop an EMS program and designate a
LEMSA responsible for planning and implementing an EMS system,
which includes day-to-day EMS system operations.
3)Requires EMSA to create emergency medical technician (EMT)
certification, recertification, disciplinary standards, and to
maintain a central registry of EMTs. Requires all EMTs to
submit fingerprints for a state and federal level Criminal
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Offender Record Information (CORI) search, as specified.
4)Permits EMSA to deny, suspend, revoke or place on probation
the license of an EMT-P upon certain findings including fraud,
gross negligence, incompetence, and unprofessional conduct,
and establishes procedures by which EMSA and LEMSAs may
investigate and carry out disciplinary action against the
conduct of EMT-Ps.
FISCAL EFFECT : This bill has not been analyzed by a fiscal
committee.
COMMENTS :
1)PURPOSE OF THIS BILL . According to the author the purpose of
this bill is to conform the oversight of EMT-Ps to the current
coordinated oversight and disciplinary action for EMT-Is and
EMT-IIs. The author states that this bill ensures that due
process rights of EMT-Ps are as effective as those protecting
EMT-Is and EMT-IIs by requiring an EMT-P employer, public
safety agency, or medical director of a local EMS agency, as
applicable, to investigate a cause for disciplinary action
prior to the revocation, suspension, or denial of an EMT-P
license. The author explains that this bill would require the
investigation and discipline be timely, decisive and
proportional to the action in question, would not preclude
disciplinary action by any authority or level of government
involved in administering an EMS program, but would expand the
structure for coordinating such actions so that the EMT-P is
not subject to duplicative processes at each jurisdictional
level.
The author argues that while California adopted a system for the
coordinated oversight of EMT-Is and EMT-IIs in AB 2917
(Torrico), Chapter 274, Statues of 2008, the same system of
coordinated oversight does not apply to EMT-Ps, and as a
result, EMT-Ps are often disciplined by multiple agencies and
levels of government. According to the author, the State
issues licenses to EMT-Ps, however multiple agencies and
levels of government -- from the employer and the LEMSA to the
EMSA 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. The author
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asserts that EMS providers and LEMSAs have a cooperative
obligation to maintain the consistency of medical policies and
procedures, as well as conform to the legal requirements
necessary to provide appropriate medical oversight to protect
the public's safety. Such standards are imperative to
providing quality emergency medical care and service.
Therefore, the author argues, effective monitoring and
supervision of an EMT-Ps activity performed under the
authority of the license they hold is an integral component of
assuring the safe and efficient delivery of lifesaving
services to the public. The author concludes that
consequently, California's EMS community and the public they
protect would further be served by conforming the oversight
for EMT-P's to the current system of coordinated oversight for
EMT-Is and EMT-II's contained in the policy enacted pursuant
to AB 2917.
2)BACKGROUND . California operates on a two-tiered EMS system.
EMSA is the state lead agency and centralized resource to
oversee emergency and disaster medical services. EMSA 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. The EMS Act establishing
this system was intended to transform a haphazard delivery of
prehospital emergency services into a more unified and
coordinated approach. Day-to-day EMS system management is the
responsibility of the local and regional LEMSA. California
has 32 LEMSA systems that are providing emergency medical
services 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
LEMSAs comprised of 33 counties and 25 single county agencies.
3)PREHOSPITAL EMERGENCY MEDICAL CARE PERSONNEL . 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. EMT-Is and EMT-IIs are
initially certified by a LEMSA 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
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service employers licensed by the California Highway Patrol,
and fire and public safety agencies.
In 1993 EMSA took over the licensure of paramedics from the
LEMSAs. This program licenses and conducts disciplinary
investigations of EMT-Ps. 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 prehospital care, inappropriate conduct, and other
related issues, including information revealed from the
criminal background checks. Until 2005, EMSA had authority to
deny, suspend, revoke, or place on probation the license of a
paramedic upon certain EMSA findings including fraud, gross
negligence, incompetence, and unprofessional conduct. In
2004, EMSA sponsored AB 1655 (Negrete McLeod), Chapter 513,
Statutes of 2004, to provide more flexibility and allow 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.
According to EMSA there are 19,476 EMT-Ps currently licensed
in California. In 2012, there were 389 cases/complaints
investigated. Of those, five resulted in license denials, 19
in revocation, 12 in suspension, 66 in probation, and 18 in
administrative fines for a total of 120 disciplinary actions.
EMSA reports that the average time it takes to investigate and
resolve a complaint is 138 days. This includes the time the
case is received in enforcement and the time it takes legal to
close the case.
4)SUPPORT . The California Professional Firefighters (CPF) writes
in support that this bill would enact the same oversight for
California's EMT-Ps as is currently applicable to EMT-Is and
EMT-IIs relative to disciplinary actions. CPF states in
support that in doing so, this bill promotes and maintains a
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statewide coordinated EMS delivery system that is guided by
consistent, clear standards and is consistent with the policy
approved by the Legislature and signed into law by the
Governor in 2008 (AB 2917). CPF states that when an EMT-P
makes a mistake, they should be corrected and when an EMT-P is
found guilty of misconduct, the punishment should fit the
crime-subject to a process that ensures fair application of
discipline and prompt and immediate resolution subject to
oversight.
5)PRIOR LEGISLATION . AB 2917 required EMSA to establish a
statewide EMT-I and EMT-II registry and develop standards,
guidelines, and regulations for certification of specified
EMTs and established rules for EMT certification and
discipline, and for investigation of conduct which threatens
public health and safety, as defined.
6)DRAFTING CONCERNS:
a) On page 8, lines 17-10, Section 1798.201 (b) reads "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 (c) of Section 1798.200". However this
should cross-reference subdivision (e) otherwise it doesn't
require the conduct to meet the definition of disciplinary
cause.
b) On page 8, lines 34-38, the same sections also reads
"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."
This is in conflict with the requirement in 1799.112 that
the notice be within 30 days.
7)POLICY CONCERN : This bill requires EMSA to delay investigation
of any complaint against an EMT-P, except for those posing an
imminent and serious threat, until the employer has first
investigated and acted or declined to act. This bill further
requires the employer to notify EMSA within three days of the
conclusion of the investigation and the disposition. However,
nothing requires the employer to investigate within a
specified time limit. This raises the possibility that an
employer could sit on a complaint, EMSA would never be
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notified, and the complaint would never be investigated.
This also may cause a time constraint for EMSA to act as the
Firefighters Procedural Bill of Rights requires that punitive
action or denial of promotion on grounds other than merit
shall not be undertaken for any act, omission, or other
allegation of misconduct if the investigation of the
allegation is not completed within one year of discovery by
the employing fire department or licensing or certifying
agency.
Shouldn't EMSA be notified at the same time the employer is
notified and authorized to begin investigation if the employer
does not act within a reasonable period of time?
REGISTERED SUPPORT / OPPOSITION :
Support
California Professional Firefighters
Opposition
None on file.
Analysis Prepared by : Marjorie Swartz / HEALTH / (916)
319-2097