BILL ANALYSIS �
AB 1944
Page 1
ASSEMBLY THIRD READING
AB 1944 (Gatto)
As Amended May 25, 2012
Majority vote
HEALTH 19-0 APPROPRIATIONS 17-0
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|Ayes:|Monning, Logue, Ammiano, |Ayes:|Fuentes, Harkey, |
| |Atkins, Bonilla, Eng, | |Blumenfield, Bradford, |
| |Garrick, Gordon, Hayashi, | |Charles Calderon, Campos, |
| |Roger Hern�ndez, | |Davis, Donnelly, Gatto, |
| |Bonnie Lowenthal, | |Ammiano, Hill, Lara, |
| |Mansoor, Mitchell, | |Mitchell, Nielsen, Norby, |
| |Nestande, Pan, | |Solorio, Wagner |
| |V. Manuel P�rez, Silva, | | |
| |Smyth, Williams | | |
| | | | |
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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;
b) The employer declines to conduct an investigation; or,
c) 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
authorizes it to be referred to the relevant employer of the
EMT-P within three days of receipt so that the employer may
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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,
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
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for discipline imposed by an employer for the same conduct.
FISCAL EFFECT : According to the Assembly Appropriations
Committee, negligible direct state fiscal impact.
COMMENTS : This bill revises the process for disciplinary
actions and investigations of EMT-Ps. 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. 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.
In 1993 EMSA took over the licensure of paramedics from the
LEMSAs. 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. However this bill
would limit the authority of EMSA and would reinstate local
discretion by allowing the employer to delay the EMSA
investigation and to affect the ultimate outcome. 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
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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, Statutes 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. Contrary to the author's
assertions, however, EMT-P licensure is already coordinated and
overseen at the state level by EMSA. By diffusing the
disciplinary authority to local employers, this bill actually
moves in the opposite direction and invites uneven and
inconsistent results. This bill is also not analogous to AB
2917 in that it does not include a statewide registry system.
Until 2005, EMSA had authority only 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.
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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.
Analysis Prepared by : Marjorie Swartz / HEALTH / (916)
319-2097
FN: 0003949