BILL ANALYSIS �
SENATE COMMITTEE ON HEALTH
Senator Ed Hernandez, O.D., Chair
BILL NO: AB 1944
AUTHOR: Gatto
AMENDED: May 25, 2012
HEARING DATE: June 20, 2012
CONSULTANT: Trueworthy
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).
Existing law:
1.Establishes the Emergency Medical Services Authority (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.Provides for the certification of an emergency medical
technician (EMT) through the issuance of certificates,
including EMT-I and EMT-II certificates, by Local Emergency
Medical Services Agencies (LEMSAs), which are designated by
counties.
3.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.
4.Requires EMSA to create EMT certification, recertification,
and disciplinary standards and to maintain a central registry
of EMTs. Requires all EMTs to submit fingerprints for a state
and federal level Criminal Offender Record Information (CORI)
search, as specified.
5.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.
This bill:
Continued---
AB 1944 | Page 2
1.Provides that EMSA may not take action against an EMT-P
license or licensee, except on the grounds of an imminent
threat to public safety, until after one of the following has
occurred:
a. The employer declines to conduct an investigation;
b. 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
c. The employer determines, after an investigation, that
the conduct requires action against the license.
2.Authorizes the medical director of the LEMSA, where an EMT-P
licensee's commission of any act or omission that appears to
constitute disciplinary cause, to refer any information
received regarding the conduct of the EMT-P licensee to the
relevant employer or, if the license holder 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.
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
as described in number (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 an EMT-P:
a. is terminated or suspended for disciplinary cause or
reason;
b. resigns following notice of an impending investigation;
or
c. is removed from paramedic duties for disciplinary cause
following an internal investigation.
AB 1944 | Page
3
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.
9.Makes legislative findings and declarations.
FISCAL EFFECT: According to the Assembly Appropriations
Committee, AB 1944 costs to EMSA are likely to be minor and
absorbable. The analysis notes potential reimbursable state
mandate costs in the range of $1 million to $2 million (General
Fund) related to the requirement that LEMSAs refer any
information received regarding the conduct of an employee to the
individual's employer or to EMSA. LEMSAs also expect additional
workload associated with reviewing and providing assistance with
employer-provided disciplinary plans, but these costs are not
reimbursable as technical assistance is not specifically
mandated by the bill.
PRIOR VOTES :
Assembly Health: 19- 0
Assembly Appropriations:17- 0
Assembly Floor: 75- 0
COMMENTS :
1.Author's statement. 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.
While the state issues licenses to EMT-Ps, multiple agencies and
levels of government -- from the employer and the LEMSA to EMSA
and its EMS Commission -- retain authority to impose EMT-P
discipline with no required coordination and often without regard
AB 1944 | Page 4
for any appropriately administered discipline imposed by those
multiple oversight agencies.
Effective monitoring and supervision of 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. Consequently, California's EMS
community and the public they protect would further be served by
conforming the oversight for EMT-Ps to the current system of
coordinated oversight for EMT-Is and EMT-IIs contained in the
policy enacted pursuant to AB 2917 in 2007.
As such, policy is needed to recognize that discipline imposed
should be timely, decisive, appropriate and fair corrective action
for those who violate the standards of conduct for the profession
and endanger public safety - regardless of whether the emergency
medical service personnel holds a EMT-I or EMT-II certificate or
an EMT-P license.
2.Background. 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 EMS agency. California has 32 LEMSA systems
that provide EMS 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 7
regional EMS agencies comprised of 33 counties and 25
single-county agencies.
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 service employers licensed by
the California Highway Patrol, and fire and public safety
agencies.
AB 1944 | Page
5
3.EMTs. An EMT is a specially trained and certified or licensed
professional who renders immediate medical care in the
pre-hospital setting to seriously ill or injured individuals.
To be certified as an EMT, an applicant must successfully
complete a training program and pass a written and skills
certifying examination. California has three levels of EMTs:
EMT-I (basic), EMT-II (intermediate), and EMT-P (paramedic).
4.EMPT-Ps. 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 pre-hospital care, inappropriate conduct, and other
related issues, including information revealed from the
criminal background checks.
According to EMSA, there are 19,476 EMT-Ps currently licensed
in California. In 2012, there were 389 cases/complaints
investigated. Of those, 5 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.
5.Related legislation. SB 1378 (Hancock) would have required
the medical director of a LEMSA to evaluate the good character
and rehabilitation of an EMT-I or EMT-II applicant who has a
prior criminal conviction before denying a certificate. SB
1378 was held on the Senate Appropriations Suspense File.
6.Prior legislation. AB 2917 (Torrico), Chapter 274, Statutes of
2007, requires EMSA to establish a statewide EMT registry and
to develop standards, guidelines, and regulations for
certification of specified EMTs. AB 2917 also establishes
rules for EMT certification and discipline and for
investigation of any conduct which threatens public health and
safety, as defined.
AB 1944 | Page 6
AB 1655 (Negrete McLeod), Chapter 513, Statutes of 2004,
provides more flexibility and allows 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.
7.Support. The California Professional Firefighters writes that
the bill would enact the same oversight system for EMT-Ps as
is currently applicable to EMT-I and EMT-IIs relative to
disciplinary action. American Federation of State, County and
Municipal Employees writes that this bill is an important step
to ensuring fairness for EMT-Ps who serve our communities.
8.Opposition. The Emergency Medical Services Administrators
Association of California (EMSAAC) opposes this bill, writing
that over the past two years, LEMSAs have been working with
employers to implement the new EMT disciplinary process
required by AB 2917 of 2007 and have encountered a number of
challenges related to employers being involved in EMT
investigations. EMSAAC argues there is still much to be done
in the ongoing implementation of AB 2917 and is very concerned
about giving employers the additional responsibility for
paramedic license investigations and discipline while problems
associated with the implementation of AB 2917 have not been
resolved. EMSAAC contends AB 1944 could delay the objective
investigations and appropriate disciplinary proceedings by
EMSA and could weaken the authority of the LEMSA medical
director and EMSA to protect patients from individuals that
pose a threat to public health and safety.
The San Joaquin County Board of Supervisors argues the medical
director of the LEMSA and physician director at EMSA are best
suited to evaluate a person to perform their duties as a
licensed EMT-P and ensure the health and safety of the public.
The San Joaquin County Board of Supervisors is particularly
concerned that the provisions of this bill require EMSAs to
delay its independent investigation, fail to distinguish
between on duty and off duty acts, fail to distinguish
criminal and non-criminal acts, and do not include a
requirement for a timely investigation.
AB 1944 | Page
7
The California Ambulance Association writes that AB 1944
complicates the efforts of LEMSAs who have worked for two
years to implement the provisions of AB 2917 and argues this
bill is unnecessary and redundant. EMT employers and the EMSA
must continue to tackle the challenges of AB 2917
implementation.
9.Policy comment. The author states that the goal of this bill
is to conform the oversight of EMT-Ps to the current oversight
and disciplinary action for EMT-Is and EMT-IIs. The author
argues California has a coordinated system for EMT-Is and
EMT-IIs, but not for EMT-Ps, and therefore EMT-Ps have
duplicative disciplinary processes within multiple agencies.
However, it should be noted that EMT-P licensure and
disciplinary action is already coordinated by EMSA. EMSA
investigates and prosecutes complaints regarding EMT-P
pre-hospital care, inappropriate conduct, and other related
issues, including information revealed from the criminal
background checks. By giving local employers the option of
disciplinary authority, and therefore taking the authority
away from EMSA, this bill could create inconsistent results
for EMT-Ps.
SUPPORT AND OPPOSITION :
Support: American Federation of State, County and Municipal
Employees, AFL-CIO
California Professional Firefighters
Oppose: California Ambulance Association
California State Association of Counties
County Health Executives Association of California
Emergency Medical Services Administrator's Association
of California
North Coast Emergency Medical Services
Paramedics Plus
San Joaquin County Board of Supervisors
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