BILL ANALYSIS                                                                                                                                                                                                    �






                             SENATE COMMITTEE ON HEALTH
                          Senator Ed Hernandez, O.D., Chair

          BILL NO:       SB 1378
          AUTHOR:        Hancock
          AMENDED:       April 16, 2012
          HEARING DATE:  April 25, 2012
          CONSULTANT:    Trueworthy

           SUBJECT  :  Emergency medical services: personnel.
           
          SUMMARY  :  Requires the medical director of a local emergency 
          medical services agency (LEMSA) to evaluate the good character 
          and rehabilitation of an emergency medical technician (EMT) I or 
          EMT-II applicant who has a prior criminal conviction before 
          denying a certificate.

          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 EMT through the issuance 
            of certificates, including EMT-I and EMT-II certificates, by 
            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.Permits public safety agencies, for public safety personnel, 
            and the State Board of Fire Services, for fire safety 
            personnel, to issue EMT-I certificates.

          5.Requires EMSA to establish EMT-I and EMT-II certification and 
            disciplinary guidelines 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 database, as specified. 

          6.Authorizes an EMT-I or EMT-II employer or medical director of 
            a LEMSA to investigate and discipline those EMT-I and EMT-II 
            employees who commit specified acts. 

                                                         Continued---



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          7.Provides that EMSA or the medical director of a LEMSA may 
            deny, suspend, or revoke certificates issued or may place a 
            certificate holder on probation, upon the occurrence of any of 
            specified events. 
          
          This bill:
          1.Requires the medical director of a LEMSA to evaluate the good 
            character and rehabilitation of an applicant for a certificate 
            who has a prior criminal conviction before denying a 
            certificate, using the following factors:
              a.    The nature and seriousness of the conduct or crime 
                under consideration and its relationship to the person's 
                employment duties and responsibilities;
              b.    Activities since conviction, including employment or 
                participation in therapy or education, that would indicate 
                changed behavior;
              c.    The time that has elapsed since the commission of the 
                conduct or offense that resulted in the criminal 
                conviction and the number of offenses;
              d.    The extent to which the person has complied with any 
                terms of parole, probation, restitution, or any other 
                sanction lawfully imposed against the person;
              e.    Any rehabilitation evidence, including character 
                references, submitted by the person;
              f.    Employment history and current employer 
                recommendations;
              g.    Circumstances surrounding the commission of the 
                offense that would demonstrate the unlikelihood of 
                repetition;
              h.    The granting by the Governor of a full and 
                unconditional pardon, where eligible;
              i.    Whether the applicant has secured a certificate of 
                rehabilitation from a superior court; or
              j.    Whether the information or accusation against the 
                applicant has been dismissed. 

          2.Requires the medical director of a LEMSA to only consider 
            prior convictions for which the applicant was prosecuted as an 
            adult in determining whether to deny an application for an 
            EMT-I or EMT-II.

           FISCAL EFFECT  :  This bill has not been analyzed by a fiscal 
          committee.
           
          COMMENTS  :  
           1.Author's statement.  According to the author, this bill is 




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            needed to ensure that local agencies have an adequate pool of 
            potential EMT applicants, especially given a population that 
            is growing in number and in age. This bill will give local 
            medical directors more discretion to consider evidence of 
            rehabilitation for applicants with past conviction histories.
            The author states that this bill originates out of problems 
            that Alameda County has had in applying existing guidelines 
            regarding EMT-I and -II certification. This bill is intended 
            to empower local medical directors to consider more evidence 
            of rehabilitation for EMT-I and EMT-II applicants. 

            The author states that this bill is intended to enshrine in 
            statute the principle that medical directors should consider 
            evidence of rehabilitation in considering EMT applicants. In 
            existing statutes, there is no obligation for medical 
            directors to do so. In doing so, it would also clarify an 
            existing ambiguity in current state regulations regarding 
            consideration of rehabilitative factors and the kinds of past 
            criminal offenses that can be considered.

          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 LEMSAs 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 




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            the California Highway Patrol, and fire and public safety 
            agencies.

            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).  
            SB1378 is limited to EMT-I and EMT-II levels.

            EMT-I, the most common of the EMTs, are skilled medical 
            workers who respond by ambulance to medical emergencies for 
            the injured and ill. Following instructions, EMT-Is examine 
            victims to determine the nature and extent of an injury or 
            illness and administer first aid and emergency basic life 
            support, such as giving oxygen and doing cardiopulmonary 
            resuscitation. EMT-Is continue the basic life-support 
            treatment during transport to hospitals, help the emergency 
            room staff with pre-admittance treatment, and obtain medical 
            histories.

            EMT-IIs perform all of the tasks required of EMT-Is, as well 
            as more complex procedures such as inserting intravenous 
            catheters, administering intravenous glucose solutions, 
            administering a limited number of drugs, and obtaining blood 
            samples for laboratory analysis. EMT-IIs are required to have 
            at least one year of experience as an EMT-I.  

          3.Related legislation. AB 1944 (Gatto) would revise the process 
            relating to disciplinary actions for cause against an EMT-P. 
            AB 1944 passed the Assembly Health Committee on April 17, 2012 
            by a vote of 19-0, and is now pending in the Assembly 
            Appropriations Committee.
            
          4.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.

          5.Support.  Alameda County Board of Supervisors writes in 
            support that SB 1378 codifies the requirement that medical 




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            directors consider rehabilitation of an individual with a 
            conviction history when determining whether to approve an 
            applicant for an EMT-I or EMT-II certificate. The National 
            Employment Law Project writes SB 1378 will help ensure 
            qualified individuals who do not pose a safety risk receive 
            the same opportunities as other young people in the community.
               
          6.Policy concerns.
               a.     What is the need for the bill?  Current regulations 
                 exempt juvenile convictions completely from consideration 
                 as a disqualifying factor for EMT certification.  
                 However, the author and sponsor are concerned the current 
                 regulations that exempt juvenile convictions are limited 
                 to narrowly construed situations. SB 1378 is intended to 
                 create a blanket exemption.  Committee staff recommends 
                 amending the exemption language to be inclusive of the 
                 section, Page 7, lines 37-40, not limited to subdivision 
                 (f) created in SB 1378 as follows:
                (g) In determining whether to deny an application for an 
          EMT-I or
                EMT-II certificate  pursuant to subdivision (f)  , the 
          medical director
                of a local EMS agency shall only consider prior 
          convictions for which
                the applicant was prosecuted as an adult. 
                 
               b.     Shortage of EMTs.  The intent of SB 1378 appears to 
                 be to ensure that local agencies have an adequate pool of 
                 potential EMT applicants.  There is no evidence 
                 demonstrating there is a shortage of EMTs in the state.
          
           SUPPORT AND OPPOSITION  :
          Support:  Alameda County Board of Supervisors (sponsor)
                    ALL OF US OR NONE
                    Books Not Bars
                    California Employment Lawyers Association
                    Californians United for a Responsible Budget
                    Drug Policy Alliance
                    East Bay Community Law Center
                    Justice First, LLP
                    Lawyers' Committee for Civil Rights of the San 
                              Francisco Bay Area
                    Los Angeles Black Worker Center
                    National Employment Law Project
                    Progressive Christians Uniting




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                    Rubicon Programs

          Oppose:   None received.

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