BILL ANALYSIS Ó
AB 1975
Page 1
Date of Hearing: May 6, 2014
ASSEMBLY COMMITTEE ON HEALTH
Richard Pan, Chair
AB 1975 (Roger Hernández) - As Amended: March 28, 2014
AS PROPOSED TO BE AMENDED
SUBJECT : Trauma care systems.
SUMMARY : Requires local emergency medical services agencies
(LEMSAs) to contract with the American College of Surgeons (ACS)
every five years to conduct a comprehensive assessment of their
regional trauma system. Specifically, this bill :
1)Requires LEMSAs, as part of the minimum standards, to work in
conjunction with other LEMSAs in the region, ACS, and the
Regional Trauma Coordinating Committee (RTCC) to perform a
regional assessment of equitability and access to the trauma
system.
2)Permits the RTCCs to perform assessment on a more frequent
basis depending on the outcomes of the initial assessment.
3)Requires the Emergency Medical Services Authority (EMSA) to
use the data collected to help implement the statewide trauma
system plan by January 1, 2016.
4)Requires LEMSAs to incorporate recommendations from the RTCC
into their trauma care plan and submit a revised plan to EMSA
for approval.
5)Appropriates $500,000 from the General Fund to be used to
implement a statewide data collection system for conducting
trauma assessments.
6)Makes a declaration that ACS is the only independent,
nonprofit organization that conducts assessment of trauma
systems.
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.
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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 a LEMSA that elects to implement a trauma care system
to develop and submit a plan to EMSA according to the
regulations established prior to the implementation.
4)Requires EMSA to draft regulations specifying minimum
standards for the implementation of a trauma care system
including, among other things, data collection regarding
system operation and patient outcome, and periodic performance
evaluation of the trauma system and its components.
FISCAL EFFECT : This bill has not yet been analyzed by a fiscal
committee.
COMMENTS :
1)PURPOSE OF THIS BILL . According to the author, this bill
would create a new state standard for EMSA certification by
requiring LEMSAs, together with the RTCCs, to contract with
ACS to conduct a comprehensive assessment of their regional
trauma system. The author states that this bill is a
necessary response to the recent State Auditor report
suggesting the need for better oversight in the spending and
allocation of Los Angeles (L.A.) County's Measure B funds.
The Author states that this bill would implement the
recommendation of the report that ACS be utilized based on
their expertise in the area.
2)BACKGROUND . According to the U.S. Department of Health and
Human Services (HHS), Health Resources and Services
Administration, a trauma system is a pre-planned,
comprehensive, and coordinated statewide and local injury
response network that includes all facilities with the
capability to care for the injured. It is the system's
inclusiveness, or range of pre-planned trauma center and
non-trauma center resource allocation, that offers the public
a cost-effective plan for injury treatment. In such an
effective system, trauma care delivery is organized through
the entire spectrum of care delivery, from injury prevention
to prehospital, hospital, and rehabilitative care delivery for
injured persons. The system begins with a state's authority
to designate various levels of trauma and burn centers and
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through data collection and analysis processes, demonstrates
its own effectiveness time and time again.
California operates on a two-tiered EMS system. EMSA is the
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. California has 33 LEMSAs: seven
regional multi-county systems and 25 single-county agencies.
The regional systems are usually comprised of small, rural,
less-populated counties, and single-county systems generally
exist in the larger and more urban counties. LEMSAs are
responsible for planning, implementing, and managing local
trauma care systems, including assessing needs, developing the
system design, designating trauma care centers, collecting
trauma care data, and providing quality assurance.
EMSA provides statewide coordination and leadership for the
planning, development, and implementation of local trauma care
systems. EMSA's responsibilities include the development of
statewide standards for trauma care systems and trauma
centers, the provision of technical assistance to local
agencies developing, implementing or evaluating components of
a trauma care system, and the review and approval of local
trauma care system plans to ensure compliance with the minimum
standards set by EMSA.
3)REGIONAL PLANNING . In 2008, EMSA defined five regions and
created corresponding RTCCs composed of trauma system
providers, LEMSA staff, and trauma system stakeholders from
within each region. The RTCCs serve in an advisory capacity
to promote regional cooperation, enhance and develop best
practices, assist with the analysis of regional data, and work
collaboratively with the state and LEMSAs to develop regional
policies and protocols in support of the State Trauma System.
4)STATEWIDE TRAUMA PLAN . In 2005, Governor Schwarzenegger
directed EMSA and the State Trauma Advisory Committee (STAC)
to complete the statewide trauma care plan. EMSA published a
planning document "California Statewide Trauma Planning:
Assessment and Future Direction" in 2006, which analyzes the
status of trauma care in the state and to make recommendations
for a California Statewide Trauma System. Since that time,
EMSA has been developing a Statewide Trauma Plan but has not
yet approved a final plan. EMSA has stated that the STAC is
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reviewing the final draft of the State Trauma Plan and that
public comment period would begin shortly.
5)LOS ANGELES COUNTY'S MEASURE B . In order to maintain and
expand the trauma system countywide, to ensure the continued
availability of EMS, and to respond effectively to biological
terrorism, voters in L.A. County approved Measure B in 2002.
With the passage of the measure, the L.A. Board of Supervisors
implemented a parcel tax of $0.03 per square foot on generally
all structural improvements, which it has increased over time.
In fiscal year 2011-12, the measure generated more than $256
million in revenue.
In recent years, concerns have been raised about the
expenditure of Measure B funds and whether they are being
equitably allocated throughout the county. Critics point to
the fact that parts of the area, such as eastern San Gabriel
Valley, are still lacking a trauma center. In 2013 the Joint
Legislative Audit Committee approved an audit by the State
Auditor to examine the spending of Measure B funds in L.A.
County. Among other things, the State Auditor recommended
that the L.A. County Board of Supervisors reinstate the
Measure B oversight committee, which was dissolved in 2004.
The Auditor also recommended that the L.A. County Board of
Supervisors use Measure B funds to engage the American College
of Surgeons to perform a comprehensive assessment, and to
address any identified weaknesses in the trauma system. In
response, the L.A. County Board of Supervisors stated that
they had addressed the region's most pressing trauma needs by
adding two new private trauma hospitals, adding 24/7 air
medical transport services, and by reducing overall mortality
rates in L.A. County since 2002.
6)SUPPORT . The American Federation of State, County and
Municipal Employees writes in support of this bill, stating it
would guarantee that trauma care systems are periodically
reviewed by qualified experts to ensure that they meet high
standards of accessibility.
7)OPPOSITION . The Emergency Medical Services Administrators
Association of California (EMSAAC) opposes this bill due to
the financial burden of mandating an ACS trauma system survey.
EMSAAC states that the cost to LEMSAs could surpass $100,000
for each assessment, and that local jurisdictions would have
no choice but to pass along these costs to hospitals by
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increasing trauma center designation fees. Furthermore,
EMSAAC notes that in meeting the regulatory requirements to
get EMSA approval for a trauma plan, the LEMSAs are already
providing ample data and metrics to assess their functioning.
The California Chapter of the American College of Emergency
Physicians writes than an assessment of the system should be
performed by a body with sufficient expertise to analyze the
varied and numerous needs of the system other than trauma
care, which is beyond the scope of ACS assay. The San Joaquin
County Health Care Services Agency writes that while there may
be value in a LEMSA choosing to use ACS, that decision should
be made at the local level and that imposing this mandate
disregards the local control that the Board of Supervisors and
the LEMSA should appropriately direct and manage.
8)RELATED LEGISLATION . AB 1621 (Lowenthal and Rodriguez)
requires EMSA to develop the State Emergency Medical Services
Data and Information System in order to assess each EMS area
or LEMSAs service area to determine the need for additional
EMS services, coordination of EMS services, and the
effectiveness of EMS. AB 1621 is pending in the Assembly
Appropriations Committee.
9)PREVIOUS LEGISLATION .
a) SB 266 (Romero) of 2005 would have required EMSA to
establish a trauma care advisory committee and required the
committee to develop a statewide trauma care plan by
January 1, 2007. SB 266 was vetoed by Governor
Schwarzenegger, stating " I am directing EMSA, informed by
its Trauma Advisory Committee, to complete its statewide
trauma care plan and provide me recommendations by no later
than June 1, 2006."
b) AB 1988 (Diaz), Chapter 333, Statutes of 2002, requires
EMSA to convene a task force to study the delivery and
provision of EMS. Requires the task force, among other
things, to develop a plan to ensure that all Californians
are served by appropriate coverage areas for emergency and
trauma services and that sufficient numbers of emergency
departments and trauma centers exist to serve each area's
population.
10)POLICY COMMENTS
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a) This bill requires the LEMSAs to incorporate the
recommendations of RTCC and ACS into their trauma plan, and
resubmit to EMSA for approval. The five RTCCs were created
by EMSA in an advisory capacity and do not exist in statute
or regulations. RTCCs are advisory bodies created by the
state. The ACS is a nonprofit entity. This bill requires
the LEMSAs, created by local elected officials, to adopt
the recommendations of these two entities, which would seem
to erode local control of the local trauma system.
b) The State Auditor's report was specific to oversight of
Measure B funds by L.A. County. The Auditor recommended
that the Board of Supervisors, not the LEMSA, engage ACS to
do the assessment. In mandating that LEMSAs and RTCCs
statewide perform this audit, this bill goes beyond the
scope of the Auditor's recommendations. It is unclear if
the recommendation of the auditor is applicable to other
LEMSAs and issues beyond those associated with Measure B
spending.
c) This bill requires implementation of the statewide
trauma system plan by January 1, 2016. In 2005, Governor
Schwarzenegger directed EMSA to "complete its statewide
trauma care plan," and the plan has not yet been finalized.
According to EMSA the plan is in final stages of review
but has not yet been opened to public comment, raising
questions if it is feasible to require implementation of a
plan that does not yet exist. The Committee may want to
consider if it should wait until the contents of the plan
are known before mandating implementation.
d) HHS has issued a guidance document titled, "Model Trauma
System Planning and Evaluation" (MTSPE) that states may use
to self-assess their trauma system. It includes suggested
indicators, benchmarks, and scoring for this evaluation.
Several states, including Texas, Florida, and Ohio have
used this to conduct self-assessments of their trauma
system. The National Association of State Emergency
Medical Services Officials has issued further companion
documents to support use of the MTSPE. The National
Highway Traffic Safety Administration has conducted reviews
of state EMS systems, as it did in Ohio in 1990. This bill
declares that ACS is the only independent, nonprofit
organization that conducts assessment of trauma systems.
The author may wish to consider whether there are other
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agencies capable of doing an audit, or if LEMSAs could
instead perform a self-assessment using federal guidance.
REGISTERED SUPPORT / OPPOSITION :
Support
American Federation of State, County and Municipal Employees,
AFL-CIO
Opposition
California Chapter of the American College of Emergency
Physicians
California Hospital Association
Emergency Medical Services Administrators Association of
California
Emergency Medical Directors Association of California
San Joaquin County Health Care Services Agency
Analysis Prepared by : Dharia McGrew / HEALTH / (916) 319-2097