BILL ANALYSIS Ó
AB 1975
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Date of Hearing: May 14, 2014
ASSEMBLY COMMITTEE ON APPROPRIATIONS
Mike Gatto, Chair
AB 1975 (Hernández) - As Amended: May 7, 2014
Policy Committee: HealthVote:11-6
Urgency: No State Mandated Local Program:
No Reimbursable: No
SUMMARY
This bill requires the Emergency Medical Services Authority
(EMSA) and local EMS agencies implementing trauma care systems
to perform specified planning and reporting activities.
Specifically, this bill:
1)Requires EMSA to develop a statewide trauma plan that
addresses all aspects of a trauma care system.
2)Appropriates $500,000 to EMSA to implement a data collection
system for conducting trauma assessments across the state, and
specifies funds shall be used for staff, setup of electronic
data collection, materials, and associated costs.
3)Requires local EMS agencies to commission an independent
nonprofit organization or governmental entity qualified to
assess trauma systems to conduct a comprehensive regional
assessment of equitability and access to its trauma system at
least once every five years.
4)Requires local EMS agencies implementing a trauma care system
to incorporate recommendations of regional trauma coordinating
committees (RTCCs) into their trauma care plans.
FISCAL EFFECT
1)State costs in the range of $500,000 GF one-time to develop
and populate a data collection system. Although it is not
mandated, ongoing staff and information technology (IT) costs
in the low hundreds of dollars GF annually could also be
incurred to support such a system. Costs would depend on the
ambitiousness and sophistication of the system.
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2)EMSA is already in the process of creating a statewide trauma
plan, so development of a plan as mandated by this bill should
not result in additional costs.
3)Potential state-reimbursable mandate costs of more than $2
million GF every five years associated with a new requirement
on local EMS agencies for comprehensive regional assessments.
Additional staff costs in the same range may be incurred by
local EMS agencies to support such assessments, but it is
unclear whether these costs will be reimbursable.
COMMENTS
1)Purpose . According to the author, this bill would create a new
state standard for EMSA certification by requiring LEMSAs to
commission 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, and also suggests
independent assessment would benefit EMS systems statewide.
2)Responsibilities for Trauma Care Systems . 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 minimum standards set
by EMSA.
California has 33 local EMS agencies: seven regional
multi-county systems and 25 single-county agencies. Local EMS
agencies 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.
3)RTCCs . In 2008, EMSA defined five regions and created
corresponding RTCCs composed of trauma system providers, local
EMS agency staff, and trauma system stakeholders from within
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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 local EMS agencies to
develop regional policies and protocols in support of the
state trauma system.
4)L.A. County's Measure B . In order to maintain, expand, and
improve the trauma system countywide, L.A. County approved
Measure B in 2002. In recent years, concerns have been raised
about the expenditure of Measure B funds and whether they are
being equitably allocated throughout the county. A February
2014 State Auditor report recommended the L.A. County Board of
Supervisors reinstate a defunct oversight committee, and that
Measure B funds be used to engage the American College of
Surgeons (ACS) to perform a comprehensive assessment of the
trauma system. A previous version of this bill would have
required each local EMS agency to commission an assessment by
ACS.
5)Opposition . Local ESM agencies and counties oppose this bill,
indicating the current framework governing trauma care is
transparent, accountable, and has served to support robust
local EMS systems for decades. They believe this bill would
upend this system by requiring local EMS agencies to
incorporate RTCC recommendations into their trauma care plans
while imposing additional mandates and costs. They argue that
while they collaborate through RTCCs, local EMS agencies
should not be forced to cede authority over system planning
and design to these committees. They further explain that
RTCCs are informal, voluntary committees that serve as a forum
to share best practices for trauma care, but lack a standard
structure or any function established in regulations.
Analysis Prepared by : Lisa Murawski / APPR. / (916) 319-2081