BILL ANALYSIS                                                                                                                                                                                                    �



                                                                            



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                                        VETO


          Bill No:  SB 535
          Author:   Nielsen (R)
          Amended:  4/17/13
          Vote:     21

           
           SENATE HEALTH COMMITTEE  :  9-0, 4/10/13
          AYES:  Hernandez, Anderson, Beall, De Le�n, DeSaulnier, Monning,  
            Nielsen, Pavley, Wolk

           SENATE APPROPRIATIONS COMMITTEE  :  Senate Rule 28.8

           SENATE FLOOR  :  37-2, 5/29/13
          AYES:  Anderson, Beall, Berryhill, Calderon, Cannella, Corbett,  
            Correa, De Le�n, DeSaulnier, Emmerson, Evans, Fuller, Gaines,  
            Galgiani, Hancock, Hernandez, Hill, Hueso, Huff, Jackson,  
            Knight, Lara, Leno, Lieu, Liu, Monning, Nielsen, Padilla,  
            Pavley, Price, Roth, Steinberg, Walters, Wolk, Wright, Wyland,  
            Yee
          NOES:  Block, Torres
          NO VOTE RECORDED:  Vacancy

           ASSEMBLY FLOOR  :  77-0, 9/3/13 - See last page for vote


           SUBJECT  :    Commission on Emergency Medical Services

           SOURCE  :     California Association of Air Medical Services


           DIGEST  :    This bill increases the membership of the Emergency  
          Medical Services (EMS) Commission from 18 to 20 members.   
          Requires the additional members to be an air ambulance  
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          representative appointed by the Senate Committee on Rules from a  
          list of three names submitted by the California Association of  
          Air Medical services, and a representative appointed by the  
          Speaker of the Assembly from a public agency that provides air  
          rescue and transport.

           ANALYSIS  :    

          Existing law:

          1.Establishes the Emergency Medical Services Authority (EMSA)  
            within the California Health and Human Services Agency, and  
            requires the director of EMSA to be a physician appointed by  
            the Governor.  

          2.Requires EMSA, among other things, to develop planning and  
            implementation guidelines for emergency medical services  
            systems which address specified components, including manpower  
            and training, communications, transportation, system  
            organization and management, data collection and evaluation,  
            and disaster response.

          3.Establishes the EMS Commission within the California Health  
            and Human Services Agency, composed of 18 members appointed by  
            the Governor, the Speaker of the Assembly, and the Senate  
            Committee on Rules to represent specified entities,  
            professions and associations.

          4.Requires the EMS Commission to review and approve regulations,  
            standards and guidelines to be developed by EMSA for  
            implementation of the EMS System and the Prehospital Emergency  
            Medical Care Personnel Act.

          5.Establishes the Emergency Medical Air Transportation Act,  
            which imposes an additional $4 on every Vehicle Code violation  
            to augment Medi-Cal reimbursement rates for medical air  
            transportation services. The penalties provision sunsets on  
            July 1, 2016, and the Emergency Medical Air Transportation Act  
            sunsets on January 1, 2018.

          This bill increases the membership of the EMS Commission from 18  
          to 20 members.  It requires the additional members to be an air  
          ambulance representative appointed by the Senate Committee on  
          Rules from a list of three names submitted by the California  

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          Association of Air Medical services, and a representative  
          appointed by the Speaker of the Assembly from a public agency  
          that provides air rescue and transport.

           Prior Legislation
           
          AB 2394 (Nielsen, 2012), was substantially similar to this bill  
          and was referred to Assembly Health Committee, but did not have  
          a hearing.

          AB 2173 (Beall, Chapter 547, Statutes of 2010), established the  
          Emergency Medical Air Transportation Act, which imposes an  
          additional $4 on every Vehicle Code violation to augment  
          Medi-Cal reimbursement rates for medical air transportation  
          services.  This penalties provision sunsets on July 1, 2016, and  
          the entire bill sunsets on January 1, 2018.

          SB 997 (Ridley-Thomas, Chapter 275, Statutes of 2008), added two  
          members to the EMS Commission:  one employee of CAL-FIRE, and  
          one employee of a city, county or special district that provides  
          fire protection.  Both of these added members are appointed by  
          the Governor from a list of names provided by the California  
          Professional Firefighters.

          AB 2917 (Torrico, Chapter 274, Statutes of 2008), require EMSA  
          to establish and maintain a statewide registry of the status of  
          emergency medical technician (EMT) licenses and certificates, to  
          be used by certifying entities, and requires EMSA to develop  
          standards, guidelines and regulations for certification of  
          specified EMTs.
          
           FISCAL EFFECT  :    Appropriation:  No   Fiscal Com.:  Yes    
          Local:  No

           SUPPORT  :   (Verified  4/30/13)

          California Association of Air Medical Services (source) 

           OPPOSITION  :    (Verified  4/30/13)

          California State Sheriffs' Association
          Los Angeles County Sheriff's Department
          San Bernardino County Sheriff's Office


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           ARGUMENTS IN SUPPORT  :    According to the author, air medical  
          service providers are based all over California. Often a base  
          will cover a 100 mile radius which could include a few counties.  
           Each helicopter usually includes a pilot, a paramedic or EMT  
          and a nurse. Based on this scenario, these providers are  
          regulated by several entities.  First, as an air carrier, they  
          are regulated by the Federal Aviation Authority (FAA).  As an  
          EMS provider, they are regulated by the state and the local EMS  
          authority.  In addition, the pilot is regulated by the FAA and  
          the paramedic or EMT is regulated by the state and local EMS  
          authority.  The nurse is regulated by the Board of Registered  
          Nursing.  Lastly, the landing zones are regulated by the FAA and  
          the California Department of Transportation.

          The author states the primary role of the EMS Commission is to  
          review and approve regulations, standards, and guidelines  
          developed by the California EMS Authority (Authority).  The EMS  
          Commission also advises the Authority with regard to  
          communications, medical equipment, training personnel,  
          facilities and other components of an emergency medical services  
          system.  However, the author states, air ambulance providers do  
          not currently have a voice on this Commission.  The author  
          claims because air ambulance providers are regulated by multiple  
          federal, state and local agencies it is important that these  
          providers are able to clarify how a proposed regulation will  
          affect the provision of air services in the state. 

          This bill is sponsored by the California Association of Air  
          Medical Services (CAAMS), which states the additional members  
          will provide the appropriate representation of this segment of  
          the EMS community at the EMS Commission. According to CAAMS, air  
          medical providers are not represented on the EMS Commission, but  
          are a key provider of emergency medical services. By adding an  
          air medical representatives, these providers will have an  
          opportunity to provide their perspective.
          
           ARGUMENTS IN OPPOSITION  :      The California State Sheriffs'  
          Association (CSSA) opposes this bill, stating that the revision  
          of the EMS Commission's membership could create policies and  
          procedures that would be detrimental to local government and the  
          law enforcement community. For example, limiting fire and  
          sheriff medical transport capabilities and the scope of the type  
          of aircraft local fire and sheriffs fly for rescue. In some  
          counties, CSSA states that these additional member companies are  

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          not part of the local emergency service plan as fire and  
          sheriffs handle rescue and transport, and adding them to the EMS  
          Commission could create policies that work against local rescue  
          efforts.

          The Los Angeles County Sheriff's Department (LACSD) also opposes  
          this bill, stating that in Los Angeles County, the Los Angeles  
          County Fire Department, the City of Los Angeles Fire Department  
          and the LACSD handles all of the rescues and related air  
          transports.  LACSD states that while it is true that private air  
          ambulance members are not represented on the EMS Commission  
          specifically, there is no member of a public agency that  
          specifically provides air rescue and transport either.  LACSD  
          states that it does not believe that the private air ambulance  
          providers should be placed on the EMS Commission.   
          
          GOVERNOR'S VETO MESSAGE:
           
            "I am returning Senate Bill 535 without my signature. 

            The bill seeks to increase the membership of the California  
            Commission on Emergency Medical Services from 18 members to  
            20 members, adding representatives from air ambulance and  
            air rescue and transport. 

            My administration proposed to eliminate this commission in  
            2011, as part of an overall effort to consolidate  
            departments and streamline boards and commissions. For as  
            long as the Commission continues to perform its work, there  
            should be no shortage of expertise or willingness of an  
            18-member body to address all aspects of the system,  
            including air ambulance and air rescue. Any lack of  
            appropriate attention should be remedied by the commission  
            and the public process that is used to address matters of  
            import to the public and other system stakeholders."

          ASSEMBLY FLOOR  :  77-0, 9/3/13
          AYES:  Achadjian, Alejo, Allen, Ammiano, Atkins, Bigelow, Bloom,  
            Bocanegra, Bonilla, Bonta, Bradford, Brown, Buchanan, Ian  
            Calderon, Campos, Chau, Ch�vez, Chesbro, Conway, Cooley,  
            Dahle, Daly, Dickinson, Donnelly, Eggman, Fong, Fox, Frazier,  
            Beth Gaines, Garcia, Gatto, Gomez, Gonzalez, Gordon, Gorell,  
            Gray, Grove, Hagman, Harkey, Roger Hern�ndez, Holden, Jones,  
            Jones-Sawyer, Levine, Linder, Logue, Lowenthal, Maienschein,  

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            Mansoor, Medina, Melendez, Mitchell, Morrell, Mullin,  
            Muratsuchi, Nazarian, Nestande, Olsen, Pan, Patterson, Perea,  
            V. Manuel P�rez, Quirk, Quirk-Silva, Rendon, Salas, Skinner,  
            Stone, Ting, Wagner, Waldron, Weber, Wieckowski, Wilk,  
            Williams, Yamada, John A. P�rez
          NO VOTE RECORDED:  Hall, Vacancy, Vacancy


          JL:nld  1/6/14   Senate Floor Analyses 

                           SUPPORT/OPPOSITION:  SEE ABOVE

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