AB 1931: Emergency medical services: paramedics: discipline.
- Session Year: 2015-2016
- House: Assembly
- Latest Version Date: 2016-04-25
Under existing law, the Emergency Medical Services System and the Prehospital Emergency Medical Care Personnel Act, the Emergency Medical Services Authority is responsible for establishing training, scope of practice, and continuing education for emergency medical technicians and other prehospital personnel, including Emergency Medical Technician-I (EMT-I), Emergency Medical Technician-II (EMT-II), and Emergency Medical Technician Paramedic (EMT-P) designations. The act authorizes an employer of an EMT-I or EMT-II to conduct investigations and take disciplinary action against an EMT-I or EMT-II who is employed by that employer for specified conduct, and authorizes the authority to, among other things, deny, suspend, or revoke any EMT-P license for the same specified conduct. Existing law requires an EMT-Ps employer to report in writing to the local EMS agency and the authority within 30 days of specified disciplinary action being taken with regard to an EMT-P.
This bill would require the authority to develop and adopt guidelines for disciplinary orders, temporary suspensions, and conditions of probation for EMT-P licenseholders. The bill would also integrate and conform the procedures for investigating misconduct of EMT-P licenseholders with those of EMT-I and EMT-II certificate holders, including requiring notification of disciplinary action with regard to an EMT-P to be given to the local EMS agency and the authority within 3 days.
Existing law authorizes the medical director of the local EMS agency to evaluate information that comes to his or her attention that appears to constitute grounds for disciplinary action against an EMT-P and to make a recommendation to the authority for further investigation or discipline. Existing law also authorizes the temporary suspension, in specified circumstances, of an EMT-P license.
This bill would require the medical director of the local EMS agency, if he or she makes a recommendation to the authority for further investigation or discipline, to notify the EMT-Ps employer within 3 days. The bill would additionally require notification of the EMT-Ps employer when there is a temporary suspension of an EMT-Ps license.
Under existing law, the Emergency Medical Services System and the Prehospital Emergency Medical Care Personnel Act, the Emergency Medical Services Authority is responsible for establishing training, scope of practice, and continuing education for emergency medical technicians and other prehospital personnel, including Emergency Medical Technician-I (EMT-I), Emergency Medical Technician-II (EMT-II), and Emergency Medical Technician Paramedic (EMT-P) designations. The act authorizes an employer of an EMT-I or EMT-II to conduct investigations and take disciplinary action against an EMT-I or EMT-II who is employed by that employer for specified conduct, and authorizes the authority to, among other things, deny, suspend, or revoke any EMT-P license for the same specified conduct. Existing law requires an EMT-Ps employer to report in writing to the local EMS agency and the authority within 30 days of specified disciplinary action being taken with regard to an EMT-P.
This bill would make a technical, nonsubstantive change to that provision. require the authority to develop and adopt guidelines for disciplinary orders, temporary suspensions, and conditions of probation for EMT-P licenseholders. The bill would also integrate and conform the procedures for investigating misconduct of EMT-P licenseholders with those of EMT-I and EMT-II certificate holders, including requiring notification of disciplinary action with regard to an EMT-P to be given to the local EMS agency and the authority within 3 days.
Existing law authorizes the medical director of the local EMS agency to evaluate information that comes to his or her attention that appears to constitute grounds for disciplinary action against an EMT-P and to make a recommendation to the authority for further investigation or discipline. Existing law also authorizes the temporary suspension, in specified circumstances, of an EMT-P license.
This bill would require the medical director of the local EMS agency, if he or she makes a recommendation to the authority for further investigation or discipline, to notify the EMT-Ps employer within 3 days. The bill would additionally require notification of the EMT-Ps employer when there is a temporary suspension of an EMT-Ps license.
Under existing law, the Emergency Medical Services System and the Prehospital Emergency Medical Care Personnel Act, the Emergency Medical Services Authority is responsible for establishing training, scope of practice, and continuing education for emergency medical technicians and other prehospital personnel, including Emergency Medical Technician-I (EMT-I), Emergency Medical Technician-II (EMT-II), and Emergency Medical Technician Paramedic (EMT-P) designations. The act authorizes an employer of an EMT-I or EMT-II to conduct investigations and take disciplinary action against an EMT-I or EMT-II who is employed by that employer for specified conduct, and authorizes the authority to, among other things, deny, suspend, or revoke any EMT-P license for the same specified conduct.
This bill would make a technical, nonsubstantive change to that provision.
The authority shall develop and, after approval by the commission pursuant to Section 1799.50, adopt all of the following:
(a)Guidelines for disciplinary orders, temporary suspensions, and conditions of probation for EMT-I and EMT-II certificate holders and EMT-P licenseholders that protect the public health and safety.
(b)Regulations for the issuance of EMT-I and EMT-II certificates by a certifying entity that protect the public health and safety.
(c)Regulations for the recertification of EMT-I and EMT-II certificate holders that protect the public health and safety.
(d)Regulations for disciplinary processes for EMT-I and EMT-II applicants and certificate holders that protect the public health and safety. These disciplinary processes shall be in accordance with Chapter 5 (commencing with Section 11500) of Part 1 of Division 3 of Title 2 of the Government Code.
SEC. 2.Section 1798.200 of the Health and Safety Code is amended to read:1798.200.(a)(1)(A)Except as provided in paragraph (2), an employer of an EMT-I, EMT-II, or EMT-P may conduct investigations, as necessary, and take disciplinary action against an EMT-I, EMT-II, or EMT-P who is employed by that employer for conduct in violation of subdivision (c). The employer shall notify the regulating entity within three days when an allegation has been validated as a potential violation of subdivision (c).
(B)Each employer of an EMT-I, EMT-II, or EMT-P shall notify the regulating entity within three days after the EMT-I, EMT-II, or EMT-P is terminated or suspended for a disciplinary cause, the EMT-I, EMT-II, or EMT-P resigns following notification of an impending investigation based upon evidence that would indicate the existence of a disciplinary cause, or the EMT-I, EMT-II, or EMT-P is removed from EMT-related duties for a disciplinary cause after the completion of the employers investigation. The employer of an EMT-P shall provide the regulating entity with all supporting documentation at the time of notification.
(C)At the conclusion of an investigation, the employer may develop and implement, in accordance with the guidelines for disciplinary orders, temporary suspensions, and conditions of probation adopted pursuant to Section 1797.184, a disciplinary plan for the EMT-I, EMT-II, or EMT-P. Upon adoption of the disciplinary plan, the employer shall submit that plan to the regulating entity within three working days. The employers disciplinary plan may include a recommendation that the director consider taking action against the holders certificate or license pursuant to paragraph (3).
(2)If an EMT-I, EMT-II, or EMT-P is not employed by an ambulance service licensed by the Department of the California Highway Patrol or a public safety agency, or if that ambulance service or public safety agency chooses not to conduct an investigation pursuant to paragraph (1) for conduct in violation of subdivision (c), the director shall conduct the investigations, and, upon a determination of disciplinary cause, take disciplinary action as necessary against the EMT-I, EMT-II, or EMT-P. At the conclusion of these investigations, the director shall develop and implement, in accordance with the recommended guidelines for disciplinary orders, temporary orders, and conditions of probation adopted pursuant to Section 1797.184, a disciplinary plan for the EMT-I, EMT-II, or EMT-P. The directors disciplinary plan may include action against the holders certificate or license pursuant to paragraph (3).
(3)The director may, upon a determination of disciplinary cause and in accordance with regulations for disciplinary processes adopted pursuant to Section 1797.184, deny, suspend, or revoke any EMT-I or EMT-II certificate or EMT-P license issued under this division, or may place an EMT-I or EMT-II certificate holder or EMT-P licenseholder on probation, upon the finding by the director of the occurrence of any of the actions listed in subdivision (c) and the occurrence of one of the following:
(A)The employer, after conducting an investigation, failed to impose discipline for the conduct under investigation, or the director makes a determination that the discipline imposed was not according to the guidelines for disciplinary orders and conditions of probation and the conduct of the EMT-I or EMT-II certificate holder or EMT-P licenseholder constitutes grounds for disciplinary action against the holders certificate or license.
(B)Either the employer further determines, after an investigation conducted under paragraph (1), or the director determines after an investigation conducted under paragraph (2), that the conduct requires disciplinary action against the holders certificate or license.
(4)The director, after consultation with the employer, may temporarily suspend, prior to a hearing, an EMT-I or EMT-II certificate, an EMT-P license, or a combination thereof upon a determination that both of the following conditions have been met:
(A)The certificate holder or licenseholder has engaged in acts or omissions that constitute grounds for revocation of the EMT-I or EMT-II certificate or EMT-P license.
(B)Permitting the certificate holder or licenseholder to continue to engage in the regulated activity without restriction would pose an imminent threat to the public health or safety.
(5)If the director temporarily suspends a certificate or license, the regulating entity shall notify the certificate holder or licenseholder that his or her certificate or license is suspended and shall identify the reasons therefor. Within three working days of the initiation of the suspension by the regulating entity, the regulating entity and employer shall jointly investigate the allegation in order for the regulating entity to make a determination of the continuation of the temporary suspension. All investigatory information not otherwise protected by law held by the regulating entity and employer shall be shared between the parties via facsimile transmission or overnight mail relative to the decision to temporarily suspend. The regulating entity shall decide, within 15 calendar days, whether to serve the certificate holder or licenseholder with an accusation pursuant to Chapter 5 (commencing with Section 11500) of Part 1 of Division 3 of Title 2 of the Government Code. If the certificate holder or licenseholder files a notice of defense, the hearing shall be held within 30 days of the regulating entitys receipt of the notice of defense. The temporary suspension order shall be deemed vacated if the regulating entity fails to make a final determination on the merits within 15 days after the administrative law judge renders the proposed decision.
(6)The director shall refer, for investigation and discipline, any complaint received on an EMT-I, EMT-II, or EMT-P to the relevant employer within three days of receipt of the complaint, pursuant to subparagraph (A) of paragraph (1) of subdivision (a).
(b)For purposes of this section, the following definitions shall apply:
(1)Director means either of the following:
(A)For purposes of EMT-I or EMT-II certificate holders, the medical director of the local EMS agency that has jurisdiction in the county in which the alleged violation occurred. jurisdiction.
(B)For purposes of EMT-P licenseholders, the Director of the Emergency Medical Services Authority.
(2)Regulating entity means either of the following:
(A)For purposes of EMT-I and EMT-II certificate holders, the local EMS agency that has jurisdiction in the county in which the alleged violation occurred. jurisdiction.
(B)For purposes of EMT-P licenseholders, the EMS Authority. When requiring a report or notification regarding an EMT-P, regulating entity refers to both the local EMS agency that has jurisdiction in the county in which the alleged violation occurred jurisdiction and the EMS Authority.
(c)Any of the following actions shall be considered evidence of a threat to the public health and safety and may result in the denial, suspension, or revocation of a certificate or license issued under this division, or in the placement on probation of a certificate holder or licenseholder under this division:
(1)Fraud in the procurement of any certificate or license under this division.
(2)Gross negligence.
(3)Repeated negligent acts.
(4)Incompetence.
(5)The commission of any fraudulent, dishonest, or corrupt act that is substantially related to the qualifications, functions, and duties of prehospital personnel.
(6)Conviction of any crime that is substantially related to the qualifications, functions, and duties of prehospital personnel. The record of conviction or a certified copy of the record shall be conclusive evidence of the conviction.
(7)Violating or attempting to violate directly or indirectly, or assisting in or abetting the violation of, or conspiring to violate, any provision of this division or the regulations adopted by the authority pertaining to prehospital personnel.
(8)Violating or attempting to violate any federal or state statute or regulation that regulates narcotics, dangerous drugs, or controlled substances.
(9)Addiction to, the excessive use of, or the misuse of, alcoholic beverages, narcotics, dangerous drugs, or controlled substances.
(10)Functioning outside the supervision of medical control in the field care system operating at the local level, except as authorized by any other license or certification.
(11)Demonstration of irrational behavior or occurrence of a physical disability to the extent that a reasonable and prudent person would have reasonable cause to believe that the ability to perform the duties normally expected may be impaired.
(12)Unprofessional conduct exhibited by any of the following:
(A)The mistreatment or physical abuse of any patient resulting from force in excess of what a reasonable and prudent person trained and acting in a similar capacity while engaged in the performance of his or her duties would use if confronted with a similar circumstance. Nothing in this section shall be deemed to prohibit an EMT-I, EMT-II, or EMT-P from assisting a peace officer, or a peace officer who is acting in the dual capacity of peace officer and EMT-I, EMT-II, or EMT-P, from using that force that is reasonably necessary to effect a lawful arrest or detention.
(B)The failure to maintain confidentiality of patient medical information, except as disclosure is otherwise permitted or required by law in Part 2.6 (commencing with Section 56) of Division 1 of the Civil Code.
(C)The commission of any sexually related offense specified under Section 290 of the Penal Code.
(d)The information shared among EMT-I, EMT-II, and EMT-P employers, medical directors of local EMS agencies, the authority, and EMT-I and EMT-II certifying entities shall be deemed to be an investigative communication that is exempt from public disclosure as a public record pursuant to subdivision (f) of Section 6254 of the Government Code. A formal disciplinary action against an EMT-I, EMT-II, or EMT-P shall be considered a public record available to the public, unless otherwise protected from disclosure pursuant to state or federal law.
(e)For purposes of this section, disciplinary cause means only an action that is substantially related to the qualifications, functions, and duties of an EMT-I, EMT-II, or EMT-P and is evidence of a threat to the public health and safety described in subdivision (c).
(f)The reporting requirements of subdivision (a) do not require or authorize the release of information or records of an EMT-P who is also a peace officer protected by Section 832.7 of the Penal Code.
(g)Proceedings against any EMT-P licenseholder shall be held in accordance with Chapter 5 (commencing with Section 11500) of Part 1 of Division 3 of Title 2 of the Government Code.
(h)(1)Pursuant to subdivision (i) of Section 1798.24 of the Civil Code, upon notification to the EMT-P, the EMS Authority may share the results of its investigation pursuant to subdivision (a) with the employer, a prospective employer when requested, in writing, as part of a preemployment background check, or the local EMS agency.
(2)An EMT-P licensee or applicant to whom the information pertains, as set forth in subdivision (a) of Section 1798.24 of the Civil Code, may view the contents of a closed investigation file upon request during the EMS Authoritys regular business hours.
SEC. 3.Section 1798.201 of the Health and Safety Code is amended to read:1798.201.(a) When information comes to the attention of the medical director of the local EMS agency that an EMT-P licenseholder has committed any act or omission that appears to constitute grounds for disciplinary action under this division, the medical director of the local EMS agency may evaluate the information to determine if there is reason to believe that disciplinary action may be necessary.
(b) If the medical director sends a recommendation to the authority for further investigation or discipline of the licenseholder, the medical director shall also notify, within three days, the EMT-Ps employer. The recommendation to the authority and the notification sent to the employer shall include all documentary evidence collected by the medical director in evaluating whether or not to make that recommendation. The recommendation and accompanying evidence shall be deemed in the nature of an investigative communication and be protected by Section 6254 of the Government Code. In deciding what level of disciplinary action is appropriate in the case, the authority shall consult with the medical director of the local EMS agency.
SEC. 4.Section 1798.202 of the Health and Safety Code is amended to read:1798.202.(a) The director of the authority or the medical director of the local EMS agency, after consultation with the relevant employer, may temporarily suspend, prior to hearing, an EMT-P license upon a determination that: (1) the licensee has engaged in acts or omissions that constitute grounds for revocation of the EMT-P license; and (2) permitting the licensee to continue to engage in the licensed activity, or permitting the licensee to continue in the licensed activity without restriction, would present an imminent threat to the public health or safety. When the suspension is initiated by the local EMS agency, subdivision (b) shall apply. When the suspension is initiated by the director of the authority, subdivision (c) shall apply.
(b) The local EMS agency shall notify the licensee that his or her EMT-P license is suspended and shall identify the reasons therefor. Within three working days of the initiation of the suspension by the local EMS agency, the agency shall transmit to the authority and the EMT-Ps employer, via facsimile transmission or overnight mail, all documentary evidence collected by the local EMS agency relative to the decision to temporarily suspend. Within two working days of receipt of the local EMS agencys documentary evidence, the director of the authority shall determine the need for the licensure action. Part of that determination shall include an evaluation of the need for continuance of the suspension during the licensure action review process. If the director of the authority determines that the temporary suspension order should not continue, the authority shall immediately notify the licensee and his or her employer that the temporary suspension is lifted. If the director of the authority determines that the temporary suspension order should continue, the authority shall immediately notify the licensee and his or her employer of the decision to continue the temporary suspension and shall, within 15 calendar days of receipt of the EMS agencys documentary evidence, serve the licensee with a temporary suspension order and accusation pursuant to Chapter 5 (commencing with Section 11500) of Part 1 of Division 3 of Title 2 of the Government Code.
(c) The director of the authority shall initiate a temporary suspension with the filing of a temporary suspension order and accusation pursuant to Chapter 5 (commencing with Section 11500) of Part 1 of Division 3 of Title 2 of the Government Code and shall notify the director of the local EMS agency, and the relevant employer.
(d) If the licensee files a notice of defense, the hearing shall be held within 30 days of the authoritys receipt of the notice of defense. The temporary suspension order shall be deemed vacated if the authority fails to make a final determination on the merits within 15 days after the administrative law judge renders the proposed decision.
SEC. 5.Section 1799.112 of the Health and Safety Code is repealed.The authority shall develop and, after approval by the commission pursuant to Section 1799.50, adopt all of the following:
(a)Guidelines for disciplinary orders, temporary suspensions, and conditions of probation for EMT-I and EMT-II certificate holders and EMT-P licenseholders that protects protect the public health and safety.
(b)Regulations for the issuance of EMT-I and EMT-II certificates by a certifying entity that protects protect the public health and safety.
(c)Regulations for the recertification of EMT-I and EMT-II certificate holders that protect the public health and safety.
(d)Regulations for disciplinary processes for EMT-I and EMT-II applicants and certificate holders that protect the public health and safety. These disciplinary processes shall be in accordance with Chapter 5 (commencing with Section 11500) of Part 1 of Division 3 of Title 2 of the Government Code.
SECTION 1.SEC. 2.Section 1798.200 of the Health and Safety Code is amended to read:1798.200.(a)(1)(A)Except as provided in paragraph (2), an employer of an EMT-I or EMT-II EMT-I, EMT-II, or EMT-P may conduct investigations, as necessary, and take disciplinary action against an EMT-I or EMT-II EMT-I, EMT-II, or EMT-P who is employed by that employer for conduct in violation of subdivision (c). The employer shall notify the medical director of the local EMS agency that has jurisdiction in the county in which the alleged violation occurred regulating entity within three days when an allegation has been validated as a potential violation of subdivision (c).
(B)Each employer of an EMT-I or EMT-II employee EMT-I, EMT-II, or EMT-P shall notify the medical director of the local EMS agency that has jurisdiction in the county in which a violation related to subdivision (c) occurred regulating entity within three days after the EMT-I or EMT-II EMT-I, EMT-II, or EMT-P is terminated or suspended for a disciplinary cause, the EMT-I or EMT-II EMT-I, EMT-II, or EMT-P resigns following notification of an impending investigation based upon evidence that would indicate the existence of a disciplinary cause, or the EMT-I or EMT-II EMT-I, EMT-II, or EMT-P is removed from EMT-related duties for a disciplinary cause after the completion of the employers investigation. The employer of an EMT-P shall provide the regulating entity with all supporting documentation at the time of notification.
(C)At the conclusion of an investigation, the employer of an EMT-I or EMT-II may develop and implement, in accordance with the guidelines for disciplinary orders, temporary suspensions, and conditions of probation adopted pursuant to Section 1797.184, a disciplinary plan for the EMT-I or EMT-II. EMT-I, EMT-II, or EMT-P. Upon adoption of the disciplinary plan, the employer shall submit that plan to the local EMS agency regulating entity within three working days. The employers disciplinary plan may include a recommendation that the medical director of the local EMS agency consider taking action against the holders certificate or license pursuant to paragraph (3).
(2)If an EMT-I or EMT-II EMT-I, EMT-II, or EMT-P is not employed by an ambulance service licensed by the Department of the California Highway Patrol or a public safety agency agency, or if that ambulance service or public safety agency chooses not to conduct an investigation pursuant to paragraph (1) for conduct in violation of subdivision (c), the medical director of a local EMS agency shall conduct the investigations, and, upon a determination of disciplinary cause, take disciplinary action as necessary against the EMT-I or EMT-II. EMT-I, EMT-II, or EMT-P. At the conclusion of these investigations, the medical director shall develop and implement, in accordance with the recommended guidelines for disciplinary orders, temporary orders, and conditions of probation adopted pursuant to Section 1797.184, a disciplinary plan for the EMT-I or EMT-II. EMT-I, EMT-II, or EMT-P. The medical directors disciplinary plan may include action against the holders certificate or license pursuant to paragraph (3).
(3)The medical director of the local EMS agency may, upon a determination of disciplinary cause and in accordance with regulations for disciplinary processes adopted pursuant to Section 1797.184, deny, suspend, or revoke any EMT-I or EMT-II certificate or EMT-P license issued under this division, or may place any an EMT-I or EMT-II certificate holder or EMT-P licenseholder on probation, upon the finding by that medical the director of the occurrence of any of the actions listed in subdivision (c) and the occurrence of one of the following:
(A)The EMT-I or EMT-II employer, after conducting an investigation, failed to impose discipline for the conduct under investigation, or the medical director makes a determination that the discipline imposed was not according to the guidelines for disciplinary orders and conditions of probation and the conduct of the EMT-I or EMT-II certificate holder or EMT-P licenseholder constitutes grounds for disciplinary action against the certificate. holders certificate or license.
(B)Either the employer of an EMT-I or EMT-II further determines, after an investigation conducted under paragraph (1), or the medical director determines after an investigation conducted under paragraph (2), that the conduct requires disciplinary action against the certificate. holders certificate or license.
(4)The medical director of the local EMS agency, director, after consultation with the employer of an EMT-I or EMT-II, employer, may temporarily suspend, prior to a hearing, any an EMT-I or EMT-II certificate or both EMT-I and EMT-II certificates certificate, an EMT-P license, or a combination thereof upon a determination that both of the following conditions have been met:
(A)The certificate holder or licenseholder has engaged in acts or omissions that constitute grounds for revocation of the EMT-I or EMT-II certificate. certificate or EMT-P license.
(B)Permitting the certificate holder or licenseholder to continue to engage in the certified regulated activity without restriction would pose an imminent threat to the public health or safety.
(5)If the medical director of the local EMS agency temporarily suspends a certificate, certificate or license, the local EMS agency regulating entity shall notify the certificate holder or licenseholder that his or her EMT-I or EMT-II certificate or license is suspended and shall identify the reasons therefor. Within three working days of the initiation of the suspension by the local EMS agency, the agency regulating entity, the regulating entity and employer shall jointly investigate the allegation in order for the agency regulating entity to make a determination of the continuation of the temporary suspension. All investigatory information not otherwise protected by law held by the agency regulating entity and employer shall be shared between the parties via facsimile transmission or overnight mail relative to the decision to temporarily suspend. The local EMS agency regulating entity shall decide, within 15 calendar days, whether to serve the certificate holder or licenseholder with an accusation pursuant to Chapter 5 (commencing with Section 11500) of Part 1 of Division 3 of Title 2 of the Government Code. If the certificate holder or licenseholder files a notice of defense, the hearing shall be held within 30 days of the local EMS agencys regulating entitys receipt of the notice of defense. The temporary suspension order shall be deemed vacated if the local EMS agency regulating entity fails to make a final determination on the merits within 15 days after the administrative law judge renders the proposed decision.
(6)The medical director of the local EMS agency shall refer, for investigation and discipline, any complaint received on an EMT-I or EMT-II EMT-I, EMT-II, or EMT-P to the relevant employer within three days of receipt of the complaint, pursuant to subparagraph (A) of paragraph (1) of subdivision (a).
(b)The authority may deny, suspend, or revoke any EMT-P license issued under this division, or may place any EMT-P license issued under this division, or may place any EMT-P licenseholder on probation upon the finding by the director of the occurrence of any of the actions listed in subdivision (c). Proceedings against any EMT-P license or licenseholder shall be held in accordance with Chapter 5 (commencing with Section 11500) of Part 1 of Division 3 of Title 2 of the Government Code.
(b)For purposes of this section, the following definitions shall apply:
(1)Director means either of the following:
(A)For purposes of EMT-I or EMT-II certificate holders, the medical director of the local EMS agency that has jurisdiction in the county in which the alleged violation occurred.
(B)For purposes of EMT-P licenseholders, the Director of the Emergency Medical Services Authority.
(2)Regulating entity means either of the following:
(A)For purposes of EMT-I and EMT-II certificate holders, the local EMS agency that has jurisdiction in the county in which the alleged violation occurred.
(B)For purposes of EMT-P licenseholders, the EMS Authority. When requiring a report or notification regarding an EMT-P, regulating entity refers to both the local EMS agency that has jurisdiction in the county in which the alleged violation occurred and the EMS Authority.
(c)Any of the following actions shall be considered evidence of a threat to the public health and safety and may result in the denial, suspension, or revocation of a certificate or license issued under this division, or in the placement on probation of a certificate holder or licenseholder under this division:
(1)Fraud in the procurement of any certificate or license under this division.
(2)Gross negligence.
(3)Repeated negligent acts.
(4)Incompetence.
(5)The commission of any fraudulent, dishonest, or corrupt act that is substantially related to the qualifications, functions, and duties of prehospital personnel.
(6)Conviction of any crime that is substantially related to the qualifications, functions, and duties of prehospital personnel. The record of conviction or a certified copy of the record shall be conclusive evidence of the conviction.
(7)Violating or attempting to violate directly or indirectly, or assisting in or abetting the violation of, or conspiring to violate, any provision of this division or the regulations adopted by the authority pertaining to prehospital personnel.
(8)Violating or attempting to violate any federal or state statute or regulation that regulates narcotics, dangerous drugs, or controlled substances.
(9)Addiction to, the excessive use of, or the misuse of, alcoholic beverages, narcotics, dangerous drugs, or controlled substances.
(10)Functioning outside the supervision of medical control in the field care system operating at the local level, except as authorized by any other license or certification.
(11)Demonstration of irrational behavior or occurrence of a physical disability to the extent that a reasonable and prudent person would have reasonable cause to believe that the ability to perform the duties normally expected may be impaired.
(12)Unprofessional conduct exhibited by any of the following:
(A)The mistreatment or physical abuse of any patient resulting from force in excess of what a reasonable and prudent person trained and acting in a similar capacity while engaged in the performance of his or her duties would use if confronted with a similar circumstance. Nothing in this section shall be deemed to prohibit an EMT-I, EMT-II, or EMT-P from assisting a peace officer, or a peace officer who is acting in the dual capacity of peace officer and EMT-I, EMT-II, or EMT-P, from using that force that is reasonably necessary to effect a lawful arrest or detention.
(B)The failure to maintain confidentiality of patient medical information, except as disclosure is otherwise permitted or required by law in Part 2.6 (commencing with Section 56) of Division 1 of the Civil Code.
(C)The commission of any sexually related offense specified under Section 290 of the Penal Code.
(d)The information shared among EMT-I, EMT-II, and EMT-P employers, medical directors of local EMS agencies, the authority, and EMT-I and EMT-II certifying entities shall be deemed to be an investigative communication that is exempt from public disclosure as a public record pursuant to subdivision (f) of Section 6254 of the Government Code. A formal disciplinary action against an EMT-I, EMT-II, or EMT-P shall be considered a public record available to the public, unless otherwise protected from disclosure pursuant to state or federal law.
(e)For purposes of this section, disciplinary cause means only an act action that is substantially related to the qualifications, functions, and duties of an EMT-I, EMT-II, or EMT-P and is evidence of a threat to the public health and safety described in subdivision (c).
(f)The reporting requirements of subdivision (a) do not require or authorize the release of information or records of an EMT-P who is also a peace officer protected by Section 832.7 of the Penal Code.
(g)Proceedings against any EMT-P licenseholder shall be held in accordance with Chapter 5 (commencing with Section 11500) of Part 1 of Division 3 of Title 2 of the Government Code.
(h)(1)Pursuant to subdivision (i) of Section 1798.24 of the Civil Code, upon notification to the EMT-P, the EMS Authority may share the results of its investigation pursuant to subdivision (a) with the employer, a prospective employer when requested, in writing, as part of a preemployment background check, or the local EMS agency.
(2)An EMT-P licensee or applicant to whom the information pertains, as set forth in subdivision (a) of Section 1798.24 of the Civil Code, may view the contents of a closed investigation file upon request during the EMS Authoritys regular business hours.
SEC. 3.Section 1798.201 of the Health and Safety Code is amended to read:1798.201.(a) When information comes to the attention of the medical director of the local EMS agency that an EMT-P licenseholder has committed any act or omission that appears to constitute grounds for disciplinary action under this division, the medical director of the local EMS agency may evaluate the information to determine if there is reason to believe that disciplinary action may be necessary.
(b) If the medical director sends a recommendation to the authority for further investigation or discipline of the licenseholder, the recommendation medical director shall also notify, within three days, the EMT-Ps employer. The recommendation to the authority and the notification sent to the employer shall include all documentary evidence collected by the medical director in evaluating whether or not to make that recommendation. The recommendation and accompanying evidence shall be deemed in the nature of an investigative communication and be protected by Section 6254 of the Government Code. In deciding what level of disciplinary action is appropriate in the case, the authority shall consult with the medical director of the local EMS agency.
SEC. 4.Section 1798.202 of the Health and Safety Code is amended to read:1798.202.(a) The director of the authority or the medical director of the local EMS agency, after consultation with the relevant employer, may temporarily suspend, prior to hearing, any an EMT-P license upon a determination that: (1) the licensee has engaged in acts or omissions that constitute grounds for revocation of the EMT-P license; and (2) permitting the licensee to continue to engage in the licensed activity, or permitting the licensee to continue in the licensed activity without restriction, would present an imminent threat to the public health or safety. When the suspension is initiated by the local EMS agency, subdivision (b) shall apply. When the suspension is initiated by the director of the authority, subdivision (c) shall apply.
(b) The local EMS agency shall notify the licensee that his or her EMT-P license is suspended and shall identify the reasons therefor. Within three working days of the initiation of the suspension by the local EMS agency, the agency shall transmit to the authority, authority and the EMT-Ps employer, via facsimile transmission or overnight mail, all documentary evidence collected by the local EMS agency relative to the decision to temporarily suspend. Within two working days of receipt of the local EMS agencys documentary evidence, the director of the authority shall determine the need for the licensure action. Part of that determination shall include an evaluation of the need for continuance of the suspension during the licensure action review process. If the director of the authority determines that the temporary suspension order should not continue, the authority shall immediately notify the licensee and his or her employer that the temporary suspension is lifted. If the director of the authority determines that the temporary suspension order should continue, the authority shall immediately notify the licensee and his or her employer of the decision to continue the temporary suspension and shall, within 15 calendar days of receipt of the EMS agencys documentary evidence, serve the licensee with a temporary suspension order and accusation pursuant to Chapter 5 (commencing with Section 11500) of Part 1 of Division 3 of Title 2 of the Government Code.
(c) The director of the authority shall initiate a temporary suspension with the filing of a temporary suspension order and accusation pursuant to Chapter 5 (commencing with Section 11500) of Part 1 of Division 3 of Title 2 of the Government Code and shall notify the director of the local EMS agency, and the relevant employer.
(d) If the licensee files a notice of defense, the hearing shall be held within 30 days of the authoritys receipt of the notice of defense. The temporary suspension order shall be deemed vacated if the authority fails to make a final determination on the merits within 15 days after the administrative law judge renders the proposed decision.
SEC. 5.Section 1799.112 of the Health and Safety Code is repealed.1799.112.(a)EMT-P employers shall report in writing to the local EMS agency medical director and the authority and provide all supporting documentation within 30 days of whenever any of the following actions are taken:
(1)An EMT-P is terminated or suspended for disciplinary cause or reason.
(2)An EMT-P resigns following notice of an impending investigation based upon evidence indicating disciplinary cause or reason.
(3)An EMT-P is removed from paramedic duties for disciplinary cause or reason following the completion of an internal investigation.
(b)The reporting requirements of subdivision (a) do not require or authorize the release of information or records of an EMT-P who is also a peace officer protected by Section 832.7 of the Penal Code.
(c)For purposes of this section, disciplinary cause or reason means only an action that is substantially related to the qualifications, functions, and duties of a paramedic and is considered evidence of a threat to the public health and safety as identified in subdivision (c) of Section 1798.200.
(d)Pursuant to subdivision (i) of Section 1798.24 of the Civil Code, upon notification to the paramedic, the authority may share the results of its investigation into a paramedics misconduct with the paramedics employer, prospective employer when requested in writing as part of a preemployment background check, and the local EMS agency.
(e)The information reported or disclosed in this section shall be deemed in the nature of an investigative communication and is exempt from disclosure as a public record by subdivision (f) of Section 6254 of the Government Code.
(f)A paramedic applicant or licensee to whom the information pertains may view the contents, as set forth in subdivision (a) of Section 1798.24 of the Civil Code, of a closed investigation file upon request during the regular business hours of the authority.
(a)(1)(A)Except as provided in paragraph (2), an employer of an EMT-I or EMT-II may conduct investigations, as necessary, and take disciplinary action against an EMT-I or EMT-II who is employed by that employer for conduct in violation of subdivision (c). The employer shall notify the medical director of the local EMS agency that has jurisdiction in the county in which the alleged violation occurred within three days when an allegation has been validated as a potential violation of subdivision (c).
(B)Each employer of an EMT-I or EMT-II employee shall notify the medical director of the local EMS agency that has jurisdiction in the county in which a violation related to subdivision (c) occurred within three days after the EMT-I or EMT-II is terminated or suspended for a disciplinary cause, the EMT-I or EMT-II resigns following notification of an impending investigation based upon evidence that would indicate the existence of a disciplinary cause, or the EMT-I or EMT-II is removed from EMT-related duties for a disciplinary cause after the completion of the employers investigation.
(C)At the conclusion of an investigation, the employer of an EMT-I or EMT-II may develop and implement, in accordance with the guidelines for disciplinary orders, temporary suspensions, and conditions of probation adopted pursuant to Section 1797.184, a disciplinary plan for the EMT-I or EMT-II. Upon adoption of the disciplinary plan, the employer shall submit that plan to the local EMS agency within three working days. The employers disciplinary plan may include a recommendation that the medical director of the local EMS agency consider taking action against the holders certificate pursuant to paragraph (3).
(2)If an EMT-I or EMT-II is not employed by an ambulance service licensed by the Department of the California Highway Patrol or a public safety agency or if that ambulance service or public safety agency chooses not to conduct an investigation pursuant to paragraph (1) for conduct in violation of subdivision (c), the medical director of a local EMS agency shall conduct the investigations, and, upon a determination of disciplinary cause, take disciplinary action as necessary against the EMT-I or EMT-II. At the conclusion of these investigations, the medical director shall develop and implement, in accordance with the recommended guidelines for disciplinary orders, temporary orders, and conditions of probation adopted pursuant to Section 1797.184, a disciplinary plan for the EMT-I or EMT-II. The medical directors disciplinary plan may include action against the holders certificate pursuant to paragraph (3).
(3)The medical director of the local EMS agency may, upon a determination of disciplinary cause and in accordance with regulations for disciplinary processes adopted pursuant to Section 1797.184, deny, suspend, or revoke any EMT-I or EMT-II certificate issued under this division, or may place any EMT-I or EMT-II certificate holder on probation, upon the finding by that medical director of the occurrence of any of the actions listed in subdivision (c) and the occurrence of one of the following:
(A)The EMT-I or EMT-II employer, after conducting an investigation, failed to impose discipline for the conduct under investigation, or the medical director makes a determination that the discipline imposed was not according to the guidelines for disciplinary orders and conditions of probation and the conduct of the EMT-I or EMT-II certificate holder constitutes grounds for disciplinary action against the certificate.
(B)Either the employer of an EMT-I or EMT-II further determines, after an investigation conducted under paragraph (1), or the medical director determines after an investigation conducted under paragraph (2), that the conduct requires disciplinary action against the certificate.
(4)The medical director of the local EMS agency, after consultation with the employer of an EMT-I or EMT-II, may temporarily suspend, prior to a hearing, any EMT-I or EMT-II certificate or both EMT-I and EMT-II certificates upon a determination that both of the following conditions have been met:
(A)The certificate holder has engaged in acts or omissions that constitute grounds for revocation of the EMT-I or EMT-II certificate.
(B)Permitting the certificate holder to continue to engage in the certified activity without restriction would pose an imminent threat to the public health or safety.
(5)If the medical director of the local EMS agency temporarily suspends a certificate, the local EMS agency shall notify the certificate holder that his or her EMT-I or EMT-II certificate is suspended and shall identify the reasons therefor. Within three working days of the initiation of the suspension by the local EMS agency, the agency and employer shall jointly investigate the allegation in order for the agency to make a determination of the continuation of the temporary suspension. All investigatory information not otherwise protected by law held by the agency and employer shall be shared between the parties via facsimile transmission or overnight mail relative to the decision to temporarily suspend. The local EMS agency shall decide, within 15 calendar days, whether to serve the certificate holder with an accusation pursuant to Chapter 5 (commencing with Section 11500) of Part 1 of Division 3 of Title 2 of the Government Code. If the certificate holder files a notice of defense, the hearing shall be held within 30 days of the local EMS agencys receipt of the notice of defense. The temporary suspension order shall be deemed vacated if the local EMS agency fails to make a final determination on the merits within 15 days after the administrative law judge renders the proposed decision.
(6)The medical director of the local EMS agency shall refer, for investigation and discipline, any complaint received on an EMT-I or EMT-II to the relevant employer within three days of receipt of the complaint, pursuant to subparagraph (A) of paragraph (1) of subdivision (a).
(b)The authority may deny, suspend, or revoke any EMT-P license issued under this division, or may place any EMT-P license issued under this division, or may place any EMT-P licenseholder on probation upon the finding by the director of the occurrence of any of the actions listed in subdivision (c). Proceedings against any EMT-P license or licenseholder shall be held in accordance with Chapter 5 (commencing with Section 11500) of Part 1 of Division 3 of Title 2 of the Government Code.
(c)Any of the following actions shall be considered evidence of a threat to the public health and safety and may result in the denial, suspension, or revocation of a certificate or license issued under this division, or in the placement on probation of a certificate holder or licenseholder under this division:
(1)Fraud in the procurement of any certificate or license under this division.
(2)Gross negligence.
(3)Repeated negligent acts.
(4)Incompetence.
(5)The commission of any fraudulent, dishonest, or corrupt act that is substantially related to the qualifications, functions, and duties of prehospital personnel.
(6)Conviction of any crime which that is substantially related to the qualifications, functions, and duties of prehospital personnel. The record of conviction or a certified copy of the record shall be conclusive evidence of the conviction.
(7)Violating or attempting to violate directly or indirectly, or assisting in or abetting the violation of, or conspiring to violate, any provision of this division or the regulations adopted by the authority pertaining to prehospital personnel.
(8)Violating or attempting to violate any federal or state statute or regulation that regulates narcotics, dangerous drugs, or controlled substances.
(9)Addiction to, the excessive use of, or the misuse of, alcoholic beverages, narcotics, dangerous drugs, or controlled substances.
(10)Functioning outside the supervision of medical control in the field care system operating at the local level, except as authorized by any other license or certification.
(11)Demonstration of irrational behavior or occurrence of a physical disability to the extent that a reasonable and prudent person would have reasonable cause to believe that the ability to perform the duties normally expected may be impaired.
(12)Unprofessional conduct exhibited by any of the following:
(A)The mistreatment or physical abuse of any patient resulting from force in excess of what a reasonable and prudent person trained and acting in a similar capacity while engaged in the performance of his or her duties would use if confronted with a similar circumstance. Nothing in this section shall be deemed to prohibit an EMT-I, EMT-II, or EMT-P from assisting a peace officer, or a peace officer who is acting in the dual capacity of peace officer and EMT-I, EMT-II, or EMT-P, from using that force that is reasonably necessary to effect a lawful arrest or detention.
(B)The failure to maintain confidentiality of patient medical information, except as disclosure is otherwise permitted or required by law in Part 2.6 (commencing with Section 56) of Division 1 of the Civil Code.
(C)The commission of any sexually related offense specified under Section 290 of the Penal Code.
(d)The information shared among EMT-I, EMT-II, and EMT-P employers, medical directors of local EMS agencies, the authority, and EMT-I and EMT-II certifying entities shall be deemed to be an investigative communication that is exempt from public disclosure as a public record pursuant to subdivision (f) of Section 6254 of the Government Code. A formal disciplinary action against an EMT-I, EMT-II, or EMT-P shall be considered a public record available to the public, unless otherwise protected from disclosure pursuant to state or federal law.
(e)For purposes of this section, disciplinary cause means an act that is substantially related to the qualifications, functions, and duties of an EMT-I, EMT-II, or EMT-P and is evidence of a threat to the public health and safety described in subdivision (c).
|
Date
|
Status
|
|---|---|
| May 4, 2016 | From committee: Do pass. To Consent Calendar. (Ayes 20. Noes 0.) (May 4). |
| Aug 11, 2016 | In committee: Held under submission. |
| Jun 27, 2016 | In committee: Referred to APPR. suspense file. |
| Jun 8, 2016 | From committee: Do pass and re-refer to Com. on APPR. (Ayes 7. Noes 0.) (June 8). Re-referred to Com. on APPR. |
| May 19, 2016 | Referred to Com. on HEALTH. |
| May 12, 2016 | Read third time. Passed. Ordered to the Senate. (Ayes 78. Noes 0.) |
| May 12, 2016 | Read third time. Passed. Ordered to the Senate. (Ayes 78. Noes 0. Page 4786.) |
| May 12, 2016 | Read third time. Passed. Ordered to the Senate. |
| May 12, 2016 | In Senate. Read first time. To Com. on RLS. for assignment. |
| May 5, 2016 | Read second time. Ordered to Consent Calendar. |
| Feb 12, 2016 | Read first time. To print. |
| Apr 26, 2016 | Re-referred to Com. on APPR. |
| Apr 25, 2016 | Read second time and amended. |
| Apr 21, 2016 | From committee: Amend, and do pass as amended and re-refer to Com. on APPR. (Ayes 18. Noes 0.) (April 19). |
| Apr 12, 2016 | In committee: Set, first hearing. Hearing canceled at the request of author. |
| Mar 28, 2016 | Re-referred to Com. on HEALTH. |
| Mar 18, 2016 | From committee chair, with author's amendments: Amend, and re-refer to Com. on HEALTH. Read second time and amended. |
| Mar 17, 2016 | Referred to Com. on HEALTH. |
| Feb 16, 2016 | From printer. May be heard in committee March 17. |
|
Date
|
Description
|
Location
|
Votes
|
|
|---|---|---|---|---|
| Jun 27, 2016 | Placed on suspense file | Senate Standing Committee on Appropriations |
Passed |
|
| Jun 8, 2016 | Do pass, but first be re-referred to the Committee on [Appropriations] | Senate Standing Committee on Health |
Passed |
|
| May 12, 2016 | AB 1931 RODRIGUEZ Consent Calendar Second Day Regular Session | Assembly Floor |
Passed |
|
| May 4, 2016 | Do pass. To Consent Calendar. | Assembly Standing Committee on Appropriations |
Passed |
|
| Apr 19, 2016 | Do pass as amended and be re-referred to the Committee on [Appropriations] | Assembly Standing Committee on Health |
Passed |
This list shows positions taken on this bill by organizations on the date displayed, which is linked to the original source.
Positions by individuals are not included.
|
Organization
|
Position
|
Date
|
|---|---|---|
| California Professional Firefighters | * Support | Jun 8, 2016 |
| EMS Administrators | * Neutral | Apr 19, 2016 |
| LIUNA Local 792 | ** Support | Apr 19, 2016 |
| Orange County Professional Firefighters Association, Local 3631 | ** Support | Apr 19, 2016 |
SENATE COMMITTEE ON
Senator Ricardo Lara, Chair
2015 - 2016 Regular Session
AB 1931 (Rodriguez) - Emergency medical services: paramedics: discipline
Version: | Policy Vote: |
Urgency: | Mandate: |
Hearing Date: | Consultant: |
This bill meets the criteria for referral to the Suspense File.
Bill Summary:
AB 1931 would change the process for performing disciplinary investigations of emergency medical technician-paramedics, by giving an employer the initial responsibility for conducting investigations.
Fiscal Impact:
- One-time costs of $265,000 over two years for the Emergency Medical Services Authority to revise existing regulations relating to disciplinary investigations (General Fund).
- Ongoing costs of about $140,000 per year for the Emergency Medical Services Authority to conduct investigations in an expedited manner if the Authority does not agree with the findings and recommendation of an employer conducting an initial disciplinary investigation (General Fund). Under the bill, employers would have the ability to conduct the initial investigation and impose discipline. The Authority would then have the ability to review those findings and conduct its own investigation if the Authority does not agree with the findings of the employer. Under current law, disciplinary proceedings against a firefighter generally must be completed within one year. The Authority anticipates that many investigations initially conducted by an employer may not be resolved until close to the one-year deadline. In those cases, the Authority will need additional staff to conduct expedited investigations under the existing deadline.
Background:
There are three levels of emergency medical technician (EMT) in the state: EMT-I, EMT-II, and EMT-P (paramedic). Under current law, EMT-Is and EMT-IIs are certified by local emergency medical services agencies. On the other hand, EMT-Ps are licensed by the state Emergency Medical Services Authority (the Authority) and the Authority has primary responsibility to conduct disciplinary investigations when allegations of misconduct regarding EMT-Ps arise.
Under current law, investigations and disciplinary proceedings against EMT-Is and EMT-IIs can be conducted by the employer. If the employer does not wish to conduct the investigation, it is conducted by the certifying entity (usually a local emergency medical services agency or LEMSA). There are requirements in law about notifications between employers, certifying entities, and the Authority.
Current law, the “Firefighters Procedural Bill of Rights”, provides for specified protections for firefighters undergoing disciplinary investigations. One of the protections in current law is one-year limitation on the duration of investigations (with certain exceptions).
Proposed Law:
AB 1931 would change the process for performing disciplinary investigations of emergency medical technician-paramedics (EMT-Ps), by giving an employer the initial responsibility for an conducting investigation. If an employer does not wish to conduct an investigation, the Authority would do so.
Related Legislation:
AB 1944 (Gatto, 2012) was similar to this bill. That bill was held on this committee’s Suspense File.
Staff Comments:
Under current law, the state licenses EMT-Ps and has the responsibility to investigate and take disciplinary action against EMT-Ps who have violated existing law or regulations relating to their professional responsibilities. Employers of EMT-Ps retain the authority to take disciplinary action relating to an EMT-P’s employment. This regulatory scheme is analogous to those used to regulate other professions and vocations licensed by the state. Under the bill, primary authority to enforce licensing and practice requirements for EMT-Ps would be delegated by the state to employers. The bill would still afford the Authority to conduct its own investigations, should the Authority disagree with the findings or actions of an employer.
-- END --
SENATE COMMITTEE ON HEALTH
Senator Ed Hernandez, O.D., Chair
BILL NO: AB 1931
AUTHOR: | Rodriguez | ||
VERSION: | April 25, 2016 | ||
HEARING DATE: | June 8, 2016 | ||
CONSULTANT: | Vince Marchand | ||
SUBJECT: Emergency medical services: paramedics: discipline
SUMMARY:
Adds Emergency Medical Technician-Paramedics to the provisions of law governing the procedures for investigations and disciplinary actions that are current law for Emergency Medical Technician-Is and IIs.
Existing law:
- 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.
- 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.
- 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.
- 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.
- Defines "Emergency Medical Technician-I" or "EMT-I" as an individual trained in all facets of basic life support, as specified. Defines an "Emergency Medical Technician-II," "EMT-II," "Advanced Emergency Medical Technician," or "Advanced EMT" as an EMT-I with additional training in limited advanced life support according to specified standards. Both EMT-Is and EMT-IIs are certified at the local level.
- Defines "Emergency Medical Technician-Paramedic," "EMT-P," "paramedic" or "mobile intensive care paramedic" means an individual whose scope of practice includes the ability to provide advanced life support, as specified, including administering specified medications. EMT-Ps are licensed and regulated at the state level through EMSA.
This bill:
- Requires EMSA to develop and adopt guidelines for disciplinary orders, temporary suspensions, and conditions of probation for EMT-P license holders, in addition to the existing requirement that they develop and adopt these guidelines for EMT-I and EMT-II certificate holders (when referring to EMT-Is, EMT-IIs and EMT-Ps collectively, “EMTs”).
- Adds EMT-Ps to the provisions of law governing the procedures for investigations and disciplinary actions that currently exist for EMT-Is and EMT-IIs. Specifically, this bill adds EMT-Ps to laws that do the following:
- Permit an employer of an EMT to conduct investigations, and take disciplinary action, against an EMT for specified conduct violations, and require the employer to notify the regulating entity of the EMT within three days when an allegation has been validated as a potential conduct violation.
- Require each employer of an EMT to notify the regulating entity within three days after the EMT is terminated or suspended for a disciplinary cause, the EMT resigns following notification of an impending investigation, or the EMT is removed from EMT-relat4ed duties for a disciplinary cause.
- Require the director of the EMT’s regulating entity to conduct the investigation and take any necessary disciplinary action against an EMT who is not employed by an ambulance service or public safety agency, or if that ambulance service or public safety agency chooses not to conduct an investigation.
- Permit the director of the EMT’s regulating entity to deny, suspend, or revoke any EMT certificate or license, or place an EMT on probation, upon a finding that the EMT employer failed to impose discipline according to the guidelines for disciplinary orders.
- Permit the director of the EMT’s regulating entity, after consultation with the EMT’s employer, to temporarily suspend, prior to a hearing, an EMT certificate or license upon a determination that the EMT has engaged in acts or omissions that constitute grounds for revocation of their certificate or license, and that permitting the EMT to continue to practice without restriction would pose an imminent threat to the public health or safety.
- Require the regulating entity, if it temporarily suspends an EMT, to notify the EMT, and within three working days, to jointly investigate, with the EMT’s employer, the allegation in order to make a determination of the continuation of the temporary suspension.
- Require the regulating entity to refer, for investigation and discipline, any complaint received on an EMT to the relevant employer within three days of receipt of the complaint.
- Defines “regulating entity,” for purposes of the provisions of law governing investigations and disciplinary actions of EMTs, as either of the following:
- For purposes of EMT-I and EMT-II certificate holders, the LEMSA that has jurisdiction; or,
- For purposes of EMT-P license-
- holders, EMSA, and when requiring a report or notification regarding an EMT-P, “regulating entity” refers to both the LEMSA and EMSA.
- Requires proceedings against any EMT-P licenseholder to be held in accordance with specified provisions of law governing administrative adjudication formal hearings.
- Clarifies that employers of EMTs are required to notify the regulating entity of the EMT of validated allegations and disciplinary actions taken, regardless of the county where the alleged violation occurred.
- Makes other conforming changes, including deleting provisions of law requiring EMT-P employers to report disciplinary action to the LEMSA, which would no longer be necessary with EMT-Ps being added to the disciplinary provisions applicable to EMT-Is and IIs, which already require sharing of disciplinary information between employers and LEMSAs.
FISCAL EFFECT:
According to the Assembly Appropriations Committee: staff costs of $130,000 GF per year for two years to EMSA to promulgate regulations.
PRIOR VOTES:
Assembly Floor: | 78 - 0 |
Assembly Appropriations Committee: | 20 - 0 |
Assembly Health Committee: | 18 - 0 |
COMMENTS:
- Author’s statement. According to the author, this bill enacts a disciplinary oversight system for California's paramedics (EMT-Ps) that is similar to the system currently applicable to EMT-Is and EMT-IIs, as approved by this Legislature and Governor in 2007. EMS providers, local EMS agencies and the state Emergency Medical Services Authority have a cooperative obligation to maintain the consistency of medical policies and procedures and the imposition of disciplinary action. This bill ensures swift and appropriate disciplinary intervention when necessary, but enacts the appropriate safeguards so our paramedics, also known as EMT-Ps, won’t be reprimanded twice or more after disciplinary action has been taken against them. Currently, multiple agencies can investigate the actions of EMT-Ps. However, there is no requirement that these agencies coordinate or communicate with each other during the course of the investigation.
- Background on emergency medical services. EMSA is lead agency and centralized resource to oversee emergency and disaster medical services. EMSA is charged with providing leadership in developing and implementing local emergency medical services systems (called local EMS agencies, or LEMSAs) 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 seven regional EMS agencies comprised of 33 counties and 25 single-county agencies. Among other responsibilities, 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 IIs. 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. California has three levels of EMTs: EMT-I (basic), EMT-II (also known as Advanced EMT); and, EMT-P (paramedic). To be certified as an EMT, an applicant must successfully complete a training program and pass a written and skills certifying examination. EMT-Is and EMT-IIs are certified by a LEMSA or a certifying entity such as a fire or police department 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 other public safety agencies. According to EMSA, there are more than 59,532 EMT-Is certified in California, while there are 106 EMT-IIs, utilized mostly in rural areas where they may be the only EMS responder.
- EMPT-Ps. Paramedics must meet significantly higher training requirements compared to EMT-Is and IIs, and have a significantly broader scope of practice. There are 21,752 EMT-Ps licensed in California. In 1993, EMSA took over the licensure of paramedics from the LEMSAs. 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.
- Prior legislation. SB 1378 (Hancock of 2012), 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.
AB 1944 (Gatto of 2012), would have revised the process relating to disciplinary actions for cause against an EMT-P, including by increasing employer authority over disciplinary investigations and actions. AB 1944 was held on the Senate Appropriations Suspense File.
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 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.
- Support. This bill is sponsored by the California Professional Firefighters (CPF), which states that all professional firefighters are trained as EMTs and in many – if not most – cases, as EMT-Ps as a condition of employment. CPF states that they believe in being held to the highest standards for training and performance in the protection of the public’s safety, especially in the area of emergency medical care. According to CPF, EMS providers, LEMSAs and EMSA have a cooperative obligation to maintain the consistency of medical policies and procedures and the imposition of disciplinary action when necessary. While the state issues licenses to EMT-Ps, CPF notes that multiple agencies and levels of government – from a fire department employer and LEMSA to the state EMSA – retain the authority to investigate the actions of an EMT-P and impose discipline without an effective system of coordination or communication with each other during the course of an investigation or when imposing such discipline. As a result, CPF states that discipline may be imposed on a paramedic licenseholder by one oversight agency without regard for any appropriately-administered discipline already imposed by another oversight agency. According to CPF, because the coordinated system made applicable to EMT-Is and IIs nearly a decade ago does not apply to EMT-Ps, this bill is needed to ensure that any EMT-P discipline imposed is timely, decisive, and appropriate.
SUPPORT AND OPPOSITION:
Support: California Professional Firefighters (sponsor)
Oppose: None received
-- END --
Date of Hearing: May 4, 2016
ASSEMBLY COMMITTEE ON APPROPRIATIONS
Lorena Gonzalez, Chair
ABPCA Bill Id:AB 1931
Author:(Rodriguez) – As Amended Ver:April 25, 2016
Policy Committee: | Health | Vote: | 18 - 0 |
|
| ||
|
|
Urgency: No State Mandated Local Program: No Reimbursable: No
SUMMARY:
This bill conforms guidelines for investigations and discipline of misconduct by Emergency Medical Technician-Paramedic license holders (paramedics) to current requirements for Emergency Medical Technician-I and II (EMT-I and EMT-II) certificate holders.
In so doing, it requires Emergency Medical Services Authority (EMSA) to promulgate regulations related to disciplinary oversight for paramedics.
FISCAL EFFECT:
Staff costs of $130,000 GF per year for two years to EMSA to promulgate regulations.
COMMENTS:
- Purpose. According to the author, California adopted a system for the coordinated oversight of EMT-Is and EMT-IIs in AB 2917 (Torrico), Chapter 274, Statutes of 2007. That same system of coordinated oversight does not apply to paramedics, and as a result, paramedics are often disciplined by multiple agencies and levels of government. The coordinated system made applicable to other EMTs nearly a decade ago does not apply to paramedics. The intent of this bill is to enact a disciplinary oversight system for California's paramedics that parallels the system currently applicable to other EMTs.
- Background. The EMS system is a partnership between the state EMSA, county-based or regional local EMS agencies, and other entities such as ambulance providers, fire stations, and hospitals. EMSA currently licenses paramedics, but to work in the state, paramedics must also be accredited by the local EMS agency with jurisdiction in the county of employment. EMSA licensure requires education, practical skills, an exam, and a background check; local EMS agency accreditation ensures a paramedic is familiar with local policies, hospitals, and EMS systems. Disciplinary action can occur at the local level, at the EMSA level, or at the employer level.
- Prior Legislation. AB 1944 (Gatto) of 2012 provided paramedic employers increased authority over disciplinary investigations and actions for paramedics in their employment, and changed existing roles of EMSA and the local EMS agencies with regard to such investigations and actions. AB 1944 was held on the Suspense File of the Senate Appropriations Committee.
Analysis Prepared by: Lisa Murawski / APPR. / (916) 319-2081
Date of Hearing: April 19, 2016
ASSEMBLY COMMITTEE ON HEALTH
Jim Wood, Chair
ABPCA Bill Id:AB 1931
Author:(Rodriguez) – As Amended Ver:March 18, 2016
SUBJECT: Emergency medical services: paramedics: discipline.
SUMMARY: Conforms guidelines for investigations and discipline of misconduct by Emergency Medical Technician-Paramedic license holders (EMT-Ps) to current requirements for Emergency Medical Technician-I and II (EMT-I and EMT-II) certificate holders. Specifically, this bill:
- Requires the Emergency Medical Services Authority (EMSA) to develop and adopt guidelines for disciplinary orders, temporary suspensions, and conditions of probation for EMT-P license holders.
- Integrates and conforms the procedures for investigating misconduct of EMT-P license holders with those of EMT-I and EMT-II certificate holders, including requiring notification of disciplinary action with regard to an EMT-P by the EMT-P’s employer to be given to the local emergency medical services agency (LEMSA) and the EMSA within three days.
- Requires the medical director of the LEMSA, if he or she makes a recommendation to the EMSA for further investigation or discipline, to notify the EMT-P’s employer within three days.
- Requires notification of the EMT-P’s employer when there is a temporary suspension of an EMT-P’s license.
EXISTING LAW:
- Establishes EMSA, which is responsible for establishing training, scope of practice, and continuing education for emergency medical technicians and other prehospital personnel, including EMT-I, EMT-II, and EMT-P designations.
- Authorizes an employer of an EMT-I or EMT-II to conduct investigations and take disciplinary action against an EMT-I or EMT-II who is employed by that employer for specified conduct, and authorizes EMSA to deny, suspend, or revoke any EMT-P license for the same specified conduct.
- Requires an EMT-P’s employer to report in writing to the LEMSA and EMSA within 30 days of specified disciplinary action being taken with regard to an EMT-P.
- Authorizes the medical director of the LEMSA to evaluate information that comes to his or her attention that appears to constitute grounds for disciplinary action against an EMT-P and to make a recommendation to EMSA for further investigation or discipline.
- Authorizes the temporary suspension, in specified circumstances, of an EMT-P license.
FISCAL EFFECT: This bill has not been analyzed by a fiscal committee.
COMMENTS:
- PURPOSE OF THIS BILL. According to the author, this bill is needed so that any EMT-P discipline imposed is timely, decisive, and appropriate, while also reflecting fair corrective action for those who violate the standards of professional conduct and endanger public safety. The author states that when an EMT-P makes a mistake, he or she should be corrected, and when an EMT-P is found guilty of misconduct, the punishment should fit the crime -- subject to a standardized, fairly applied, and timely process. The current disciplinary system is not fair, timely, or efficient. Although not a state law requirement, all professional firefighters are trained as EMTs and most, as a condition of employment, are paramedics (EMT-Ps). While the state issues licenses to EMT-Ps, multiple agencies and levels of government -- from a fire department employer and LEMSA to the state EMSA and its Emergency Medical Services (EMS) Commission -- retain the authority to investigate the actions of an EMT-P and impose discipline without an effective system of coordination or communication with each other during the course of the investigation or when imposing such discipline. As a result, discipline may be imposed on a paramedic license holder by one oversight agency without regard for any appropriately administered discipline already imposed by another oversight agency. The coordinated system made applicable to EMT-Is and EMT-IIs nearly a decade ago does not apply to EMT-Ps. This bill enacts a disciplinary oversight system for California's EMT-Ps that parallels the system currently applicable to EMT-Is and EMT-IIs. The author concludes, in doing so, this bill promotes and maintains a statewide coordinated EMS delivery system guided by consistent and clear standards and, by coordinating resources, saves money.
- BACKGROUND. EMSA is charged with providing leadership in developing and implementing EMS systems throughout California and setting standards for the training and scope of practice of various levels of EMS personnel. EMSA is mandated by statute to develop and implement regulations that set training standards and the scope of practice for emergency medical personnel, including EMT-I, EMT-II, and EMT-P. EMSA provides statewide coordination and leadership for the planning, development, and implementation of LEMSA systems. California has 33 LEMSAs and seven regional EMS systems comprised of small, rural, less-populated counties.
- SUPPORT. California Professional Firefighters (CPF), the sponsor of this bill, argues that this bill promotes and maintains a statewide coordinated EMS delivery system, one that is not only guided by clear standards, but is also consistent with policy that is applicable to other EMS personnel, as approved by the Legislature and Governor in 2007. This bill provides efficiency in both investigations and imposition of disciplinary action as well as cost saving benefits to employers and EMSA. CPF states that communities are entitled to transparency and an assurance that firefighters are dedicated to patient care. LUNA local 792 and the Orange County Professional Firefighters Association, Local 3631note that multiple agencies have authority to investigate actions and impose discipline on EMT-Ps and that coordination of these activities will better ensure the health and safety of the public.
- OPPOSE UNLESS AMENDED. The EMS Administrators Association (EMSAAC) opposes this bill unless amended. EMSAAC is concerned that this bill makes two significant changes to existing process that would have significant negative effects on LEMSAs and the ability of LEMSA medical directors to hold EMS personnel accountable for their actions. EMSAAC has proposed amendments to address their concerns.
- PREVIOUS LEGISLATION. AB 2917 (Torrico), Chapter 274, Statutes of 2008, requires EMSA to establish and maintain a statewide registry of the status of EMT licenses and certificates, to be used by certifying entities and to develop standards, guidelines, and regulations for certification of EMT-I and EMT-2. AB 2907 also establishes guidelines for EMT investigation and discipline.
- AMENDMENTS. The author proposes the following amendments, all on page 6 of the bill, to meet the concerns of EMSAAC:
- On line 13-14, delete “in the county in which the alleged violation occurred”
- On line 19-20, delete “in the county in which the alleged violation occurred”
- On line 24, delete “in the county in which the alleged violation occurred”
REGISTERED SUPPORT / OPPOSITION:
Support
California Professional Firefighters (sponsor)
California State Firefighters Association
LIUNA Local 792
Orange County Professional Firefighters Association, Local 3631
Opposition
None on file.
Analysis Prepared by: John Gilman / HEALTH / (916) 319-2097
Discussed in Hearing
Senate Standing Committee on Health
Assembly Standing Committee on Health
Bill Author
Bill Co-Author(s):