Existing law, the Emergency Medical Services System and the Prehospital Emergency Medical Care Personnel Act, governs local emergency medical services systems, and establishes the Emergency Medical Services Authority (authority), which is responsible for the coordination and integration of all state agencies concerning emergency medical services. The act creates the Commission on Emergency Medical Services (commission) to, among other things, advise the authority on the development of an emergency medical data collection system.

The act authorizes each county to establish an emergency medical services program under which the county is required to designate a local emergency medical services (EMS) agency. Existing law requires the medical director of a local EMS agency to issue a certificate to, or recertify, an individual as an Emergency Medical Technician-I (EMT-I) or Emergency Medical Technician-II (EMT-II), upon proof that the individual has met specified requirements.

This bill would require each local EMS agency and other certifying entities to annually submit to the authority, by July 1 of each year, data on the approval or denial of EMT-I or EMT-II applicants, containing specified information with respect to the preceding calendar year, including, among other things, the number of applicants with a prior criminal conviction who were denied, approved, or approved with restrictions. By creating new duties for local EMS agencies, the bill would impose a state-mandated local program.

The bill would require the authority to annually report to the commission on the extent to which prior criminal history may be an obstacle to certification as an EMT-I or EMT-II, and would require the authority to annually submit the same report to the Legislature and make the report easily accessible on the authoritys Internet Web site.

This bill would make these provisions inoperative on July 1, 2024, and would repeal them as of January 1, 2025.

The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.

This bill would provide that, if the Commission on State Mandates determines that the bill contains costs mandated by the state, reimbursement for those costs shall be made pursuant to the statutory provisions noted above.

Existing law, the Emergency Medical Services System and the Prehospital Emergency Medical Care Personnel Act, governs local emergency medical services systems, and establishes the Emergency Medical Services Authority (authority), which is responsible for the coordination and integration of all state agencies concerning emergency medical services. The act creates the Commission on Emergency Medical Services (commission) to, among other things, advise the authority on the development of an emergency medical data collection system.

The act authorizes each county to establish an emergency medical services program under which the county is required to designate a local emergency medical services (EMS) agency. Existing law requires the medical director of a local EMS agency to issue a certificate to, or recertify, an individual as an Emergency Medical Technician-I (EMT-I) or Emergency Medical Technician-II (EMT-II), upon proof that the individual has met specified requirements.

This bill would require each local EMS agency and other certifying entities to annually submit to the authority, by July 1 of each year, data on the approval or denial of EMT-I or EMT-II applicants, containing specified information with respect to the preceding calendar year, including, among other things, the number of applicants with a prior criminal conviction who were denied, approved, or approved with restrictions. By creating new duties for local EMS agencies, the bill would impose a state-mandated local program.

The bill would require the authority to annually report to the commission on the extent to which prior criminal history may be an obstacle to certification as an EMT-I or EMT-II, and would require the authority to annually submit the same report to the Legislature and make the report easily accessible on the authoritys Internet Web site.

This bill would make these provisions inoperative on July 1, 2024, and would repeal them as of January 1, 2025.

The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.

This bill would provide that, if the Commission on State Mandates determines that the bill contains costs mandated by the state, reimbursement for those costs shall be made pursuant to the statutory provisions noted above.

Under existing law, the Emergency Medical Services System and the Prehospital Emergency Medical Care Personnel Act, the Emergency Medical Services Authority (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). Existing law authorizes the authority to, among other things, deny, suspend, or revoke an EMT EMT-P license for specified conduct to protect the public health and safety. Existing law authorizes an EMT-I, EMT-II, and EMT-P to file a notice of defense within 15 days of service of an accusation.

This bill would modify allow the authority to deny an application submitted by an individual for an EMT-I or EMT-II license and would establish the criteria related to conduct that the authority may consider in denying an EMT application, the application, as specified, and would permit the authority to consider whether an applicant demonstrates substantial rehabilitation, as defined. The bill would extend the time for an applicant to file a notice of defense from 15 to allow an applicant 30 days in response to respond to a denied EMT EMT-I or EMT-II application.

Under existing law, the Emergency Medical Services System and the Prehospital Emergency Medical Care Personnel Act, the Emergency Medical Services Authority (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). 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 for specified conduct to protect the public health and safety. Existing law requires the employer to notify the local emergency medical services (EMS) agency of the violation. Existing law authorizes an EMT-I, EMT-II, and EMT-P to file a notice of defense within 15 days of service of an accusation. Existing law authorizes the authority to, among other things, deny, suspend, or revoke an EMT license for the conduct. specified conduct to protect the public health and safety. Existing law authorizes an EMT-I, EMT-II, and EMT-P to file a notice of defense within 15 days of service of an accusation.

This bill would extend the time for filing a notice of defense from 15 to 30 days. The bill would revise the criteria related to conduct that the employer, local EMS agency, or the authority can consider in taking disciplinary action against an EMT, thereby limiting disciplinary action to specified acts, such as conduct that directly relates to the course of employment. The bill would allow an EMT who demonstrates substantial rehabilitation, as specified, to be exempt from disciplinary action. The bill would prohibit an employer, agency, or authority from taking disciplinary action against an EMT on the basis of criminal history, including expungements and arrests, as specified. modify the criteria related to conduct that the authority may consider in denying an EMT application, as specified, and would permit the authority to consider whether an applicant demonstrates substantial rehabilitation, as defined. The bill would extend the time for an applicant to file a notice of defense from 15 to 30 days in response to a denied EMT application.

Existing law establishes the California Conservation Camp program, to provide for the training and use of inmates and wards for conservation projects, including, among other things, forest fire prevention and control. Existing law authorizes the Emergency Medical Services Authority to develop regulations for the issuance of EMT-I and EMT-II certificates and the disciplinary processes for EMT-I and EMT-II applicants and certificate holders that protect public health and safety.

This bill would require the authority, in developing regulations for the issuance of EMT-I and EMT-II certificates, to ensure that conviction of an offense, except as specified, shall not be grounds for determining that public health and safety requires denial or revocation of an EMT-I or EMT-II certificate to an individual who is no longer incarcerated and, while incarcerated for that offense, completed a California Conservation Camp program.

CONCURRENCE IN SENATE AMENDMENTS

CSA1 Bill Id:AB 2293

Author:(Reyes)

As Amended Ver:July 5, 2018

Majority vote

Original Committee Reference: HEALTH

SUMMARY: Prohibits the Emergency Medical Services Authority (EMSA) from denying an emergency medical technician (EMT)-I or EMT-II license, upon the finding by the EMSA Director of the occurrence of evidence of a threat to the public health, if the license holder demonstrates substantial rehabilitation, as defined. Limits the criteria related to conduct that an employer, local emergency medical services agency (LEMSA), or EMSA can consider when denying an EMT-I or EMT-II license to conduct that directly relates to the course of employment, and authorizes an applicant to file a notice of defense within 30 days after service of an accusation. Specifically, this bill:

1. Defines the following actions as evidence of a threat to the public health and safety:
   1. Fraud in the procurement of any certificate or license under the provisions of this bill;
   2. A grossly negligent act in the course of employment in a related field:
   3. Repeated negligent acts in the course of employment in a related field;
   4. Demonstrated incompetence in the course of employment in a related field;
   5. The commission of any fraudulent, dishonest, or corrupt act committed in the course of employment in a related field;
   6. Conviction of a violent felony, including, but not limited to: i) murder or voluntary manslaughter; ii) mayhem; iii) rape; iv) lewd or lascivious acts; v) robbery; vi) arson; or, vii) attempted murder.
   7. Conviction of a crime within the last five years that is directly related to, and adversely impacts the qualifications, functions, and duties of, prehospital personnel;
   8. Violation of any of the provisions of this bill or regulation adopted by EMSA pertaining to prehospital personnel, which occur in the course of employment;
   9. Conviction for the violation of any federal or state statute or regulation that regulates narcotics, dangerous drugs, or controlled substances within the last five years which resulted in incarceration;
   10. Excessive use of alcoholic beverages, narcotics, dangerous drugs, or controlled substances;
   11. 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;
   12. 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 duties normally expected may be impaired;
   13. Unprofessional conduct exhibited by any of the following:
       1. 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 their would use if confronted with a similar circumstance;
       2. The failure to maintain confidentiality of patient medical information, except as permitted by existing law; or,
       3. The conviction of any sexually related offense. Authorizes EMSA to temporarily suspend its review of the application until the criminal proceeding is resolved.
2. Defines "substantial rehabilitation" as meaning the applicant for an EMT-I or EMT-II license has done either of the following:
   1. Satisfied the criteria for rehabilitation developed by the certification board; or,
   2. Provided documentation to the authority that they maintained employment in a related field for at least one year prior to licensure or successfully completed a course of training in related field, and there is no public record of an official finding related to professional misconduct.
3. Specifies that a "related field" includes employment duties that are substantially similar to the field regulated by the board and may be uncompensated or compensated or performed while incarcerated.
4. Prohibits a certificate or license issued under the provisions of this bill from being denied on the basis of a felony conviction, or the acts underlying the conviction, that has been dismissed.
5. Requires an applicant to furnish to the employer, agency, or EMSA proof of the dismissal as described in 4) above, if the employer, agency, or EMSA does not have documentation.
6. Prohibits a certificate or license issued pursuant to these provisions from being denied on the basis of an arrest, infraction, or citation for a misdemeanor or infraction, or adjudicated within the jurisdiction of the juvenile court.

The Senate amendments delete the contents of the bill and instead require each LEMSA or other certifying entities to annually submit to EMSA, by July 1 of each year, data on the approval or denial of EMT-I or EMT-II applicants as follows:

1. Requires the data to include, at a minimum, all of the following information with respect to the preceding calendar year:
   1. The total number of applicants who applied for initial certification;
   2. The total number of applicants with a prior criminal conviction who applied for initial certification;
   3. The number of applicants denied, the number of applicants approved, and the number of applicants approve with restrictions;
   4. The reason or reasons stated for denying an applicant with a prior criminal conviction, or the reason or reasons stated for denying an applicant with a prior criminal conviction, or the reason or reasons state for approving wit restrictions an applicant with a prior criminal conviction;
   5. The restrictions imposed on approve applicants with a prior criminal conviction, and the duration of those impose restrictions; and,
   6. Race, ethnicity, gender, and age demographic data for all applicants who were denied, approved, or approved with restrictions.
2. Requires EMSA to annually report to the Commission on Emergency Medical Services (Commission) on the extent to which prior criminal history may be an obstacle to certification as an EMT, and requires EMSA to annually submit the same report to the Legislature.
3. Prohibits data submitted to EMSA and the reports to the Commission and Legislature from containing any personal identifying information of the EMT applicants.
4. Makes the provisions of this bill inoperative on July 1, 2024.

FISCAL EFFECT: According to the Senate Appropriations Committee, EMSA anticipated costs include:

1. Costs of $143,000 (General Fund (GF)) in fiscal year 2018-2019 and $136,000 (GF) annually thereafter, for 1.0 full-time associate governmental program analyst of collect the required information from the 69 certifying entities, analyze the data, and prepare the annual report.
2. Approximately $50,000 (GF) for modifications needed to the My License Office database, the system for certifying entities to enter the data, for data collection and reporting. Staff notes this figure may need to be adjusted upwards a few tens of thousands (GF), depending on the complexity of the change orders needed to implement the bill’s provisions.

The Assembly Appropriations Committee notes additional potential state mandate costs, should the Commission State Mandates finds reimbursement to local agencies is required.

COMMENTS: According to the author, this year, our state has seen increased fire seasons in both acreage burned and duration. In response, there is a sharp need for additional firefighters and EMTs. Under current law, we are forced to flatly deny qualified individuals based purely on a past criminal history. California can and should work harder to provide a pathway to stable employment, especially when we are in dire need of these positions. This bill reduces barriers for individuals who have already served their time to have an opportunity for employment that requires an EMT license.

1. 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.
2. Occupational licensure for formerly incarcerated persons. According to a November 2016 report by the Ewing Marion Kauffman Foundation, "No Bars: Unlocking the Economic Power of the Formerly Incarcerated," nearly 7 million Americans are currently involved in the criminal justice system. One in three adults has been arrested by the age of 23, and it is estimated that as many as 100 million Americans have criminal records. High rates of incarceration disproportionately affect people of color. Compared to white men, black men are six times more likely to be incarcerated, and Hispanic men are 2.5 times more likely to be incarcerated.

According to the Center for American Progress, every year, more than 600,000 Americans are released from federal and state prisons. Barriers to successful employment are clear: Department of Justice data show that one year following release, between 60% and 75% of formerly incarcerated people are still unemployed. Many states have adopted "Ban the Box" statutes that prohibit public employers from seeking information about criminal records in job applications, resulting in as much as a 4% increase in employment of residents of high-crime neighborhoods. While a reduced focus on criminal histories represents a step forward in efforts to increase employment among the formerly incarcerated, other barriers remain.

Occupational licenses, where a government mandates an individual secure a license to work in certain professions stands as an obstacle. Occupational licenses typically require a specific application process, a prescribed amount of educational training, and fees, and individuals with criminal records may be banned from receiving licenses based on their criminal histories, regardless of the relevancy of their conviction to the job.

Analysis Prepared by: Lara Flynn / HEALTH / (916) 319-2097 FN: 0004229

 THIRD READING  

Bill No: AB 2293

Author:

:

Vote:

SENATE HEALTH COMMITTEE: 7-2, 6/27/18

AYES: Pan, Beall, Hernandez, Leyva, Mitchell, Monning, Roth

NOES: Nguyen, Nielsen

SENATE APPROPRIATIONS COMMITTEE: 5-2, 8/16/18

AYES: Portantino, Beall, Bradford, Hill, Wiener

NOES: Bates, Nielsen

ASSEMBLY FLOOR: 42-29, 5/31/18 - See last page for vote

SUBJECT: Emergency medical services: report

SOURCE: East Bay Community Law Center

DIGEST:

This bill requires local emergency medical services (EMS) agencies to annually submit to the Emergency Medical Services Authority (EMSA), by July 1 of each year, data on the approval or denial of EMT-I or EMT-II applicants who have prior criminal convictions, and requires EMSA to make an annual report to the Legislature. Sunsets the bill on July 1, 2024.

ANALYSIS:

Existing law:

1. Establishes EMSA, which is responsible for the coordination and integration of all state activities concerning EMS, including the establishment of minimum standards, policies, and procedures. [HSC §1797.100 et seq.]
2. Establishes an 18-member Commission on EMS, within the California Health and Human Services Agency. Defines the duties of the Commission to include reviewing regulations, standards, and guidelines developed by EMSA; advising EMSA on a data collection system; advising EMSA on emergency facilities and services, emergency communications, medical equipment, personnel training, and various aspects of the EMS system; and, making recommendations for further development of the EMS system. [HSC §1799 et seq.]
3. Authorizes counties to develop an EMS program and designate a local EMS agency (LEMSA) responsible for planning and implementing an EMS system, which includes day-to-day EMS system operations. [HSC §1797.200 et seq.]
4. 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 by the LEMSA. [HSC §1797.80 and §1797.82]
5. Permits a medical director of a LEMSA to deny, suspend, or revoke any EMT-I or –II certificate upon a finding by the medical director of the occurrence of any of specified actions, including the following:
   1. Fraud in the procurement of any EMS certificate or license;
   2. Gross negligence or repeated negligent acts;
   3. Incompetence;
   4. The commission of any fraudulent, dishonest, or corrupt act that is substantially related to the qualifications, functions, and duties of prehospital personnel;
   5. Conviction of any crime which is substantially related to the qualifications, functions, and duties of prehospital personnel;
   6. Violating or attempting to violate any federal or state law regulating narcotics, dangerous drugs, or controlled substances;
   7. Addiction to, the excessive use of, or the misuse of, alcohol, narcotics, dangerous drugs, or controlled substances; and,
   8. Commission of any sexually related offense that requires being registered as a sex offender under the Sex Offender Registration Act.

This bill:

1. Requires each local EMS agency and other certifying entities to annually submit to EMSA, by July 1 of each year, data on the approval or denial of EMT-I or EMT-II applicants. Requires the data submitted to EMSA to include, at a minimum, all of the following information with respect to the preceding calendar year:
   1. The total number of applicants who applied for initial certification;
   2. The total number of applicants with a prior criminal conviction who applied for initial certification;
   3. The number of applicants who were denied, the number of applicants who were approved, and the number of applicants who were approved with restrictions;
   4. The number of applicants with a prior criminal conviction who were denied, the number of applicants with a prior criminal conviction who were approved, and the number of applicants with a prior criminal conviction who were approved with restrictions;
   5. The reason or reasons stated for denying an applicant with a prior criminal conviction, or the reason or reasons stated for approving with restrictions an applicant with a prior criminal conviction;
   6. The restrictions imposed on approved applicants with a prior criminal conviction, and the duration of those imposed restrictions;
   7. Race, ethnicity, gender, and age demographic data for all applicants who were denied, approved, or approved with restrictions.
2. Requires EMSA to annually report to the Commission on EMS on the extent to which prior criminal history may be an obstacle to certification as an EMT-I or EMT-II. Requires EMSA to annually submit the same report to the Legislature, and to make the report easily accessible on EMSA’s Internet Web site.
3. Prohibits data submitted to EMSA pursuant to this bill, and the reports EMSA makes pursuant to this bill, from containing any personal identifying information of the EMT-I or EMT-II applicants.
4. Sunsets the provisions of this bill on July 1, 2024.

Background

1. EMS. EMSA is the lead agency and centralized resource to oversee emergency and disaster medical services. EMSA is charged with providing leadership in developing and implementing 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 33 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. 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..
2. 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.
3. Conservation (fire) camps. The Conservation Camp Program was initiated by California Department of Corrections and Rehabilitation (CDCR) to provide able-bodied inmates the opportunity to work on meaningful projects throughout the state. There are 43 conservation camps for adult offenders and one camp for juvenile offenders. Three of the adult offender camps house female fire fighters. Thirty-nine adult camps and the juvenile offender camp are jointly managed by CDCR and the California Department of Forestry and Fire Protection, known as CalFire. Five camps are jointly managed with the Los Angeles County Fire Department. The conservation camps, which are located in 29 counties, can house up to 4,522 adult inmates and 80 juveniles, which make up approximately 219 fire-fighting crews. A typical camp houses five 17-member firefighting crews as well as inmates who provide support services. In an average year, the Conservation Camp Program provides approximately three million person-hours responding to fires and other emergencies and seven million person-hours in community service projects, saving California taxpayers approximately $100 million. Those projects can include clearing fire breaks, restoring historical structures, maintaining parks, sand bagging and flood protection, reforestation and clearing fallen trees and debris. All inmates must earn the right to work in a conservation camp by their non-violent behavior and conformance to rules while they are incarcerated. Only minimum-custody inmates are eligible to volunteer for assignment in conservation camps. All volunteers are carefully screened and medically cleared on a case-by-case basis before they are accepted into the program. Some convictions automatically make an inmate ineligible for conservation camp assignment, even if they have minimum custody status. Those convictions include: sexual offenses, arson and any history of escape with force or violence. Inmates considered potential fire crew members are evaluated for their physical fitness by CDCR and are trained in fire-fighting techniques by CalFire, which includes a week of classroom instruction and a second week of field exercises.
4. Budget trailer bill allows emergency medical responder certification of conservation camp firefighters. AB 1812 (Committee on Budget), a recently passed budget trailer bill that is pending consideration before the Governor, contains provisions permitting CalFire to certify an individual as an emergency medical responder (EMR) if the individual meets the following conditions: the individual is a graduate of the CalFire training program at a CDCR conservation camp and received a letter of recommendation from the Director of CalFire; and, while participating in the CalFire training program, the individual was working toward a high school diploma or its equivalent, unless he or she already earned one. AB 1812 requires the individual to also meet the training requirements for an EMR in specified regulations. Additionally, AB 1812 specifically states that an individual is not disqualified from certification as an EMR for having committed any of the actions in existing law that can be used to disqualify an individual for certification as an EMT, such as a prior criminal history. Under AB 1812, to be certified as an EMR, you need to meet the training requirements under regulations developed for “public safety first aid,” which is defined as the recognition of and immediate care for injury or sudden illness, including medical emergencies, by public safety personnel prior to the availability of medical care by licensed or certified health care professionals. Except for those whose duties are primarily clerical or administrative, lifeguards, firefighters, and peace officers are required to meet the requirements of public safety first aid, also known as EMR. These individuals must take an initial training course of at least 21 hours in first aid and CPR, which includes a long list of first aid and CPR content, and on completion of the training, are authorized to provide medical care at the scene of an emergency under a prescribed list of authorized skills.
5. Firefighters and EMT certification. A firefighter is defined in law as any regularly employed and paid officer, employee, or member of a fire department or fire protection or firefighting agency of the State of California, a city, county, city and county, district, or other public or municipal corporation or political subdivision of this state or member of an emergency reserve unit of a volunteer fire department or fire protection district. Firefighters are not statutorily required to have EMT certification, but according to the California Professional Firefighters (CPF), it is often a condition of employment in municipal fire departments that provides EMS services.

Comments

1. Author’s statement. According to the author, this year, our state has seen increased fire seasons in both acreage burned and duration. In response, there is a sharp need for additional firefighters and EMTs. Under current law, we are forced to flatly deny qualified individuals based purely on a past criminal history. California can and should work harder to provide a pathway to stable employment, especially when we are in dire need of these positions.

FISCAL EFFECT: Appropriation: Fiscal Com.: Local:

According to the Senate Appropriations Committee, EMSA anticipated costs include:

• $143,000 (General Fund) in fiscal year 2018-2019, and $136,000 (General Fund) annually thereafter, for 1.0 full-time associate governmental program analyst of collect the required information from the 69 certifying entities, analyze the data, and prepare the annual report.
• Approximately $50,000 (General Fund) for modifications needed to the My License Office database, the system for certifying entities to enter the data, for data collection and reporting. Staff notes this figure may need to be adjusted upwards a few tens of thousands (General Fund), depending on the complexity of the change orders needed to implement the bill’s provisions.

SUPPORT: (Verified 8/15/18)

East Bay Community Law Center (source)

Alameda County Public Defenders

All of Us or None

Alliance for Boys and Men of Color

American Civil Liberties Union

Bay Area Council

Bay Area Legal Aid

Californians for Prop 57

Homeboy Industries

Legal Services for Prisoners with Children

National Employment Law Project

PolicyLink

Root & Rebound

Rubicon Programs

OPPOSITION: (Verified 8/22/18)

None received

ASSEMBLY FLOOR: 42-29, 5/31/18

AYES: Aguiar-Curry, Berman, Bloom, Bonta, Burke, Caballero, Calderon, Carrillo, Chau, Chiu, Chu, Cooley, Daly, Eggman, Friedman, Cristina Garcia, Eduardo Garcia, Gipson, Gloria, Gonzalez Fletcher, Grayson, Holden, Jones-Sawyer, Kalra, Kamlager-Dove, Levine, Limón, Low, Mayes, McCarty, Medina, Mullin, Nazarian, Quirk, Reyes, Santiago, Mark Stone, Thurmond, Ting, Weber, Wood, Rendon

NOES: Acosta, Travis Allen, Baker, Bigelow, Brough, Cervantes, Chávez, Chen, Choi, Cunningham, Dahle, Flora, Fong, Gallagher, Gray, Harper, Irwin, Lackey, Maienschein, Mathis, Melendez, Obernolte, O'Donnell, Patterson, Quirk-Silva, Salas, Steinorth, Voepel, Waldron

NO VOTE RECORDED: Arambula, Cooper, Frazier, Kiley, Muratsuchi, Rodriguez, Rubio

Prepared by:

8/22/18 17:17:13

**** END ****

SENATE COMMITTEE ON APPROPRIATIONS

Senator Anthony Portantino, Chair

2017 - 2018 Regular Session

AB 2293 (Reyes) - Emergency medical services: report

This bill meets the criteria for referral to the Suspense File.

Bill Summary:

Requires each local EMS agency and other certifying entities to submit a report to the Emergency Medical Services Authority (EMSA) by July 1 of each year, data on the approval or denial of specified EMT applicants, with the report to include: the number of applicants who applied for certification, number of applicants with a prior criminal conviction,

Fiscal Impact:

According to EMSA, anticipated costs include:

• $143,000 (General Fund) in fiscal year 2018-2019, and $136,000 (General Fund) annually thereafter, for 1.0 full-time associate governmental program analyst of collect the required information from the 69 certifying entities, analyze the data, and prepare the annual report.
• Approximately $50,000 (General Fund) for modifications needed to the My License Office database, the system for certifying entities to enter the data, for data collection and reporting. Staff notes this figure may need to be adjusted upwards a few tens of thousands (General Fund), depending on the complexity of the change orders needed to implement the bill’s provisions.

Staff notes additional potential state mandate costs, should the Commission State Mandates finds reimbursement to local agencies is required.

Background:

1. The Emergency Medical Services Authority (EMSA) is the state’s centralized entity that coordinates EMS services and programs statewide. Day-to-day EMS system operations is the responsibility of the local and regional EMS agency. California has 33 LEMSA systems across the state’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. 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-Paramedic (EMT-Ps), mobile intensive care nurses, firefighters, peace officers, and lifeguards.

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.

AB 1812 (Committee on Budget, Chapter 36, Statutes of 2018), the public safety budget trailer bill, contains provisions permitting CalFire to certify an individual as an emergency medical responder (EMR) if the individual meets the following conditions: the individual is a graduate of the CalFire training program at a CDCR conservation camp and received a letter of recommendation from the Director of CalFire; and, while participating in the CalFire training program, the individual was working toward a high school diploma or its equivalent, unless he or she already earned one. AB 1812 requires the individual to also meet the training requirements for an EMR in specified regulations. Additionally, AB 1812 specifically states that an individual is not disqualified from certification as an EMR for having committed any of the actions in existing law that can be used to disqualify an individual for certification as an EMT, such as a prior criminal history.

Under AB 1812, to be certified as an EMR, you need to meet the training requirements under regulations developed for “public safety first aid,” which is defined as the recognition of and immediate care for injury or sudden illness, including medical emergencies, by public safety personnel prior to the availability of medical care by licensed or certified health care professionals. Except for those whose duties are primarily clerical or administrative, lifeguards, firefighters, and peace officers are required to meet the requirements of public safety first aid, also known as EMR. These individuals must take an initial training course of at least 21 hours in first aid and CPR, which includes a long list of first aid and CPR content, and on completion of the training, are authorized to provide medical care at the scene of an emergency under a prescribed list of authorized skills.

Proposed Law:

The bill includes the following provisions, among others:

• Requires each local EMS agency and other certifying entities shall annually submit to EMSA, by July 1 of each year, data on the approval or denial of EMT-I or EMT-II applicants. The data submitted to the authority shall include, at a minimum, all of the following information with respect to the preceding calendar year:
  • The total number of applicants who applied for initial certification.
  • The total number of applicants with a prior criminal conviction who applied for initial certification.
  • The number of applicants who were denied, the number of applicants who were approved, and the number of applicants who were approved with restrictions.
  • The number of applicants with a prior criminal conviction who were denied, the number of applicants with a prior criminal conviction who were approved, and the number of applicants with a prior criminal conviction who were approved with restrictions.
  • The reason or reasons stated for denying an applicant with a prior criminal conviction, or the reason or reasons stated for approving with restrictions an applicant with a prior criminal conviction.
  • The restrictions imposed on approved applicants with a prior criminal conviction, and the duration of those imposed restrictions.
  • Race, ethnicity, gender, and age demographic data for all applicants who were denied, approved, or approved with restrictions.
• Requires the EMSA to annually report to the commission on the extent to which prior criminal history may be an obstacle to certification as an EMT-I or EMT-II. The authority shall annually submit the same report to the Legislature, in compliance with Section 9795 of the Government Code, and shall make the report easily accessible on the authority’s Internet Web site.
• Requires that data submitted to the authority pursuant to subdivision (a) and the reports described in subdivision must not contain any personal identifying information of the EMT-I or EMT-II applicants.
• Sets an inoperative date of July 1, 2024, and, repeal date of January 1, 2025.

Related Legislation:

The Legislature considered similar proposals related to EMSA training standards and rehabilitation, including:

• AB 2102 (Rodriguez) requires EMSA to establish training standards and licensing reciprocity procedures for out-of-state paramedic personnel who are requested through the California Disaster and Civil Defense Master Mutual Aid Agreement to render aid on a temporary basis during a declared state of emergency. AB 2102 is set for hearing on August 6, 2018 in this committee.
• SB 1378 (Hancock, 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 under submission on the Assembly Appropriations Suspense File.
• AB 1944 (Gatto, 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 under submission 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. 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. 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.

Staff Comments:

Firefighters are not statutorily required to have EMT certification, but is often a condition of employment in municipal fire departments that provides EMS services.

-- END --

SENATE COMMITTEE ON HEALTH

Senator Dr. Richard Pan, Chair

BILL NO: AB 2293

SUBJECT: Emergency medical services: licensure

SUMMARY: Removes the ability of a medical director of a local emergency medical services agency (LEMSA) to deny an application for an EMT-I or EMT-II certificate based on a list of specified actions in existing law that are considered a threat to the public health and safety for purposes of denial, suspension or revocation of a certificate, and instead establishes a revised and more limited list of actions that can be used to deny an EMT-I or-II certificate, and provides the ability for an applicant to demonstrate rehabilitation that would prevent the denial of an EMT certificate based on criminal convictions.

Existing law:

1. Establishes the Emergency Medical Services Authority (EMSA), which is responsible for the coordination and integration of all state activities concerning emergency medical services (EMS), including the establishment of minimum standards, policies, and procedures. [HSC §1797.100 et seq.]
2. Establishes an 18-member Commission on EMS, within the California Health and Human Services Agency. Defines the duties of the Commission to include reviewing regulations, standards, and guidelines developed by EMSA; advising EMSA on a data collection system; advising EMSA on emergency facilities and services, emergency communications, medical equipment, personnel training, and various aspects of the EMS system; and, making recommendations for further development of the EMS system. [HSC §1799 et seq.]
3. Requires the Commission on EMS 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. [HSC §1799.50]
4. Authorizes counties to develop an EMS program and designate a LEMSA responsible for planning and implementing an EMS system, which includes day-to-day EMS system operations. [HSC §1797.200 et seq.]
5. 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 by the LEMSA. [HSC §1797.80 and §1797.82]
6. Permits a medical director of a LEMSA to deny, suspend, or revoke any EMT-I or –II certificate upon a finding by the medical director of the occurrence of any of specified actions, including the following:
   1. Fraud in the procurement of any EMS certificate or license;
   2. Gross negligence or repeated negligent acts;
   3. Incompetence;
   4. The commission of any fraudulent, dishonest, or corrupt act that is substantially related to the qualifications, functions, and duties of prehospital personnel;
   5. Conviction of any crime which is substantially related to the qualifications, functions, and duties of prehospital personnel;
   6. Violating or attempting to violate any federal or state law regulating narcotics, dangerous drugs, or controlled substances;
   7. Addiction to, the excessive use of, or the misuse of, alcohol, narcotics, dangerous drugs, or controlled substances; and,
   8. Commission of any sexually related offense that requires being registered as a sex offender under the Sex Offender Registration Act.

This bill:

1. Removes the ability of a medical director of a LEMSA to deny an application for an EMT-I or EMT-II certificate based on a list of specified actions in existing law that are considered a threat to the public health and safety for purposes of denial, suspension or revocation of a certificate, and instead establishes a revised and more limited list of actions that can be used to deny an EMT-I or-II certificate.
2. Permits an application submitted by an individual for an EMT-I or –II certificate to be denied based on any of the following actions, unless the applicant demonstrates substantial rehabilitation, as defined:
   1. Fraud in the procurement of any emergency response certificate or license;
   2. A grossly negligent act in the course of employment in a related field;
   3. Repeated negligent acts in the course of employment in a related field;
   4. Demonstrated incompetence in the course of employment in a related field;
   5. The commission of any fraudulent, dishonest, or corrupt act committed in the course of a related field;
   6. Conviction of a violent felony, as defined;
   7. Conviction of a crime within the last five years that is directly related to, and adversely impacts the qualifications, functions, and duties of, prehospital personnel;
   8. Violation of any provision of the Prehospital Emergency Medical Care Personnel Act, which occurs in the course of employment;
   9. Conviction for the violation of any federal or state law regulating narcotics, dangerous drugs, or controlled substances within the last five years which resulted in incarceration. Requires the facts underlying the conviction to directly relate to, and adversely impact the qualification, functions and duties of, prehospital personnel;
   10. Excessive use of alcoholic beverages, narcotics, dangerous drugs, or controlled substances;
   11. Functioning outside of the supervision of medical control in the field care system operating at the local level, except as authorized by any other license or certification;
   12. 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 duties normally expected may be impaired;
   13. 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 in a similar circumstance;
   14. Failure to maintain confidentiality of patient medical information, except as permitted or required by law, as specified; and,
   15. Conviction of any sexually related offense that requires registration under the Sex Offender Registration Act, as specified.
3. Prohibits an application from being denied based on any of the actions listed in 2) above if the applicant has demonstrated substantial rehabilitation. Defines “substantial rehabilitation” as the applicant having done one of the following:
   1. Satisfied the criteria for rehabilitation developed by the board;
   2. Provided documentation to EMSA that he or she maintained employment in a related field, which is defined to include employment duties that are substantially similar to emergency medical responders, and may be uncompensated or compensated, or performed while incarcerated; or,
   3. Successfully completed a course of training in a related field.
4. Prohibits an application for an EMT-I or –II certificate from being denied on the basis of a conviction that has been dismissed, pardoned, or expunged, or on the basis of a citation or arrest punishable as an infraction or misdemeanor, or for a matter adjudicated within the jurisdiction of the juvenile court, as defined.
5. Requires proceedings against applicants to be held in accordance with specified provisions of existing law governing administrative hearings by administrative law judges, and permits applicants to file a notice of defense within 30 days after service of an accusation.

FISCAL EFFECT:

According to the Assembly Appropriations Committee, costs to EMSA in the range of $500,000 annually for at least three years to revise regulations and guidelines, process additional new applications, and information technology changes to the central EMS registry (GF, or Emergency Medical Services Personnel Fund with an estimated fee

increase of $12 per license). Ongoing costs are expected to be minor once the required changes

are made.

PRIOR VOTES:

COMMENTS:

1. Author’s statement. According to the author, this year, our state has seen increased fire seasons in both acreage burned and duration. In response, there is a sharp need for additional firefighters and EMTs. Under current law, we are forced to flatly deny qualified individuals based purely on a past criminal history. California can and should work harder to provide a pathway to stable employment, especially when we are in dire need of these positions. This bill reduces barriers for individuals who have already served their time to have an opportunity for employment that requires an EMT license.
2. Background on emergency medical services. EMSA is the lead agency and centralized resource to oversee emergency and disaster medical services. EMSA is charged with providing leadership in developing and implementing 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 33 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. 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..
3. 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.
4. Conservation (fire) camps. The Conservation Camp Program was initiated by California Department of Corrections and Rehabilitation (CDCR) to provide able-bodied inmates the opportunity to work on meaningful projects throughout the state. There are 43 conservation camps for adult offenders and one camp for juvenile offenders. Three of the adult offender camps house female fire fighters. Thirty-nine adult camps and the juvenile offender camp are jointly managed by CDCR and the California Department of Forestry and Fire Protection, known as CalFire. Five camps are jointly managed with the Los Angeles County Fire Department. The conservation camps, which are located in 29 counties, can house up to 4,522 adult inmates and 80 juveniles, which make up approximately 219 fire-fighting crews. A typical camp houses five 17-member firefighting crews as well as inmates who provide support services. In an average year, the Conservation Camp Program provides approximately three million person-hours responding to fires and other emergencies and seven million person-hours in community service projects, saving California taxpayers approximately $100 million. Those projects can include clearing fire breaks, restoring historical structures, maintaining parks, sand bagging and flood protection, reforestation and clearing fallen trees and debris. All inmates must earn the right to work in a conservation camp by their non-violent behavior and conformance to rules while they are incarcerated. Only minimum-custody inmates are eligible to volunteer for assignment in conservation camps. All volunteers are carefully screened and medically cleared on a case-by-case basis before they are accepted into the program. Some convictions automatically make an inmate ineligible for conservation camp assignment, even if they have minimum custody status. Those convictions include: sexual offenses, arson and any history of escape with force or violence. Inmates considered potential fire crew members are evaluated for their physical fitness by CDCR and are trained in fire-fighting techniques by CalFire, which includes a week of classroom instruction and a second week of field exercises.
5. Budget trailer bill allows emergency medical responder certification of conservation camp firefighters. AB 1812 (Committee on Budget), a recently passed budget trailer bill that is pending consideration before the Governor, contains provisions permitting CalFire to certify an individual as an emergency medical responder (EMR) if the individual meets the following conditions: the individual is a graduate of the CalFire training program at a CDCR conservation camp and received a letter of recommendation from the Director of CalFire; and, while participating in the CalFire training program, the individual was working toward a high school diploma or its equivalent, unless he or she already earned one. AB 1812 requires the individual to also meet the training requirements for an EMR in specified regulations. Additionally, AB 1812 specifically states that an individual is not disqualified from certification as an EMR for having committed any of the actions in existing law that can be used to disqualify an individual for certification as an EMT, such as a prior criminal history.
   
   Under AB 1812, to be certified as an EMR, you need to meet the training requirements under regulations developed for “public safety first aid,” which is defined as the recognition of and immediate care for injury or sudden illness, including medical emergencies, by public safety personnel prior to the availability of medical care by licensed or certified health care professionals. Except for those whose duties are primarily clerical or administrative, lifeguards, firefighters, and peace officers are required to meet the requirements of public safety first aid, also known as EMR. These individuals must take an initial training course of at least 21 hours in first aid and CPR, which includes a long list of first aid and CPR content, and on completion of the training, are authorized to provide medical care at the scene of an emergency under a prescribed list of authorized skills.
6. Data does not show criminal history as a barrier to EMT certification. According to data provided by the Emergency Medical Directors Association of California, the data does not necessarily back up the claim that a criminal history is an obstacle to certification as an EMT. There is data from 17 of the 33 LEMSAs, including large agencies such as Los Angeles County, Riverside County, Orange County, Sacramento County, and the City and County of San Francisco. Since these agencies started collecting data (the length of data collection varied from agency to agency, some as far back as 2009, others only over the last couple of years), there have been 2,712 applicants with a criminal history that have applied for EMT certification, and only 60 were denied, or 2.21%. Some had higher rates, such as Alameda County, which since 2013 has had 27 applicants with a criminal history, and denied 10 of them, for a 37% denial rate. Sacramento, on the other hand, had 106 applicants with a criminal history since 2014, and only denied one, for a 0.94% denial rate. To be clear, this data did not distinguish between types of criminal history convictions, the denial rate may be higher for more serious convictions, and many others with criminal convictions may be dissuaded from even applying. According to the EMS registry, of the 62,039 active EMTs, 3,132 have a criminal history, or 5.05%.
7. Firefighters and EMT certification. A firefighter is defined in law as any regularly employed and paid officer, employee, or member of a fire department or fire protection or firefighting agency of the State of California, a city, county, city and county, district, or other public or municipal corporation or political subdivision of this state or member of an emergency reserve unit of a volunteer fire department or fire protection district. Firefighters are not statutorily required to have EMT certification, but according to the California Professional Firefighters (CPF), it is often a condition of employment in municipal fire departments that provides EMS services.
8. Related legislation. AB 2102 (Rodriguez) requires EMSA to establish training standards and licensing reciprocity procedures for out-of-state paramedic personnel who are requested through the California Disaster and Civil Defense Master Mutual Aid Agreement to render aid on a temporary basis during a declared state of emergency. AB 2102 is set for hearing on June 27, 2018 in this Committee.
9. 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. 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. 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.

1. Support. Root & Rebound writes in support that this bill gives qualified individuals with arrest and conviction records a fair opportunity to work as firefighters and EMTs. At the core of Root & Rebound’s work is the belief that a criminal record should not be a life sentence and that individuals impacted by incarceration should have a true second chance. Root & Rebound argues that approximately 30% of forest fighters, about 4,000 people, are currently incarcerated, but once released, it is nearly impossible for them to become firefighters. This bill will allow them to use the skills learned while in prison in order to earn a living. The National Employment Law Project states that this bill will increase public safety through reduced recidivism, as research indicates that employment is the single most important factor to reducing recidivism. Homeboy Industries states in support that this bill will reduce overly restrictive barriers that prevent applicants with a criminal record from obtaining certification by limiting the consideration to related convictions within the preceding five years, violent felonies, or convictions resulting in placement on the sex offender registry.
2. Opposition. The Emergency Medical Services Administrators Association of California (EMSAAC) and the Emergency Medical Directors Association of California (EMDAC) oppose this bill stating that it severely restricts the ability of LEMSA medical directors and the director of EMSA to protect the public health and safety by denying licenses to applicants for EMTs. EMSAAC and EMDAC note that existing statutory standards for discipline of pre-hospital personnel was developed in collaboration with numerous EMS stakeholders to ensure both patient safety and to not unnecessarily exclude people from certification for past criminal convictions unrelated to the duties, qualifications and functions of prehospital medical care personnel. EMDAC and EMSAAC conclude that pre-hospital personnel serve on ambulances, emergency response apparatus, and remote first-aid areas providing services to vulnerable patients, many who are elderly and alone, in their homes with little direct supervisions. For this reason and others they believe that standards for who is eligible for certification and licensure should remain high. The California Ambulance Association (CAA) states in opposition that there are thousands of career fields and employment possibilities that a rehabilitated felon could probably perform successfully. However, EMTs are entrusted with life-giving care to serve people in their most stressful and vulnerable times, and must be beyond reproach. CAA states that lowering the standards for EMT certification is not the answer to the societal problem of finding gainful employment for ex-cons. The California State Sheriffs’ Association (CSSA) states in opposition that it understands the desire to facilitate re-entry efforts but is concerned that relaxing standards for EMT licensure with respect to an applicant’s job and criminal history will put the public at risk. CSSA states that under this bill, a person convicted of a violent felony, for example, could not be denied an EMT license based on that offense if the person demonstrated substantial rehabilitation, and that the bar for that is too low given that a person can demonstrate substantial rehabilitation by merely providing documentation to EMSA that he or she maintained employment in a related field for at least a year or successfully completed a course of training in a related field.
   
3. Oppose unless amended. CPF writes that it opposes this bill unless it is amended to conform with provisions in AB 1812 authorizing CalFire to certify a graduate of CDCR’s conservation camp as an EMR. CPF states that certification as an EMR will provide the certification necessary for inmate firefighters, formerly incarcerated individuals, or others with criminal or related activity that may appear on a background check, to seek gainful employment in a public safety-related field without compromising the minimum standards that currently exist for EMT personnel. CPF recommends amendments to authorize a LEMSA to certify an individual as an EMR under similar conditions that AB 1812 authorizes CalFire to certify individuals as EMRs.
4. Policy comment. This bill establishes a parallel standard for issuing EMT-I and II certificates that is different than what is applied to suspend or revoke existing certificate holders. The intent is to make it easier for people with a criminal history to get an initial certificate, at which point they would have to adhere to the existing standard once they obtain a certificate. However, the way the bill is drafted raises significant concerns that it would excessively limit the ability to deny certificates even in egregious instances, as described below:
   1. “Related field” limitation. By adding the qualifier “in the course of employment in a related field” to many of the actions, it means that even if an applicant committed a grossly negligent act, or repeated negligent acts, committed fraud or a corrupt act, or demonstrated incompetence, as long as none of these actions were in the “course of employment in a related field,” they couldn’t be used to deny a certificate.
   2. Rehabilitation applies to all offenses. This bill prohibits a certificate from being denied for any of the listed actions if the applicant demonstrates substantial rehabilitation. There are no exceptions, which means that even a conviction of a violent felony, or a conviction of a sex offense which requires registration as a sex offender, cannot be used to deny a certificate if the applicant meets the rehabilitation standard.
   3. Rehabilitation standard is not well defined. Under this bill, a person can demonstrate rehabilitation for any conviction if they meet “criteria developed by the board,” which probably means EMSA (see technical drafting issues below), OR one year of employment in a related field, which can include uncompensated employment while incarcerated, OR completion of a course of training in a related field. There is no definition of what a “course of training” means, but even if defined, it is unclear why completing a training course in a related field of employment would demonstrate rehabilitation of a potentially violent crime. Even if the course of training, as well as the year of employment, were removed from the definition of rehabilitation, and it was only based on criteria developed by EMSA, shouldn’t the Legislature provide at least some guidance to EMSA as to what should be considered evidence of rehabilitation?
5. Technical drafting issues.
   1. EMSA vs LEMSA, license vs. certificate. On page 6, beginning on line 13, this bill gives the “authority” the ability to deny a “license” to an EMT-I or EMT-II. The “authority” refers to EMSA, but it is actually medical directors of LEMSAs which issue EMT-I and –II certificates (not licenses) to EMT-I’s and -II’s. (EMSA issues licenses to EMT-Ps, or paramedics.)
   2. Does “board” refer to EMSA? On page 8, beginning on line 9, this bill gives the “board” the ability to develop criteria for rehabilitation. There is no board within the body of law governing emergency services personnel. EMSA is typically charged with developing guidelines and regulations, while the Commission on EMS reviews and approves these guidelines and regulations. This needs to be clarified, along with another reference to a board on page 8, line 17.

SUPPORT AND OPPOSITION:

Support: East Bay Community Law Center (sponsor)

Alameda County Public Defenders

All of Us or None

Alliance for Boys and Men of Color

American Civil Liberties Union

Bay Area Legal Aid

Californians for Prop 57

Homeboy Industries

Legal Services for Prisoners with Children

National Employment Law Project

PolicyLink

Root & Rebound

Rubicon Programs

Showing Up for Racial Justice

Oppose: California Ambulance Association

California Professional Firefighters (unless amended)

California State Association of Counties

California State Sheriffs’ Association

City of Camarillo

Emergency Medical Directors Association of California

Emergency Medical Services Administrators Association of California

Nor-Cal EMS

-- END --

ASSEMBLY THIRD READING

ATR Bill Id:AB 2293

Author:(Reyes)

As Amended Ver:May 25, 2018

Majority vote

SUMMARY: Prohibits the Emergency Medical Services Authority (EMSA) from denying an emergency medical technician (EMT)-I or EMT-II license, upon the finding by the EMSA Director of the occurrence of evidence of a threat to the public health, if the license holder demonstrates substantial rehabilitation, as defined. Limits the criteria related to conduct that an employer, local emergency medical services agency (LEMSA), or EMSA can consider when denying an EMT-I or EMT-II license to conduct that directly relates to the course of employment, and authorizes an applicant to file a notice of defense within 30 days after service of an accusation. Specifically, this bill:

1. Defines the following actions as evidence of a threat to the public health and safety:
   1. Fraud in the procurement of any certificate or license under the provisions of this bill;
   2. A grossly negligent act in the course of employment in a related field:
   3. Repeated negligent acts in the course of employment in a related field;
   4. Demonstrated incompetence in the course of employment in a related field;
   5. The commission of any fraudulent, dishonest, or corrupt act committed in the course of employment in a related field;
   6. Conviction of a violent felony, including, but not limited to:
      1. Murder or voluntary manslaughter;
      2. Mayhem;
      3. Rape;
      4. Lewd or lascivious acts;
      5. Robbery;
      6. Arson; or,
      7. Attempted murder.
   7. Conviction of a crime within the last five years that is directly related to, and adversely impacts the qualifications, functions, and duties of, prehospital personnel;
   8. Violation of any of the provisions of this bill or regulation adopted by EMSA pertaining to prehospital personnel, which occur in the course of employment;
   9. Conviction for the violation of any federal or state statute or regulation that regulates narcotics, dangerous drugs, or controlled substances within the last five years which resulted in incarceration;
   10. Excessive use of alcoholic beverages, narcotics, dangerous drugs, or controlled substances;
   11. 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;
   12. 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 duties normally expected may be impaired;
   13. Unprofessional conduct exhibited by any of the following:
       1. 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 their would use if confronted with a similar circumstance;
       2. The failure to maintain confidentiality of patient medical information, except as permitted by existing law; or,
       3. The conviction of any sexually related offense. Authorizes EMSA to temporarily suspend its review of the application until the criminal proceeding is resolved.
2. Defines "substantial rehabilitation" as meaning the applicant for an EMT-I or EMT-II license has done either of the following:
   1. Satisfied the criteria for rehabilitation developed by the certification board; or,
   2. Provided documentation to the authority that they maintained employment in a related field for at least one year prior to licensure or successfully completed a course of training in related field, and there is no public record of an official finding related to professional misconduct.
3. Specifies that a "related field" includes employment duties that are substantially similar to the field regulated by the board and may be uncompensated or compensated or performed while incarcerated.
4. Prohibits a certificate or license issued under the provisions of this bill from being denied on the basis of a felony conviction, or the acts underlying the conviction, that has been dismissed.
5. Requires an applicant to furnish to the employer, agency, or EMSA proof of the dismissal as described in 4) above, if the employer, agency, or EMSA does not have documentation.
6. Prohibits a certificate or license issued pursuant to these provisions from being denied on the basis of an arrest, infraction, or citation for a misdemeanor or infraction, or adjudicated within the jurisdiction of the juvenile court.

FISCAL EFFECT: According to the Assembly Appropriations Committee, costs to EMSA in the range of $500,000 annually for at least three years to revise regulations and guidelines, process additional new applications, and information technology changes to the central emergency medical services (EMS) registry (General Fund, or Emergency Medical Services Personnel Fund with an estimated fee increase of $12 per license). Ongoing costs are expected to be minor once the required changes are made.

COMMENTS: According to the author, this year, our state has seen increased fire seasons in both acreage burned and duration. In response, there is a sharp need for additional firefighters and EMTs. Under current law, we are forced to flatly deny qualified individuals based purely on a past criminal history. California can and should work harder to provide a pathway to stable employment, especially when we are in dire need of these positions. This bill reduces barriers for individuals who have already served their time to have an opportunity for employment that requires an EMT license.

1. 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.
2. Firefighters. A firefighter is defined in law as any regularly employed and paid officer, employee, or member of a fire department or fire protection or firefighting agency of the State of California, a city, county, city and county, district, or other public or municipal corporation or political subdivision of this state or member of an emergency reserve unit of a volunteer fire department or fire protection district. Firefighters are not statutorily required to have EMT or EMT-P certification, but according to the California Professional Firefighters, it is often a condition of employment in municipal fire departments that provides EMS services.
3. Occupational licensure for formerly incarcerated persons. According to a November 2016 report by the Ewing Marion Kauffman Foundation, "No Bars: Unlocking the Economic Power of the Formerly Incarcerated," nearly seven million Americans are currently involved in the criminal justice system. One in three adults has been arrested by the age of twenty-three, and it is estimated that as many as 100 million Americans have criminal records. High rates of incarceration disproportionately affect people of color. Compared to white men, black men are six times more likely to be incarcerated, and Hispanic men are 2.5 times more likely to be incarcerated.

According to the Center for American Progress, every year, more than 600,000 Americans are released from federal and state prisons. Barriers to successful employment are clear: Department of Justice data show that one year following release, between 60% and 75% of formerly incarcerated people are still unemployed. Many states have adopted "Ban the Box" statutes that prohibit public employers from seeking information about criminal records in job applications, resulting in as much as a 4% increase in employment of residents of high-crime neighborhoods. While a reduced focus on criminal histories represents a step forward in efforts to increase employment among the formerly incarcerated, other barriers remain.

Occupational licenses, where a government mandates an individual secure a license to work in certain professions stands as an obstacle. Occupational licenses typically require a specific application process, a prescribed amount of educational training, and fees, and individuals with criminal records may be banned from receiving licenses based on their criminal histories, regardless of the relevancy of their conviction to the job.

Analysis Prepared by: Lara Flynn / HEALTH / (916) 319-2097 FN: 0003385

Date of Hearing: May 9, 2018

ASSEMBLY COMMITTEE ON APPROPRIATIONS

Lorena Gonzalez Fletcher, Chair

ABPCA Bill Id:AB 2293

Author:(Reyes) – As Amended Ver:April 26, 2018

Urgency: No State Mandated Local Program: No Reimbursable: No

SUMMARY:

For purposes of an application for emergency medical technician-paramedic (EMT-P) license, this bill would limit and narrow the types of crimes and violations that can result in the denial of the application. Specifically, this bill:

1. Allows the Emergency Medical Services Authority (EMSA) to deny an EMT-paramedic application for specified reasons, which are narrower than those under existing law, unless the applicant can demonstrate substantial rehabilitation, as defined.
2. Narrows many of the potentially disqualifying acts to only those acts committed in the course of employment or those directly related to an EMT-P's qualifications, functions, and duties.
3. Allows EMSA to suspend its application review pending resolution of a criminal proceeding related to a sexual offense, as specified.
4. Prohibits EMSA from denying an application based on convictions that have been dismissed, pardoned, or expunged or for which a certificate of rehabilitation has been issued.
5. Prohibits EMSA from denying an application based on arrests, infractions, or citations, as specified, or a matter adjudicated in juvenile court.

FISCAL EFFECT:

Costs to EMSA in the range of $500,000 annually for at least three years to revise regulations and guidelines, process additional new applications, and information technology changes to the central EMS registry (GF, or Emergency Medical Services Personnel Fund with an estimated fee increase of $12 per license). Ongoing costs are expected to be minor once the required changes are made.

COMMENTS:

1. Purpose. According to the author, recent wildfires demonstrate the need for additional firefighters and EMTs. The author contends under current law EMSA denies qualified individuals based purely on a past criminal history. This bill reduces barriers for individuals who have already served their time to have an opportunity for employment that requires an EMT-P license.
2. Background. An EMT is a 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). Paramedics must meet higher training requirements compared to EMT-Is and IIs, and have a broader scope of practice. There are nearly 22,000 licensed EMT-Ps in California.

This Legislature, think-tanks, and advocacy groups have recently demonstrated interest in reducing barriers for formerly incarcerated persons. Occupational licensure for formerly incarcerated persons, which generally include background checks that can disqualify a person from licensure, pose a significant barrier to entry in many professions.

1. Current Process. According to the National Registry of EMTs, EMS professionals under the authority of state licensure have unsupervised, intimate, physical and emotional contact with patients at a time of maximum physical and emotional vulnerability, as well as unsupervised access to a patient’s personal property. They note EMS professionals, therefore, are placed in a position of the highest public trust. Accordingly, the National Registry has adopted criminal conviction policies for issuing certifications to safeguard the public and preserve public trust. In order to work as an EMT or paramedic in California, an individual must first pass the National Registry certification test.

At the state level, model disciplinary orders were developed by EMSA in consultation with emergency medical services constituent groups from across the state to provide consistent and equitable treatment for violations and denial of applications.

1. Prior Legislation. AB 1931 (Rodriguez), of the current session, would have added EMT-Ps to the provisions of law governing the procedures for investigations and disciplinary actions that are current law for EMT-Is and IIs. AB 1931 was held on the Senate Appropriations Suspense File.

AB 1008 (McCarty), Chapter 789, Statutes of 2017, prohibits an employer, with certain exceptions, from inquiring about or considering a job applicant's conviction history prior to a conditional offer of employment, and sets requirements regarding the consideration of conviction histories in employment decisions

1. Staff Comment. In ongoing discussions about this bill since it passed the policy committee, concerns have been raised about conflict between this bill and conviction policy for the federal EMT certification that could render this bill’s attempt to relax certification standards moot. In other words, unless federal policy changes or the state takes the dramatic step of no longer requiring federal certification, a person could be federally disqualified for many of the acts this bill would allow on a licensed EMT-P’s record.

Analysis Prepared by: Lisa Murawski / APPR. / (916) 319-2081

Date of Hearing: April 24, 2018

ASSEMBLY COMMITTEE ON HEALTH

Jim Wood, Chair

ABPCA Bill Id:AB 2293

Author:(Reyes) – As Amended Ver:April 16, 2018

SUBJECT: Emergency medical services: licensure.

SUMMARY: Prohibits the Emergency Medical Services Authority (EMSA) from denying, suspending, or revoking, an emergency medical technician - paramedic (EMT-P) license or placing an EMT-P license holder on probation upon the finding by the EMSA director of the occurrence of evidence of a threat to the public health, if the license holder demonstrates substantial rehabilitation, as defined. Revises the criteria related to conduct that an employer, local emergency medical services agency (LEMSA) or EMSA can consider in taking disciplinary action against an EMT to conduct that directly relates to the course of employment. Prohibits an employer, agency or EMSA from taking disciplinary action against an EMT on the basis of criminal history, including expungements and arrests, as specified. Specifically, this bill:

1. Prohibits EMSA from denying, suspending, or revoking, an EMT-P license or placing an EMT-P license holder on probation upon the finding by the EMSA director of the occurrence of evidence of a threat to the public health, if the license holder demonstrates substantial rehabilitation, as defined.
2. Authorizes an EMT-P License holder to file a notice of defense within 30 days after service of an accusation.
3. Limits LEMSA/EMSAs ability to deny, suspend, or revoke a certificate or license for gross negligence, repeated negligent acts, incompetence, and the commission of fraudulent, dishonest, or corrupt acts, to those instances which occur in the course of employment.
4. Limits LEMSA/EMSAs ability to deny, suspend, or revoke a certificate or license for violations of the provisions of this bill or the regulations adopted by EMSA pertaining to prehospital personnel, to those instances which occur in the course of employment.
5. Limits LEMSA/EMSAs ability to deny, suspend, or revoke a certificate or license for violation of any federal or state statute or regulation that regulates narcotics, dangerous drugs, or controlled substance, to those which resulted in incarceration. Specifies that the facts underlying the conviction must directly relate to and adversely impact the qualifications, functions, and duties of prehospital personnel.
6. Limits LEMSA/EMSAs ability to deny, suspend, or revoke a certificate or license for the excessive use of alcoholic beverages, narcotics, dangerous drugs, or controlled substances to those instances which occur in the course of employment.
7. Specifies that pending criminal trial proceeding related to as sexually related offense, EMSA may stay disciplinary action against the certificate holder, license holder, or applicant.
8. Defines "substantial rehabilitation" as the certificate holder, license holder, or applicant has either:
   1. Satisfied the criteria of rehabilitation developed by the certification board; or,
   2. Provided documentation to EMSA that he or she maintained employment in a related field for at least one year prior to licensure or successfully completed a course of training in a related field, and there is no public record of an official finding related to professional misconduct.
9. Specifies that a "related field" includes employment duties that are substantially similar to the field regulated by the board and may be uncompensated or compensated, or performed while incarcerated.
10. Prohibits a certificate or license issued under the provisions of this bill from being denied, suspended or revoked, or placed on probation on the basis of a felony conviction, or the acts underlying the conviction, that has been dismissed.
11. Requires a certificate holder, license holder, or applicant to furnish to the employer, agency, or EMSA proof of the dismissal as described in 10) above, if the employer, agency, or EMSA does not have documentation.
12. Prohibits a certificate or license issued pursuant to these provision from being denied, suspended, or revoked, or placed on probation on the basis of an arrest, infraction, or citation for a misdemeanor or infraction, or adjudicated within the jurisdiction of the juvenile court.

EXISTING LAW:

1. Establishes EMSA, which, among other functions, 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.
2. 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. Established certification for both EMT-Is and EMT-IIs at the local level.
   
3. Defines "Emergency Medical Technician-Paramedic," "EMT-P," "paramedic" or "mobile intensive care paramedic" as an individual whose scope of practice includes the ability to provide advanced life support, as specified, including administering specified medications. Licenses and regulates EMT-Ps at the state level through EMSA.
   
4. 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.
   
5. 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.
   
6. 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.
   
7. Authorizes the temporary suspension, in specified circumstances, of an EMT-P license.
   
8. Requires EMSA to develop, and after approval by the Emergency Medical Services Commission, adopt all of the following:
   1. Guidelines for disciplinary orders, temporary suspensions, and conditions of probation for EMT-I and EMT-II certificate holders that protects the public health and safety;
   2. Regulations for the issuance of EMT-I and EMT-II certificates by a certifying entity that protects the public health and safety;
   3. Regulations for the recertification of EMT-I and EMT-II certificate holders that protect the public health and safety; and,
   4. Regulations for disciplinary processes for EMT-I and EMT-II applicants and certificate holders that protect the public health and safety.

FISCAL EFFECT: This bill has not yet been analyzed by a fiscal committee.

COMMENTS:

1. PURPOSE OF THIS BILL. According to the author, this year, our state has seen increased fire seasons in both acreage burned and duration. In response, there is a sharp need for additional firefighters and EMTs. Under current law, we are forced to flatly deny qualified individuals based purely on a past criminal history. California can and should work harder to provide a pathway to stable employment, especially when we are in dire need of these positions. This bill reduces barriers for individuals who have already served their time to have an opportunity for employment that requires an EMT license.
   
2. BACKGROUND.
   1. 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.
   2. EMT-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.
   3. Conservation (fire) Camps. The Conservation Camp Program was initiated by California Department of Corrections and Rehabilitation (CDCR) to provide able-bodied inmates the opportunity to work on meaningful projects throughout the state. There are 43 conservation camps for adult offenders and one camp for juvenile offenders. Three of the adult offender camps house female fire fighters. Thirty-nine adult camps and the juvenile offender camp are jointly managed by CDCR and the California Department of Forestry and Fire Protection, known as CalFire. Five camps are jointly managed with the Los Angeles County Fire Department. The conservation camps, which are located in 29 counties, can house up to 4,522 adult inmates and 80 juveniles, which make up approximately 219 fire-fighting crews. A typical camp houses five, 17-member fire-fighting crews as well as inmates who provide support services. In an average year, the Conservation Camp program provides approximately three million person-hours responding to fires and other emergencies and seven million person-hours in community service projects, saving California taxpayers approximately $100 million. Those projects can include clearing fire breaks, restoring historical structures, maintaining parks, sand bagging and flood protection, reforestation and clearing fallen trees and debris.
      

All inmates must earn the right to work in a conservation camp by their non-violent behavior and conformance to rules while they are incarcerated. Only minimum-custody inmates are eligible to volunteer for assignment in conservation camps. All volunteers are carefully screened and medically cleared on a case by case basis before they are accepted into the program.

Some convictions automatically make an inmate ineligible for conservation camp assignment, even if they have minimum custody status. Those convictions include: sexual offenses, arson and any history of escape with force or violence. Inmates considered potential fire crew members are evaluated for their physical fitness by CDCR and are trained in fire-fighting techniques by CalFire, which includes a week of classroom instruction and a second week of field exercises.

• 1. Firefighters. A firefighter is defined in law as any regularly employed and paid officer, employee, or member of a fire department or fire protection or firefighting agency of the State of California, a city, county, city and county, district, or other public or municipal corporation or political subdivision of this state or member of an emergency reserve unit of a volunteer fire department or fire protection district. Firefighters are not statutorily required to have EMT or paramedic certification, but according to the California Professional Firefighters, it is often a condition of employment in municipal fire departments that provides EMS services.
     
  2. EMSA recommended guidelines for disciplinary orders and conditions of probation. Model disciplinary orders were developed by EMSA in consultation with emergency medical services constituent groups from across the state in order to provide consistent and equitable discipline in cases dealing with violations. These guidelines are a standard to use in settling disciplinary matters when a respondent wishes to resolve the allegations through a negotiated settlement. If a respondent invokes his or her privilege to contest the allegations through the Administrative Procedure Act, the administrative law judge uses this document as a guide in making recommendations for discipline, if needed, to EMSA.
     
     The following factors are considered when determining the appropriate discipline:
     
     1. Nature and severity of the act, offense, or crime under consideration;
     2. Actual or potential harm to the public;
     3. Actual or potential harm to any patient;
     4. Prior disciplinary record;
     5. Prior warnings on record or prior remediation;
     6. Number and/or variety of current violations;
     7. Aggravating evidence;
     8. Mitigating evidence;
     9. Any discipline imposed by the paramedic's employer for the same occurrence of that conduct;
     10. Rehabilitation evidence;
     11. In case of a criminal conviction, compliance with the terms of the sentence and/or court-ordered probation;
     12. Overall criminal record;
     13. Time that has elapsed since the act, or offense occurred; and,
     14. If applicable, evidence of expungement proceedings.

These guidelines provide progressive discipline, unless the facts and circumstances of a particular case warrant more substantive discipline. A fine is considered the least intrusive discipline that can be imposed, followed by probation, suspension, and then revocation. For example, in cases involving the commission of any fraudulent, dishonest, or corrupt act which is substantially related to the qualifications, functions, and duties of prehospital personnel, the guidelines are as follows:

i) Maximum discipline: revocation;

ii) Recommended discipline: revocation stayed, 60 day suspension, and three years' probation with terms and conditions; or,

iii) Minimum discipline: Revocation stayed, and three years' probation with terms and conditions.

• 1. Occupational licensure for formerly incarcerated persons. According to a November 2016 report by the Ewing Marion Kauffman Foundation: No Bars: Unlocking the Economic Power of the Formerly Incarcerated, nearly seven million Americans are currently involved in the criminal justice system. One in three adults has been arrested by the age of twenty-three, and it is estimated that as many as 100 million Americans have criminal records. High rates of incarceration disproportionately affect people of color. Compared to white men, black men are six times more likely to be incarcerated, and Hispanic men are 2.5 times more likely to be incarcerated.

According to the Center for American Progress, every year, more than 600,000 Americans are released from federal and state prisons. Barriers to successful employment are clear: Department of Justice data show that one year following release, between 60% and 75% of formerly incarcerated people are still unemployed. Many states have adopted "Ban the Box" statutes that prohibit public employers from seeking information about criminal records in job applications, resulting in as much as a 4% increase in employment of residents of high-crime neighborhoods. While a reduced focus on criminal histories represents a step forward in efforts to increase employment among the formerly incarcerated, other barriers remain.

Occupational licenses, where a government mandates an individual secure a license to work in certain professions stands as an obstacle. Occupational licenses typically require a specific application process, a prescribed amount of educational training, and fees, and individuals with criminal records may be banned from receiving licenses based on their criminal histories, regardless of the relevancy of their conviction to the job.

1. SUPPORT. Rubicon Programs supports this bill and states that it will give qualified individuals with arrest and conviction records a fair opportunity to work as firefighters and emergency medical technicians. Rubicon states that occupational licenses provide the opportunity for participants to build a career, but many face barriers to obtaining licenses because of their criminal record. Rubicon notes that currently, approximately 30% of forest fighters, about 4,000 people, are currently incarcerated, and that unfortunately, once released, it is nearly impossible for them to be certified as firefighters. Rubicon concludes that this bill will allow them to use the skills learned while in prison in order to earn a living and contribute to their communities.
   
   The National Employment Law Project (NELP) supports this bill, stating that it will increase public safety through reduced recidivism. NELP states that many of the people leaving California prisons are qualified to work as firefighters and EMTs, because they; train and work as firefighters while incarcerated. Nevertheless, once released, it becomes nearly impossible for them to be certified as firefighters because of unjust restrictions in current law.
2. OPPOSITION. The Emergency Medical Services Administrators Association of California (EMSAAC) and the Emergency Medical Directors Association of California (EMDAC) oppose this bill stating that it severely restricts the ability of LEMSA medical directors and the director of EMSA to protect the public health and safety by denying licenses to applicants or imposing disciplinary action against EMTs, EMT-IIs, and paramedics. EMSAAC and EMDAC note that existing statutory standards for discipline of pre-hospital personnel was developed in collaboration with numerous EMS stakeholders to ensure both patient safety and the opportunity for individuals not be unnecessarily excluded from certification for past criminal convictions unrelated to the duties, qualifications and functions of prehospital medical care personnel. EMDAC and EMSAAC conclude that pre-hospital personnel serve on ambulances, emergency response apparatus, and remote first-aid areas providing services to vulnerable patients, many who are elderly and alone, in their homes with little direct supervisions. For this reason and others they believe that standards for who is eligible for certification and licensure should remain high.
3. RELATED LEGISLATION. AB 2380 (Aguiar-Curry) Requires the Governor’s Office of Emergency Services (Cal OES), in collaboration with the Department of Forestry and Fire Protection (Cal FIRE), to develop standards and regulations for any privately contracted private fire prevention resources (private fire resource) operating in the state. AB 2380 is pending a hearing in the Natural Resources Committee.
4. PREVIOUS LEGISLATION.
   1. AB 1931 (Rodriguez) of 2017 would have added EMT-Ps to the provisions of law governing the procedures for investigations and disciplinary actions that are current law for EMT-Is and IIs. AB 1931 was held on the Senate Appropriations Suspense File.
   2. 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.
   3. 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.
   4. AB 2917 (Torrico) Chapter 274, Statutes of 2007, requires EMSA to establish a statewide EMT registry and to develop standards, guidelines, and regulations for certification of specified EMTs. AB 2917 also establishes rules for EMT certification and discipline and for investigation of any conduct which threatens public health and safety, as defined.
5. SUGGESTED AMENDMENTS.
   1. Pathway. This bill would significantly change the way EMSA licenses EMTs/paramedics by limiting the certification board’s consideration to: i) directly and adversely related convictions within the preceding five years; and, ii) violent felonies (such as murder, mayhem, rape, or felonies punishable by death or life in prison) or convictions resulting in placement on the sex offense registry. The Committee may wish to amend this bill to require EMSA to work with stakeholders to revise the existing criteria for the certification board to consider regarding individuals with past convictions applying for EMT/paramedic licensure.
   2. Public safety. This bill limits LEMSAs and EMSAs disciplinary authority to acts that occur primarily on the job, which would let significant acts that are currently being disciplined go unchecked. For example, an EMT/paramedic convicted of driving while intoxicated off duty would not be subject to discipline. However, off duty DUIs represent about 60% of EMSAs disciplinary caseload, and of that 60% are re-offenders. Multiple DUIs are indicative of an alcohol or substance use disorder, a condition that should be referred to treatment, yet EMSA would be unable to take action until an EMT/paramedic was intoxicate on the job, posing a threat to the public safety. The Committee may wish to amend this bill to restore LEMSAs and EMSAs ability to discipline EMTs and Paramedics for violations which occur off the job.
      

REGISTERED SUPPORT / OPPOSITION:

Support

Root & Rebound (sponsor)
Alliance for Boys and Men of Color
East Bay Community Law Center

Homeboy Industries

Legal Services for Prisoners with Children
National Employment Law Project

Rubicon Programs

Opposition

Emergency Medical Directors Association of California

Emergency Medical Services Administrators Association of California

Analysis Prepared by: Lara Flynn / HEALTH / (916) 319-2097