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AB 210
THIRD READING
Bill No:
Author:
Amended:
Vote:
AB 210
Solorio (D)
8/15/11 in Senate
21
SENATE HEALTH COMMITTEE: 5-3, 07/06/11
AYES: Hernandez, Alquist, De León, DeSaulnier, Rubio
NOES: Strickland, Anderson, Blakeslee
NO VOTE RECORDED: Wolk
SENATE APPROPRIATIONS COMMITTEE: 6-3, 08/25/11
AYES: Kehoe, Alquist, Lieu, Pavley, Price, Steinberg
NOES: Walters, Emmerson, Runner
ASSEMBLY FLOOR: 53-20, 06/03/11 - See last page for vote
SUBJECT:
Emergency medical services
SOURCE:
California Professional Firefighters
DIGEST: This bill revises existing statute pertaining to the role of city,
county, and fire districts in the provision of prehospital emergency medical
services (EMS).
ANALYSIS: Existing law:
1.
Establishes the EMS Act for the purpose of providing the state with a
statewide EMS system.
2.
Establishes the EMS Authority, within the Health and Human
Services Agency, responsible for the coordination and integration of
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all state activities concerning EMS including establishing the
minimum standards for the policies and procedures necessary for
medical control of the EMS system.
3.
Establishes a 16-member EMS Commission within the Health and
Human Services Agency, and defines duties and criteria for its
members. Ten commissioners are appointed by the Governor, three
by the Senate, and three by the Speaker of the Assembly.
4.
Authorizes counties to develop an EMS program and designate a local
EMS agency (LEMSA) responsible for planning and implementing an
EMS system.
5.
Requires the Authority to authorize LEMSAs, review and approve
LEMSA plans for implementation of EMS and trauma care systems,
and provide for a LEMSA to appeal a negative determination to the
EMS Commission.
6.
Allows a LEMSA to create an exclusive operating area (EOA) in the
development of a local plan if a competitive process is utilized to
select the provider.
7.
Defines an EOA to mean an EMS area or subarea defined by the EMS
plan for which a LEMSA restricts operations to one or more
emergency ambulance services or providers of advanced life support
(ALS) or limited advanced life support (LALS).
8.
Does not require a competitive process if the LEMSA develops or
implements a local plan that continues the use of existing providers
that have continuously provided services without interruption since
January 1, 1981.
9.
Requires a LEMSA which elects to develop an EOA to submit a plan
to the Authority for approval.
10.
Requires this plan to include provisions for a competitive process held
at periodic intervals.
11.
Provides that nothing in the provisions pertaining to the creation of an
EOA supersedes the provisions pertaining to the grandfathering of
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administration of pre-hospital EMS by cities and fire districts as of
June 1, 1980.
12.
Allows an emergency medical care committee to be established in
each county.
13.
Requires every emergency medical care committee to report its
observations and recommendations at least annually to the Authority.
This bill:
1. Continues the authorization of a city or fire district to provide prehospital
EMS that it had continuously contracted for or provided since June 1,
1980, within the geographical service area that it continuously served
during that time, if the city or fire district makes a formal written request
to the LEMSA prior to January 1, 2014, as specified. If the city or fire
district fails to enter into an agreement by January 1, 2014, it would be
prohibited from performing prehospital EMS for that type of service
unless formally authorized to so by the LEMSA. It may appeal to first
the local emergency medical care committee, or its equivalent, then the
LEMSA, and then to the courts.
2. Authorizes a city or fire district to increase its geographical area and
increase or decrease its level of service, as specified.
3. Prohibits a LEMSA from creating an exclusive operating area for a type
of prehospital EMS provided or contracted for by a city or fire district
that is providing continuing prehospital EMS.
4. Prohibits a city or fire district that has not continuously provided or
contracted for a type of prehospital EMS since June 1, 1980, from
providing or contracting for that type of prehospital EMS unless it is
formally authorized to do so by a LEMSA. A LEMSA would be required
to include all cities and fire districts that comply with these provisions in
its local EMS plan.
5. Requires the local emergency medical care committees, authorized by the
EMS Act and currently required to annually review ambulance services
operating within the county, to review the county’s EMS system and to
act in an advisory capacity to the county board or boards of supervisors.
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6. States that these provisions should not be construed to affect, limit, or
otherwise invalidate any decision by a court. This body of law has a 30
year history of litigation. For example, in its most recent case, County of
Butte v. California Emergency Medical Services Authority, 3rd Appellate
Court (2009), EMSA paid $75,000 in legal costs to the Attorney
General’s Office.
Background
The EMS system in California began its development with the passage of
the Wedworth-Townsend Pilot Paramedic Act SB 772 (Wedworth), Chapter
1188, Statutes of 1974). Paramedic programs began forming throughout the
state without regard to EMS system planning. The first paramedic program
was formed in 1970 in the county of Los Angeles. California was seen as a
leader in EMS, with the utilization of paramedics in the EMS system.
Although most EMS systems that developed nationwide have been
structured with state involvement and/or standardization, the EMS system in
California evolved at the local level.
Prior to 1981, California did not have a central state agency responsible for
ensuring the development and coordination of EMS services and programs
statewide. Because of the manner in which EMS evolved in California,
system management and operation developed independently from county to
county throughout the state. Each county established its own EMS system
(including protocols, scope of practice, training standards, etc.) and tailored
it to meet the specific needs of its geography, economy, and client
population. Though fragmented, these individual systems worked well as
long as EMS calls were confined within the local jurisdiction. However,
when the services of one county were required across county lines (e.g., for
multi-casualty incidents, patient transport, or mutual aid), the absence of
common operating procedures and methodologies often resulted in
inconsistency of care. Questions regarding scope of practice and specific
protocols, created indecision and confusion among responders at the scene.
The EMS Act created the Authority, effective January 1, 1981, and now
provides the foundation for EMS in the state. As the lead agency and
centralized resource to oversee emergency and disaster medical services, the
Authority is charged with providing leadership in developing and
implementing local EMS systems throughout California, and setting
standards for the training and scope of practice of various levels of EMS
personnel. This includes assessing each EMS area to determine the need for
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additional services, coordination and effectiveness of EMS. The Authority
reviews EMS plans submitted by LEMSAs to determine whether the plans
effectively meet the needs of the persons in the geographical areas served
and are consistent with local coordinating activities as well as with the
guidelines and regulations established by the Authority.
LEMSAs occupy the second tier of governance under the EMS Act.
California has 32 local EMS systems that provide EMS for California's 58
counties. (Seven regional EMS systems comprised of 33 counties and 25
single-county agencies provide the services.) Regional systems are usually
comprised of small, rural, less-populated counties, and single-county
systems generally exist in the larger and more urban counties. LEMSAs are
required to develop a formal plan for the system in accordance with the
Authority's guidelines and to submit the plan to the Authority annually. The
EMS Act also provides that medical direction and management of an EMS
system is under the medical control of the medical director of the LEMSA.
The EMS Act includes a provision that "grandfathers" the administration of
pre-hospital EMS by cities and fire districts as of June 1, 1980, and requires
those rights to be retained until there is a written agreement regarding the
provision of these services between the LEMSA and the city or fire district
(referred to as Section 201 rights or administrative control). A city or fire
district must provide pre-hospital EMS during the transitional period of time
before an agreement is reached to integrate into the local EMS system. In
1984, the EMS Act was amended for the purpose of authorizing LEMSAs to
grant EOAs to private EMS providers such as ambulance companies
(referred to as Section 224).
FISCAL EFFECT: Appropriation: No Fiscal Com.: Yes Local: Yes
According to the Senate Appropriations Committee:
Fiscal Impact (in thousands)
Major Provisions
Increased ambulance
zone reviews
2011-12
$50
2012-13
$100
2013-14
$50
Fund
General
SUPPORT: (Verified 8/25/11)
California Professional Firefighters (source)
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American Federation of State, County and Municipal Employees
California Fire Chiefs Association
California Senior Legislature
OPPOSITION: (Verified 8/25/11)
American Medical Response
California Ambulance Association
Mono County Board of Supervisors
San Joaquin County Board of Supervisors
Tulare County Board of Supervisors
ARGUMENTS IN SUPPORT: The California Professional Firefighters
(CPF) states that agencies with Section 201 rights have frequently
functioned without entering into written agreements with their respective
LEMSAs to coordinate, participate in the local EMS plan, and abide by
standard field protocols. CPF adds that while this approach may work in
some jurisdictions, in others it has not and this is what has led to expensive
litigation over the proper provision of pre-hospital EMS. CPF contends that
it is appropriate to statutorily clarify the need for a written agreement, as
well as to clarify exactly what should be contained in that agreement to
recognize a city or fire district’s continuing authorization to provide prehospital EMS in its jurisdiction, manage its own EMS resources and be
subject to LEMSA medical control. Understanding that pre-hospital patient
care treatment protocols and policies regarding emergency medical services
vary by county, and, in order to promote an efficient delivery of the highest
level of patient care and transport, CPF states that each county should
establish and maintain an Emergency Medical Care Committee
representative of local EMS system participants so that collaboration among
stakeholders is streamlined and coordinated.
ARGUMENTS IN OPPOSITION: The California Ambulance
Association (CAA) states that the Authority is hosting a task force which is
developing regulations on the very issues AB 210 addresses, and it is critical
that this work be allowed to continue and be completed before additional
statutory changes to the EMS act are made. CAA contends that the best
approach is to defer statutory changes and allow the regulatory process to
continue.
The county of Tulare states that this bill changes EMS systems in every
county even though there have been problems in only a few jurisdictions.
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The county of Tulare contends that this bill attempts to overturn
longstanding legal precedent which currently provides clarity and
consistency to the EMS planning process in counties. The county of Tulare
adds that this bill unnecessarily removes Section 201 and re-creates it in
another form, inviting more legal challenges to counties.
ASSEMBLY FLOOR: 53-20, 06/03/11
AYES: Alejo, Allen, Ammiano, Atkins, Beall, Block, Blumenfield, Bonilla,
Bradford, Brownley, Buchanan, Butler, Charles Calderon, Campos,
Cedillo, Chesbro, Cook, Davis, Dickinson, Eng, Feuer, Fletcher, Fong,
Fuentes, Furutani, Galgiani, Gatto, Gordon, Hall, Hayashi, Hill, Huber,
Hueso, Huffman, Lara, Logue, Bonnie Lowenthal, Ma, Mendoza,
Mitchell, Monning, Pan, Perea, V. Manuel Pérez, Portantino, Skinner,
Solorio, Swanson, Torres, Wieckowski, Williams, Yamada, John A.
Pérez
NOES: Achadjian, Bill Berryhill, Donnelly, Beth Gaines, Garrick, Grove,
Hagman, Halderman, Harkey, Jones, Knight, Mansoor, Morrell, Nielsen,
Norby, Olsen, Silva, Smyth, Valadao, Wagner
NO VOTE RECORDED: Carter, Conway, Gorell, Roger Hernández,
Jeffries, Miller, Nestande
CTW:nl 8/26/11 Senate Floor Analyses
SUPPORT/OPPOSITION:
SEE ABOVE
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