Sept. 6, 2018

CSAC, along with the County Health Executives Association of California, the Emergency Medical Services Administrators’ Association of California,  the California Hospital Association, and the California Ambulance Association are requesting that Governor Brown veto AB 3115, by Assembly Member Mike Gipson.

AB 3115 was a “gut and amend” that was created in the last days of the legislative session, received no policy committee review, and contains multiple changes to the operation of the state and local emergency medical services (EMS) system.

AB 3115 is a combination of two measures that failed to move forward earlier in the legislative session (AB 1795 also by Assembly Member Gipson and SB 944 by Senator Hertzberg). Counties were supportive of AB 1795, which would have allowed our members to continue alternate destination pilot programs designed to divert intoxicated patients from emergency departments to clinically-supervised sobering centers. Furthermore, counties have strongly supported efforts to operate community paramedicine and alternate destination programs to safely transport some patients, including those who are not sober or who are experiencing a behavioral health crisis, to appropriate facilities with the proper level of clinical oversight and safety.

While SB 944 also sought to extend the community paramedicine pilots, it included several worrisome provisions, including the development of new requirements for both existing and new alternate destination programs and a provision requiring counties to give public agencies, such as city fire departments, the first right of refusal to operate a paramedicine program. The Assembly Appropriations Committee did not move SB 944 forward due to $400,000 in projected one-time state costs and ongoing annual state costs of $300,000.

Now AB 3115 contains the majority of SB 944’s language, along with several alarming new provisions. CSAC is asking the Governor to veto this bill for the following reasons:

1. Infringement on County Authority to Choose Providers. An egregious infringement on local control of the EMS system is found in AB 3115’s §1841(e)(1), which requires the county Local Emergency Medical Services Authority (LEMSA) to provide the first right of refusal for operating an alternate destination program only to public agencies, such as local municipal fire departments. Besides infringing on the county’s authority to implement the program in the safest and most effective way, this provision is unworkable in a county-wide EMS system in which both public and private entities are overseen by the LEMSA to provide prehospital EMS transportation services.
2. Local Committees. Existing law authorizes county LEMSAs to establish local emergency medical care committees. These voluntary committees are not advisory in nature, as each county’s Medical Director retains ultimate medical control of the local EMS system under Health and Safety code § 1797.220. By requiring a minimum of five additional specified members for local emergency medical committees, along with forcing the formation of such a committee in a county that chooses to create a community paramedicine or alternate destination program, AB 3115 infringes on established medical oversight and local control of our EMS systems.
3. EMS Commission Changes. AB 3115 seeks to add two additional members to the current state EMS Commission, and adds additional requirements regarding who or which entities must be consulted. While AB 3115 would only authorize community paramedicine and alternate destination programs for five years, the bill’s proposed Commission changes will permanently alter the composition of that statewide body.

Counties continue to strongly support community paramedicine and alternate destination pilots, and CSAC remains committed to working with the bill’s sponsors, the state EMS Agency, and medical specialists to promote safe and effective community paramedicine and alternate destination pilots in the future.  

AB 3115 is a hastily constructed measure that erodes local control of the EMS system. View the CSAC Veto Request letter here.