CSAC is urging all counties to oppose a late “gut and amend” of SB 443 by Senator Robert Hertzberg last week that seeks to dismantle county medical control authority for prehospital ground emergency medical services.

The bill, as amended on June 16 and set for hearing in the Assembly Health Committee on June 28, would overturn Emergency Medical Services (EMS) case law and allow public EMS providers, such as municipal fire agencies, to determine their own medical control policies when it comes to EMS patient care.

REQUESTED ACTION: We are asking all counties to adopt and oppose position and remit opposition letters to the Assembly Health Committee as soon as possible. Please find a sample letter here and the County joint coalition letter opposing SB 443 here. The main reasons for county opposition include:

1. SB 443 goes against the intent of the EMS Act, which was to bring state and county integration, coordination, and oversight to a fragmented system.                                                  
2. SB 443 will severely limit counties from ensuring all areas are served safely and equitably by the EMS system.                                            
3. SB 443 would allow inconsistent medical standards across the jurisdiction, whereas today, the existing state-county system provides consistency and is steered by neutral EMS medical directors who are qualified physicians.                                                 

Background

County Local Emergency Medical Services Authorities (LEMSAs) are required to develop an equitable and safe EMS system, which also must be approved by the state Emergency Medical Services Authority (EMSA). Each LEMSA also must employ a Medical Director, who is a medical doctor and is tasked with setting uniform medical control policies and procedures that apply to all EMS providers in their jurisdiction. This state-county, medical-based model ensures safe and equitable care for all patients regardless of which EMS provider handles the call.

Analysis

As written, SB 443’s three sections would erode or end uniform patient standards in the following ways:

Section 1: Creates a new definition of “Level of prehospital EMS” or “level” to allow any agency to offer any level of care regardless of the current level or service. This also could allow nearly every agency offering EMS to qualify for .201 rights, which were previously limited to the specific level of prehospital EMS provided by a qualifying agency prior to June 1, 1980. Thus, it broadens the definition of level of care, reduces LEMSA oversight over increases or reductions in care, and qualifies agencies offering any level of care for .201 rights. 

Section 2: Seeks to reverse the City of Oxnard v. County of Ventura (2021) court decision in which the County of Ventura prevailed and would allow a city or fire department that “provided or contracted for” any prehospital emergency medical services as of June 1, 1980, to be “re-grandfathered” into .201 rights. This would allow the agencies to provide or change their level of prehospital emergency medical services without any coordination with LEMSAs.

Section 3: Would reverse the South County Fire Authority v. County of San Joaquin (2020) case and expressly abrogate the California Supreme Court ruling in County of San Bernardino v. City of San Bernardino (1997). It prohibits a LEMSA from exercising any medical control that would limit, supplant or alter a public safety agency’s authority to directly receive and process requests for assistance other than adopt lifesaving instructions or dispatch pre-arrival instructions.  Additionally, this section guts the EMS Act by abrogating San Bernardino and preventing a LEMSA from ever extinguishing an agency’s .201 rights. This destroys the ability of LEMSAs to coordinate a safe and equitable EMS system, which was a linchpin of the EMS Act to ensure patient service and safety for all residents.

Intent

The author and the California Fire Chiefs Association, assert SB 443 is meant to “clarify” Senator Hertzberg’s SB 438 (Chapter 389, Statutes of 2019), which allowed fire departments more dispatching control in the operation of public safety answering points and 9-1-1 EMS dispatch centers. CSAC and the county coalition were assured by Senator Hertzberg during negotiations on SB 438 that the measure was not intended to undermine local LEMSA medical control and was limited to dispatch only. After intense negotiations, SB 438 preserved county medical control and our organizations eventually adopted a neutral position on SB 438.

Bottom Line

SB 443 expressly goes beyond SB 438 by removing longstanding county and state medical oversight of local fire departments and other emergency medical services. The measure risks patient safety and care by creating a fragmented and inequitable “wild west” where EMS providers may operate without the accountability and safety of local medical oversight and state accountability. This bill will also impact all patients and EMS systems across the state, whether they live in rural, urban or suburban counties in California.

Joining CSAC in opposition are Urban Counties of California (UCC), Rural County Representatives of California (RCRC), County Health Executives Association of California (CHEAC), Emergency Medical Services Administrators Association of California (EMSAAC), and the Emergency Medical Services Medical Directors Association of California (EMDAC), as well as more than 10 individual counties to date. The California Ambulance Association and American Medical Response are also in opposition.

We urge all counties to oppose SB 443 because it would create a fragmented, inequitable patchwork of EMS medical practices. For questions, please contact CSAC Senior Legislative Representative Jolie Onodera at jonodera@counties.org. Thank you.