LEGISLATION COMMITTEE
Meeting Date: April 16, 2024
Subject: AB 2973 (Hart) Emergency Services
Submitted For: Legislation Committee
Department: County Administrator’s Office
Referral No:
Referral Name: AB 2973
Presenter: Marshall Bennett, Director of Emergency Medical Services; Lewis Broschard, Fire Chief of Contra Costa County Fire Protection District
Contact: L. DeLaney, 925-655-2057
Referral History:
The Contra Costa County Board of Supervisors has a recent history of legislative advocacy related to Emergency Medical Services bills. In 2021, the County successfully sponsored and advocated for AB 389 (Grayson), a bill that authorizes the Fire District to continue to utilize the effective “Fire-EMS Alliance” model as well as provide this subcontracting model as an option for other counties and fire agencies to use for their own emergency ambulance deployment systems.
The County has also taken “Oppose” positions on two recent bills: SB 443 (2022) and AB 1168 (2023). See Attachment E for more information.
AB 2973 (Hart) was brought to the attention of Legislation Committee staff by both the County Director of Emergency Medical Services, Marshall Bennett, and the Fire Chief of Contra Costa County Fire Protection District, Lewis Broschard. Their respective statewide associations have taken opposing advocacy positions on the bill, with the EMSAAC on record to oppose the bill, and the California Fire Chiefs Association (CalChiefs) and the Fire Districts Association of California (FDAC) in support. The California State Association of Counties (CSAC) is presently reviewing the bill and has no formal position. The Urban Counties of California (UCC) has expressed concerns. (See Attachment D for position letters.)
The Board of Supervisors’ adopted 2023-24 State Legislative Platform contains the following related policies:
• SUPPORT legislation to maintain or strengthen the authority and governing role of counties and their local emergency medical services agencies to plan, implement, and evaluate all aspects and components of the emergency medical services system.
• SUPPORT legislation to maintain or strengthen the administration and medical control of emergency medical services, pre-hospital emergency medical care, and ambulance services at the county level.
• SUPPORT legislation that provides adequate and stable funding for LEMSAs and EMS systems components including but not limited to: EMS administration, trauma systems, specialty centers (e.g. trauma, pediatric, cardiac, stroke), ambulance transport, emergency and disaster preparedness and response, reimbursable transport to alternate destinations, and uncompensated care by emergency department physicians and on-call specialists.
• OPPOSE legislation that would threaten or weaken the authority and governing role of counties or local medical control over the locally coordinated and standardized provision of emergency medical services.
• OPPOSE legislation that may result in the fragmentation of the emergency medical services systems, prehospital emergency medical care, and ambulance services.
• OPPOSE legislation that would prevent or weaken the ability of the LEMSA Medical Director to assure medical control of the EMS system.
Referral Update:
AB 2973 (Hart): For the bill text, see Attachment A. The analysis for the Assembly Committee on Emergency Management is Attachment B. For the Fact Sheet from the author, see Attachment C.
Summary
Existing law, the Emergency Medical Services System and the Prehospital Emergency Medical Care Personnel Act, governs local emergency medical services (EMS) systems, authorizes each county to develop an EMS program and designate a local EMS agency, and requires the Emergency Medical Services Authority to receive plans for the implementation of EMS systems from local EMS agencies, as specified. Existing law requires a county to enter into a written agreement with a city or fire district that contracted for or provided prehospital EMS as of June 1, 1980. Existing law requires, until that written agreement is reached, prehospital EMS to be continued at not less than the existing level and the administration of prehospital EMS by cities and fire districts contracting for or providing those services as of June 1, 1980, to be retained by those cities and fire districts, as specified.
This bill would authorize a county board of supervisors to provide or support the provision of EMS to persons located within the county, as specified. The bill would require the county board of supervisors to review and approve a single-county local EMS agency’s plans for the EMS system prior to the submission of the plans to the authority, and would require a multicounty local EMS agency’s plans to be approved as provided for in the contract between the counties and the agency, as provided for in the joint powers agreement that created the agency, or by the board of supervisors in each of the counties served by the agency prior to the submission of the plans to the authority. This bill contains other related provisions and other existing laws. (Based on text date 4/2/2024)
Analysis of the bill from the Contra Costa County Director of Emergency Medical Services, Marshall Bennett, follows:
“AB 2973 is sponsored by Assembly Member Hart of Santa Barbara and attempts to depart from existing statutory emergency ambulance procurement process. The bill provides options for ambulance contracting at the sole discretion of counties' Boards without a requirement for any procurement process. This action would circumvent existing statutory process (California Health and Safety Code Section 1797.224) that provides for an objective, transparent, competitive, and anti-trust immune procurement process. The contracting pathways this bill intends to create would result in de facto exclusivity for an Operational Area, unless the Board authorized all ambulance providers that were qualified and interested in providing emergency ambulance service to do so. If the contracting pathways of this bill are codified and exercised by counties, the result will either be anti-trust exposure for the county or an unmanageable and fragmented EMS system with multiple providers.
For each county in California, the local Board of Supervisors designates either the Local Emergency Medical Services Agency (LEMSA) or engages in a Joint Powers Authority (JPA) model where a LEMSA has a multiple county jurisdiction. In both paradigms, each county's Board has the authority to approve or disapprove of the procurement process within their county that the LEMSA submits to them. Additionally, the authority to award the contract to a prospective bidder lies solely with the Board. In the event the Board is not satisfied with the outcome of the competitive procurement process, the Board can direct the LEMSA to begin a new procurement process that is aligned with statute. This bill intends to put the full discretion of procurement of emergency ambulance service and contracting on the board of supervisors without the benefit and protection of a structured, objective, competitive, and publicly transparent process. A multi-year service contract that protects the health and safety of the community should rely on a structured and publicly transparent process that is defendable, ensures the best available care for the public, and is immune from anti-trust exposure. The current statutory process supports these outcomes.
Over the last three years there has been a bill during each legislation season that seeks to reduce the public health and safety protection standards that the EMS Act (CA HSC) offers us today.”
The bill has been referred to the Assembly Committee on Health, having passed out of Assembly Committee on Emergency Management (6-0-2).
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History |
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4/8/2024 - VOTE: Do pass as amended and be re-referred to the Committee on [Health] (PASS) 04/03/2024 Re-referred to Com. on E.M. |
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04/02/2024 From committee chair, with author's amendments: Amend, and re-refer to Com. on E.M. Read second time and amended. |
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04/01/2024 Re-referred to Com. on E.M. |
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03/21/2024 Referred to Coms. on E.M. and HEALTH. From committee chair, with author's amendments: Amend, and re-refer to Com. on E.M. Read second time and amended. |
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02/17/2024 From printer. May be heard in committee March 18. |
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02/16/2024 Read first time. To print. |
Recommendation(s)/Next Step(s):
CONSIDER recommending a position on AB 2973 (Hart) to the Board of Supervisors on their May 14, 2024 consent agenda.
Fiscal Impact (if any): Unknown.