AMENDED IN ASSEMBLY APRIL 2, 2024
AMENDED IN ASSEMBLY MARCH 21, 2024
california legislature—2023–24 regular session
ASSEMBLY BILL No. 2973
Introduced by Assembly Member Hart
February 16, 2024
An act to amend Section 1797.202 of, and to add Section 1797.234 to, to the Health and Safety Code, relating to emer gency medical services.
legislative counsel’s digest
AB 2973, as amended, Hart. Emergency services.
Existing la w, the Emer gency Medical Services System and the Prehospital Emer gency Medical Care Personnel Act, go verns local emergency medical services (EMS) systems, authorizes each county to develop an EMS program and designate a local EMS agenc y, and requires the Emer gency Medical Services Authority to recei ve plans for the implementation of EMS systems from local EMS agencies, as specified. Existing la w requires a county to enter into a written agreement with a city or fire district that contracted for or pro vided prehospital EMS as of June 1, 1980. Existing la w 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 pro vision of EMS to persons located within the county ,
97 including indigent persons, as specified. The bill w ould 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. authority, and would require a multicounty local EMS agency’s plans to be appr oved as pr ovided for in the contr act between the counties and the agency, as provided for in the joint powers agreement that created the a gency, or by the boar d of supervisor s in each of the counties served by the agency prior to the submission of the plans to the authority.
Existing law authorizes a local EMS agenc y to create one or more exclusive operating areas in the de velopment of a local plan, if a competitive process is used to select the service pro vider pursuant to the plan, with specified exceptions.
This bill would require the county and the EMS agency that elect to use the abo ve-described competiti ve process to meet certain requirements.
Existing law requires a local EMS agency to have a licensed physician and surgeon, as specified, as medical director to provide medical control and to assure medical accountability for the EMS system, as specified.
This bill would make the official conduct of the medical director and their staff subject to the supervision of a county board of supervisors, as specified.
The bill would make related findings and declarations.
Vote: majority. Appropriation: no. Fiscal committee: no. State-mandated local program: no.
The people of the State of California do enact as follows:
line 1 SECTION 1. (a) The Legislature finds and declares all of the line 2 following:
line 3 (1) The Legislature designed the Emergency Medical Services line 4 System and the Prehospital Emer gency Medical Care Personnel line 5 Act, Division 2.5 of the Health and Safety Code (EMS Act) to line 6 encourage coordination and planning among the state, local line 7 governments, and private providers to achieve the most effective line 8 and cost-effective prehospital emergency medical services (EMS) line 9 on a countywide or regionwide basis.
line 10 (2) The EMS Act defines the roles, responsibilities, and line 11 functions of the Emergency Medical Services Authority (Authority) line 12 and the local EMS agencies, and some, b ut not all, of the roles, 97 — 2 — AB 2973
line 1 responsibilities, and functions of the counties and boards of line 2 supervisors regarding prehospital EMS and ambulance services. line 3 (3) Since the enactment of the EMS Act, the courts in Hunt v. line 4 Superior Court (1999) 21 Cal.4th 984, City of Lomita v . County line 5 of Los Angeles (1983) 148 Cal.App.3d 671, City of Lomita v . line 6 Superior Court (1986) 186 Cal.App.3d 479, and Fuchino v . line 7 Edwards-Buckley (2011) 196 Cal.App.4th 1128, determined that line 8 a county has the obligation to provide EMS and ambulance services line 9 to all persons located in the county and to relieve indigent county line 10 residents of the cost of paying for such services pursuant to Section line 11 17000 of the Welfare and Institutions Code (established prior to line 12 the EMS Act), and articulated the county’ s options for fulfilling line 13 such obligations.
line 14 (4) In turn, Section 17001 of the Welfare and Institutions Code line 15 provides that the board of supervisors of each county, or the agency line 16 authorized by county charter, shall adopt standards for the medical line 17 care for indigent county residents.
line 18 (5)
line 19 (3) Other statutory authorities and obligations of a county and line 20 the board of supervisors regarding the provision and regulation of line 21 ambulance services, whether by public or pri vate agreement, line 22 permit, license, or other means, and the pro vision of ambulance line 23 services for indigent county residents are located in statutes outside line 24 of the EMS Act including, but not limited to, Sections 25369.5, line 25 26612, 29606, and 54980 through 54983, inclusi ve, of the line 26 Government Code, Sections 1443 through 1445, inclusi ve, 1451 line 27 through 1455, inclusive, and 1473 through 1475, inclusive, of the line 28 Health and Safety Code, Section 2512 of the Vehicle Code, and line 29 Sections 14136 and 16817 of the Welfare and Institutions Code. line 30 (6)
line 31 (4) As a result of ho w and where these v arious statutory line 32 authorities are codified, significant confusion and uncertainty in line 33 the state e xists re garding the statutory authorities, roles, line 34 responsibilities, rights, oblig ations, and functions of counties, line 35 boards of supervisors, and local EMS agencies re garding line 36 prehospital EMS and amb ulance services and the interplay of line 37 statutes addressing these services within and outside of the EMS line 38 Act.
line 39 (b) It is the intent of the Legislature in enacting this act to clarify line 40 do both of the following:
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line 1 (1) Clarify the statutory authorities, roles, responsibilities, line 2 rights, obligations, and functions of counties, boards of supervisors, line 3 and local EMS agencies regarding EMS and ambulance services. line 4 (2) Reaffirm the authority of boar ds of supervisor s to decide , line 5 as a policy matter , whether to pr ovide pr ehospital EMS and line 6 ambulance services to per sons located within the county’ s line 7 jurisdiction thr ough a county department or a gency or by line 8 contracting with other local agencies or private providers. line 9 SEC. 2. Section 1797.202 of the Health and Safety Code is line 10 amended to read:
line 11 1797.202. (a) Every local EMS agenc y shall ha ve a full- or line 12 part-time licensed physician and surgeon as medical director, who line 13 has substantial experience in the practice of emergency medicine, line 14 as designated by the county or by the joint po wers agreement, to line 15 provide medical control and to assure medical accountability line 16 throughout the planning, implementation and e valuation of the line 17 EMS system. The authority director may w aive the requirement line 18 that the medical director have substantial experience in the practice line 19 of emergency medicine if the requirement places an undue hardship line 20 on the county or counties.
line 21 (b) The medical director of the local EMS agency may appoint line 22 one or more physicians and surgeons as assistant medical directors line 23 to assist the medical director with the dischar ge of the duties of line 24 medical director or to assume those duties during an y time that line 25 the medical director is unable to carry out those duties as the line 26 medical director deems necessary.
line 27 (c) The medical director may assign to administrati ve staff of line 28 the local EMS agency for completion under the supervision of the line 29 medical director, any administrative functions of their duties which line 30 do not require their professional judgment as medical director. line 31 (d) The official conduct of the local EMS agenc y’s medical line 32 director, assistant medical directors, and administrati ve staf f is line 33 subject to the supervision of the board of supervisors pursuant to line 34 Section 25303 of the Government Code.
line 35 (e) Nothing in this section affects, modifies, limits, or otherwise line 36 impairs the medical control of the medical director of a local EMS line 37 agency granted under the EMS Act.
line 38 (f) Nothing in this section affects, modifies, limits, or otherwise line 39 impairs the authority’ s enumerated po wers and authority under line 40 the EMS Act.
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line 1 (g) The Legislature finds and declares that the changes made line 2 by the act that added this subdi vision are declaratory of e xisting line 3 law.
line 4 SEC. 3.
line 5 SEC. 2. Section 1797.234 is added to the Health and Safety line 6 Code, to read:
line 7 1797.234. (a) The county and the board of supervisors may line 8 exercise their statutory authority authority, including their statutory line 9 authority regarding prehospital EMS and amb ulance services to line 10 perform their functions and oblig ations under this di vision and line 11 Part 5 (commencing with Section 17000) of Di vision 9 of the line 12 Welfare and Institutions Code and to support the local EMS line 13 agency’s functions under this division.
line 14 (b) The county and the board of supervisors may fulfill the line 15 county’s oblig ation to pro vide amb ulance services to persons line 16 located in the county within the county’ s jurisdiction under this line 17 division and Part 5 (commencing with Section 17000) of Division line 18 9 of the Welfare and Institutions Code by an y of the follo wing line 19 means or combination of means:
line 20 (1) Creating a separate county department to provide ambulance line 21 services, pro viding the department with the necessary staffing, line 22 vehicles, and equipment, and operating such department as it staffs line 23 and operates other county departments.
line 24 (2) Assigning the duty of pro viding amb ulance services to line 25 residents of the county to an e xisting county department and line 26 providing the department with the necessary staffing, v ehicles, line 27 and equipment to provide ambulance services.
line 28 (3) Contracting with cities or local public agencies located line 29 within the county to provide ambulance services within areas under line 30 the jurisdiction of the county , the cities, or the local public line 31 agencies.
line 32 (4) Contracting with private ambulance companies as provided line 33 for by statute, including under this division.
line 34 (c) Contracts or assignments made under paragraph (2) (1), (2), line 35 or (3) of subdi vision (b) that r estrict oper ations to a county line 36 department or a gency or other local a gency do not constitute line 37 exclusive operating areas as defined by Section 1797.85. line 38 (d) All county agreements for implementation of the EMS line 39 system, including for prehospital EMS and amb ulance services, 97 AB 2973 — 5 —
line 1 shall be in the name of the county and shall be appro ved by the line 2 board of supervisors.
line 3 (e) When a local EMS agency, upon the recommendation of the line 4 county, elects to create an e xclusive operating area using a line 5 competitive process pursuant to Section 1797.224, all of the line 6 following shall apply:
line 7 (1) The county’s purchasing and acquisition personnel and the line 8 EMS agency shall jointly de velop and administer a competiti ve line 9 process pursuant to the county’ s purchasing policies, rules, and line 10 requirements and government procurement best practices. line 11 (2) The board of supervisors shall re view and appro ve a line 12 competitive process prior to issuance of the competitive processes line 13 to the public.
line 14 (3) The board of supervisors shall ha ve the sole authority to line 15 approve the award of agreements or operating rights for prehospital line 16 EMS or ambulance services by the county or the local EMS agency line 17 pursuant to a competitive process.
line 18 (f) (1) Contracts for amb ulance services de veloped pursuant line 19 to this section shall comply with the requirements of subdivisions line 20 (c) and (d) of Section 1797.230.
line 21 (2) Subcontracts for emergency ambulance services developed line 22 pursuant to this section shall comply with the r equirements of line 23 subdivisions (b), (c), and (d) of Section 1797.231. line 24 (f) The board of supervisors shall re view and approve a local line 25 EMS agency’s plans for the EMS system prior
line 26 (g) Prior to the submission of the plans to the authority of the line 27 local EMS a gency’s plans for the EMS system pursuant to this line 28 division including, but not limited to, Article 2 (commencing with line 29 Section 1797.250). 1797.250), one of the following shall apply:
line 30 (1) For a single-county local EMS a gency, the boar d of line 31 supervisors shall r eview and appr ove the local EMS a gency’s line 32 plans.
line 33 (2) For a multicounty local EMS agency, the local EMS agency’s line 34 plans shall be approved through one of the following:
line 35 (A) As provided for in the contract for local emergency medical line 36 services administration between the counties and the local EMS line 37 agency.
line 38 (B) As provided for in the joint powers agreement that created line 39 the local EMS agency.
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line 1 (C) By the board of supervisors of each of the counties served line 2 by the local EMS agency.
line 3 (g)
line 4 (h) This section does not supersede Section 1797.201. line 5 (h)
line 6 (i) Nothing in this section affects, modifies, limits, or otherwise line 7 impairs the authority’s enumerated powers and authorities under line 8 the EMS Act.
line 9 (j) Nothing in this section affects, modifies, limits, or otherwise line 10 impairs the medical control of the medical director of a local EMS line 11 agency granted under the EMS Act.
line 12 (i)
line 13 (k) The Legislature finds and declares that the provisions of this line 14 section are declaratory of existing law.
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