SENATE SUBSTITUTE NO. 1
SENATE BILL NO. 1
AS AMENDED BY
SENATE AMENDMENT NO. 1 AND HOUSE AMENDMENT NO. 2
AN ACT TO AMEND TITLE 16 AND TITLE 29 OF THE DELAWARE CODE RELATING TO EMERGENCY MEDICAL SERVICES; AND PROVIDING FOR A DELAWARE PARAMEDIC SERVICES ACT.
BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF DELAWARE:
Section 1. Amend subsection (c), §7917, Chapter 79, Title 29 of the Delaware Code by striking and replacing the existing paragraph (7) of said subsection and also adding a new paragraph, which new paragraph shall be designated as (18), as follows:
"(7) the Paramedic Administrator of the Division of Public Health. (18) the Paramedic Medical Director of the Division of Public Health."
Section 2. Amend Chapter 79, Part VIII, Title 29 of the Delaware Code by striking present §7952 of said Chapter; and by re-designating present §7917 of Title 29 as new §7952.
Section 3. Amend Part X, Title 16 of the Delaware Code by re-designating present Chapter 97 as new Chapter 92, Part VIII of said Title 16; and by re-designating each section therein accordingly.
Section 4. Amend Part X, Title 16 of the Delaware Code by striking the title of said Part X, and substituting in lieu thereof the following:
"PART X. PARAMEDIC AND OTHER EMERGENCY MEDICAL SERVICE SYSTEMS"
Section 5. Amend Subchapter IV, Chapter 79, Title 29 of the Delaware Code by re-designating said Subchapter IV as new Chapter 97, Part X, Title 16 of the Delaware Code; and by re-designating each section therein accordingly.
Section 6. Amend Part X, Title 16 of the Delaware Code by adding thereto a new Chapter, designated as Chapter 98, which new Chapter shall read as follows:
"CHAPTER 98. PARAMEDIC SERVICES
(1) It is the purpose of this Act to establish a statewide paramedic program under the direction of the Office of Paramedic Administration, Division of Public Health, Department of Health and Social Services.
(2) The Paramedic Program includes a coordinated Advanced Life Support System, under qualified medical supervision, which has the responsibility for providing a rapid response capability in the delivery of Emergency Medical Services to individuals who become unexpectedly ill or incapacitated or who are otherwise placed in a position where highly skilled medical assistance must be rendered to sustain or maintain such individual prior to institutional health care.
(3) The Paramedic Services Program shall be utilized for medical emergencies, either at the scene or while the patient is in transit to a health facility.
(4) It is the further purpose of this Act to provide a program which Shalt have a direct impact on the morbidity and mortality rates of this State and which, over a period of time will also reduce health care costs to each emergency patient.
(5) It is the further purpose of this Act to establish a framework for the creation of an effective and efficient means for the provision of advanced life support services to the citizens of the State of Delaware regardless of their economic status, who require such serVices without prior inquiry as to the patient's ability to pay.
(6) This Act is intended to promote the public health, safety and welfare of the citizens of this State by providing for the creation of a statewide advanced life support services system, in conjunction with the efforts of all providers of emergency medical services in this State, with uniform standards for all such providers of advanced life support services.
(7) It is the further purpose of this Act to insure that emergency patients requiring advanced life support services are transported from the scene of a medical emergency to the nearest emergency medical institution or the institution of their choice, within reason, that possesses the equipment and staff resources to immediately attend to the particular needs of the patient. This statement is tempered by the understanding that, in certain circumstances, it may be necessary to bypass the closest medical facility if specialized medical care is required. It shall also be understood that the use of paramedics to assist in the transfer of patients to facilities and programs which offer such follow-up care and rehabilitation as is necessary to effect the maximum recovery of the patient, shall be permitted when deemed medically necessary.
The following words, terms and phrases, when used in this Chapter, shall have the meanings ascribed to them in this Section, except where the context clearly indicates a different meaning:
(a) "Administrator" shall mean the program chief of the paramedic services responsible for advanced life support and the administration of the Delaware Paramedic Services Act;
(b) "Advanced Life Support" (ALS) shall have the same definition as is set forth in Chapter 97 of this Title;
(c) "Basic Life Support" (BLS) shall have the same definition as is set forth in Chapter 97 of this Title;
(d) "Board" shall mean the Board of Medical Practice;
(e) 'County" or "Counties" shall refer singularly or collectively to New Castle, Kent and Sussex Counties of the State of Delaware.
(f) "County paramedic service" shall mean the paramedic service operated pursuant to this Act by a county with its own employees or under contract with another governmental entity.
(g) "Department" shall mean the Delaware Department of Health and Social Services.
(h) "Emergency medical unit" shall mean an ambulance, rescue vehicle or any other specialized vehicle staffed by paramedics and other certified or licensed medical care providers, and utilized solely for providing mobile pre-hospital care and other emergency medical treatment;
(I) "Medical command facility" shall mean the distinct unit within a hospital which meets the operational, staffing and equipment requirements established by the Board of Health for providing medical control to the providers of advanced life support services. Any hospital that operates an emergency medical facility and desires to be designated as a medical command facility shall maintain and staff such facility on its premises and at its own expense with the exception of base station communication devices which shall be an authorized shared expense pursuant to the provisions of this chapter.
(j) "Medical control" shall mean an order or directive given to a paramedic by an authorized medical control physician. These orders or directives shall normally be provided from a specifically authorized and designated medical command facility with such medical supervision supplying professional support to the paramedic through radio or telephonic communication for on-scene and in-transit advanced life support services.
(k) "Medical control physician" shall mean any physician board-certified or board-prepared in emergency medicine, or a physician-certified in Advanced Trauma Life Support (ATLS) and Advanced Cardiac Life Support (ACLS) who is credentialed by the hospital within which a medical command facility is located, and who Is authorized by the medical command facility to give medical control commands via radio or other telecommunication devices to a paramedic. When a medical control physician establishes contact with a paramedic and provides medical control instructions that exceed or otherwise modify the standing orders of the statewide standard treatment protocol, the paramedic shall, solely for the purpose of compliance with the Medical Practices Act, be considered to be operating under the license of said medical control physician.
(1) "Office" shall mean the Office of Paramedic Administration, an agency within the Division of Public Health, Department of Health and Social Services;
(m) "Paramedic" shall be synonymous with "emergency medical technician - paramedic (EMT-P)," as the same is defined in Chapter 97 of this Title;
(n) "Pre-hospital care" shall mean any emergency medical service, including advanced life support, rendered by an emergency medical unit before and during transportation to a hospital or other facility, and upon arrival at the facility until such care is assumed by the facility's staff;
(o) "Service and/or training reciprocity agreements" shall mean written agreements negotiated between two counties or between a county and an adjoining state or a governmental entity of an adjoining state and approved pursuant to the provisions of this chapter which provide for the scheduled delivery of paramedic services by paramedics to citizens of this state or a neighboring state by personnel certified to render such services by this state or a neighboring state, or such similar agreements as are required by and between the counties of this state, in order to effectively and efficiently deliver paramedic services. Such agreements may also include provisions that provide for the temporary rotation of paramedics and/or equipment between the counties of this state in order to provide such personnel with proper experience and training opportunities, address seasonal demands, or adequately respond to a disaster or severe emergency incident. All such agreements shall include any financial terms, or other considerations included as part of the agreement.
(p) "State Paramedic Medical Director" shall mean a physician who is board-prepared or board-certified by the American Board of Emergency Medicine and who shall be the chief physician for the statewide paramedic system and under whose license all paramedics shall operate for the purpose of delivering the standing orders of the statewide standard treatment protocol.
(q) "Statewide standard treatment protocol" shall mean written and uniform treatment and care plans for emergency and critical patients statewide that constitute the standing orders of paramedics. The treatment protocol for advanced life support must be approved and signed by the State Paramedic Medical Director and the Director of Public Health, Department of Health and Social Services. The treatment protocol shall be prepared by the Board of Medical Practice. In preparing and, from time to time, amending the Statewide standard treatment protocol, the Board shall consult with the State Paramedic Medical Director and the Emergency Medical Services Committee of the Delaware Chapter of the American College of Emergency Physicians or its successor organization.
§9803. Statewide paramedic system
(a) Except for those activities and responsibilities for basic life support and other emergency services which are under the jurisdiction of State Fire Prevention Commission, the Office of Paramedic Administration shall have jurisdiction over the development, implementation and maintenance of a Statewide paramedic system. As part of its responsibilities, the Office shall:
(1) hire an administrator and staff to carry out the intent of this legislation, which shall include identifying the minimum number of paramedics that are required to be hired by a county and assisting as requested in the recruitment of such persons and their referral and admission to approved training programs, so as to achieve advanced life support coverage throughout the State;
(2) assure reasonable conditions and qualifications for certification of any person serving as a paramedic that meets or exceeds the advance life support standard of the United States Department of Transportation;
(3) assure that county boundaries do not become barriers to the effective and efficient deployment of paramedic units by coordinating the development of and approving service and/or training reciprocity agreements between counties;
(4) approve or deny the request of a hospital to become designated as a medical command facility. Such approval, denial or subsequent revocation or limitation of such designation shall be based on the ability of the hospital to comply with the operational and staffing requirements prescribed for medical command facilities by the Board of Health. In making decisions pursuant to this paragraph, the Office shall seek the advice of the Board of Medical Practice;
(5) assure that training and continuing education opportunities required for paramedic certification are reasonably accessible from a geographic standpoint.
(b) A "Memorandum of Agreement" shall be established between the Office, Division of Public Health, Delaware State Police, State Fire Prevention Commission, Board of Medical Practice and any other agency serving as a component to the emergency medical services system in compliance with their respective agency's statutory provisions. To foster continuity and program coordination, the Office shall enforce each such Memorandum of Agreement.
§9804. Paramedic Advisory Council
The Paramedic Advisory Council shall advise the administrator in matters relating to the paramedic program. The Advisory Council may also advise the Office, the Delaware Emergency Medical Services Advisory Council (DEMSAC), the Division of Public Health, or any other agency which has authority or duties relating to emergency medical services. The Council shall have no authority over such agencies. As part of its responsibilities, the Advisory Council shall:
(1) monitor, review and evaluate on an on-going basis the operations, administration, and efficiency of the statewide Paramedic System, or any component thereof;
(2) prepare and submit such assessments, reports and other documents, including minority reports, relating to the paramedic system or to any matters relating to paramedics within the emergency medical services system; and
(3) provide a constant dialog with component groups and the public in matters relating to paramedics, and to paramedic services within the emergency medical services system.
(b) The Paramedic Advisory Council shall consist of twenty (20) members who shall be appointed by the Governor to serve terms of three years. The members shall represent the following interest:
(1) One representative from the Delaware State Police Trooper Medic Program.
(2) Three representatives from the Delaware Volunteer Firemen's Association, one from each county.
(3) One representative from each county government.
(4) One representative from the Medical Society of Delaware.
(5) One practicing paramedic from each county.
(6) Three representatives from the Association of Delaware Hospitals, Inc., one from a hospital in each county.
(7) Three representatives from the Delaware Chapter of the American College of Emergency Physicians, one member from each county.
Three public members, one from each county, who are not otherwise involved in medicine or in the emergency medical, fire, or ambulance services.
(8) (c) Each member of the Advisory Council shall serve without compensation; but shall be reimbursed for necessary expenses incurred in the performance of his duties, including travel expenses. The Chairman of the Council shall be designated by the Governor and shall serve during the pleasure of the Governor. A majority of the members of the Council shall constitute a quorum for the conduct of business. The Council may create special committees or task forces within or outside its membership; and may appoint persons who are not members of the Council to serve as advisors or Consultants to any committee created by the Council.
0805. Paramedic Administrator
The Paramedic Administrator shall be employed within the Division of Public Health responsible directly to the Director of the Division of Public Health. The Paramedic Administrator shall be a state employee within the Merit System and shall be responsible for the following:
(a) shall hire sufficient personnel to provide staff and clerical support for the office;
(b) verify certification from the Board for each paramedic employed by a county or its subcontractor;
(c) he shall be required to administer and coordinate all activities of the program including periodic inspections;
(d) he shall be required to develop appropriate uniforms as required;
(e) he shall be required to develop and negotiate contracts with county paramedic services;
(f) he shall be required to develop annual budgets;
(g) he shall procure the necessary equipment to carry out the requirements of this legislation and follow the current state bidding and procurement policies for equipment; i.e. vehicles, communication equipment, medical equipment and uniforms as required;
(h) certify the curriculum of each university, college or other facility which provides paramedical instruction in accordance with the ALS standards of the Board of Medical Practices; and
(i) he shall provide reports of activities as required by the Director of the Division of Public Health.
(j) shall, with the approval of the Secretary of the Department of Health and Social Services, determine the number and approximate locations of paramedic units required to efficiently and effectively operate the statewide paramedic services program, and the number of paramedics needed to staff each unit. In order to effectively plan the implementation of the statewide paramedic services program, it shall be understood that seven (7) units are initially authorized for New Castle County, that three (3) units are initially authorized for Kent County, and that five (5) units are initially authorized for Sussex County. It shall also be understood that each operating paramedic unit should be continuously staffed by two (2) paramedics.
§9806. Paramedic Medical Directors
There shall be four part-time Paramedic Medical Directors: one State Paramedic Medical Director and three County Paramedic Medical Directors. Each County Medical Director shall reside in the county in which he serves as Director. The State Paramedic Medical Director shall supervise the three county directors and shall serve as an advisor for BLS training to the State Fire Prevention Commission. Each County Medical Director shall be available at all times to advise supervising physicians and paramedics; and shall review all reports made out by those paramedics which are employed in the county in which he is a Director.
As part of their responsibilities, the Paramedic Medical Directors shall:
Cl) establish and ensure compliance with standing orders and treatment protocols;
(2) review and evaluate the medical interventions of the paramedics;
(3) co-ordinate and advise the administrator of any deficiencies within the system with suggested remedies;
(4) monitor the paramedics for skill degradation and recommend appropriate remedies to the administrator; and
(5) offer technical assistance to both advanced life support and basic life support personnel within the county they serve as medical director.
(6) have authority to suspend paramedics immediately from patient treatment for a period not to exceed thirty (30) days, if they determine that it is necessary in order to prevent a clear and immediate danger to the public health.
Each Paramedic Medical Director shall be employed by the State, by contract or otherwise, and shall be a board certified or qualified emergency physician actually involved in the practice of emergency medicine.
The Paramedic Medical Directors shall be appointed by the Director of Public Health who shall consult with the Board of Medical Practice as part of the selection process.
(a) A paramedic may provide such paramedic services as are set forth in his certificate if such services are provided under the supervision of a physician, or in any context where voice contact by radio or telephone is monitored by a physician; and such paramedic may provide advanced life support where authorized to do so by a physician.
(b) If direct voice communication between a physician and a paramedic fails or is technically impossible, the paramedic may perform any emergency medical service for which the paramedic is certified, in compliance with treatment protocols, set forth by the Board when the life of the patient is in immediate danger and requires such care for its preservation.
§9808. Role of County Governments
(a) Each county shall participate in the operation and funding of the statewide paramedic services program, and shall provide the Office of Paramedic Administration with all necessary information requested by the Secretary of the Department of Health and Social Services in the timeframes and in the format prescribed.
(b) Any paramedic employed by a county or its subcontractor must be certified by the Administrator and the State Paramedic Medical Director in accordance with the standards of the Board. Direct initial training, testing and re-certification costs shall be paid at state expense. The salary of paramedics while undergoing training shall be a shared cost pursuant to the provisions of this chapter.
(c) The counties shall be bound by the rules, regulations, requirements and procedures established pursuant to this Act.
(d) Th. authority to select, discipline and terminate a paramedic or any administrative staff authorized as a shared expense shall reside with the county or its subcontractor, except that suspension or revocation of an EMT-P certification for reasons covered by § 9811 of this chapter shall be conducted in accordance with this Act.
(e) A county may choose to operate its own paramedic service using regular county employees entirely, or it may contract portions of its service to other governmental entities.
(f) If a county elects in the design of its paramedic service to exceed the training standards, minimum unit deployment, or otherwise exceed the requirements established in accordance with this Act, the county shall be 100% liable for any additional cost. At a minimum, a county shall deploy the number of paramedics and paramedic units determined to be necessary to meet the operational requirements of this Act. As it regards the initial deployment of the units authorized by subsection (j) of § 9805 of the this Act, each county shall deploy the requisite number of units by not later than June 30, 1992.
(a) No individual shall represent himself or herself, as a paramedic certified by this State unless the persons so represented is in fact certified by the Board.
(b) No person nor governmental agency shall represent itself as a paramedic service, emergency medical service, or similar type of service certified by this State unless such person or governmental agency is in fact certified by the Department.
(c) No person shall provide, offer, nor advertise to provide advanced life support services outside a hospital, unless so authorized by law.
(d) Notwithstanding any other provision of this Chapter, any paramedic who has been certified by the Board of Medical Practice prior to the effective date of this Chapter shall automatically be certified under this Chapter, and shall be deemed to have complied with all the requirements of this Chapter.
Where a person applies for a certification as a paramedic and has already been licensed or certified as such in another State, the Administrator shall accept a true copy of such license or certificate, or evidence of any examination scores issued by a testing service or professional paramedic association, which shows that the applicant has met requirements in the previous state which are equal to those required in this State; such applicant shall be required to meet such written and practical examinations as determined by the medical directors; and the Board shall certify such person to be a paramedic in the State.
§9811. Violations; disciplinary procedure; non-disciplinary hearings
(a) The Administrator may at any time upon his own motion; and shall, upon verified written complaint of any person, cause an investigation to be conducted to determine whether or not there are grounds to recommend suspension, revocation, or any other penalty upon a person certified under the provisions of this Chapter. The Administrator shall recommend to the Board to suspend or revoke any certificate if after a hearing it is found that the holder thereof has:
(1) obtained such certificate by means of fraud or deceit;
(2) demonstrated gross negligence, or has shown himself otherwise to be grossly incompetent; or
(3) violated or aided or abetted in the violation of any provision of this Chapter.
(b) If a paramedic's physical or mental capacity to safely perform his duties and responsibilities is at issue in a non-disciplinary hearing, the County may order such paramedic to submit to a reasonable physical or mental examination. Failure to comply with this order shall render such paramedic liable to suspension or revocation of his certificate.
§9812. Suspension; revocation and other penalties
(a) For purpose of the public health, safety and welfare; and notwithstanding any other statute or provision of law the Administrator may recommend to a county or the Board that any of the following penalties, singly or in combination, be imposed:
(1) that a letter of reprimand be issued;
(2) that a paramedic be placed on probationary status with limited responsibilities and be required to;
(I) regularly report to the county upon the matters which are the basis of the probation;
(ii) limit all paramedical activities to those areas specifically recommended by the Administrator; and/or
(iii) take either remedial or continuing education until the required degree of skill has been attained in those areas which are the basis of the probation.
(3) that a paramedic's certification be suspended; or
(4) that a paramedic's certification be revoked.
(b) No penalties shall be imposed by a county without a hearing. Each county shall establish and promulgate Its own administrative procedures relevant to disciplinary matters which shall include provisions for a public hearing unless the paramedic requests that the hearing not be public, and which shall provide for a copy of all charges, together with a notice of the time and place fixed for the hearing, to be personally delivered or served upon the person charged at least twenty days prior to the date of the hearing. Copies of all charges and notices shall also be provided to the State Medical Director.
(c) All hearings shall be informal, and without the use of the rules of evidence. Upon conclusion of a hearing, the county shall take such action as Is permitted by law, and shall make and enter an order stating its decision, which order shall specify the reasons for such decision. The county shall cause a copy of such order to be served in person or by certified mail, return receipt requested, on the person charged.
(d) Any person against whom a county or the Board has taken any disciplinary action may appeal such action to the Superior Court within 30 days of the date that a copy of the order rendered by the county or the Board is personally served upon or mailed to the person charged. The appeal shall be on the record without a trial de novo.
§9813. Liability:, limitations
(a) Physician instructions.
No emergency physician or designee of such physician who in good faith gives instructions to a paramedic shall be liable for any civil damages which may occur as the result of issuing such instructions; unless the conduct of the physician or the designee of such physician in issuing such instructions rises to the level of willful and wanton, reckless or grossly negligent conduct.
No paramedic who in good faith attempts to render or facilitate emergency medical care authorized by this Chapter shall be liable for any civil damages which occur as a result of any act or omission of the paramedic in the rendering of such care; unless such paramedic is guilty of willful and wanton, reckless or grossly negligent conduct.
(c) Educational programs.
No university, college, medical facility or other entity participating as part of an educational program; nor any faculty member of any such entity; nor any student of such entity who is enrolled in a course of instruction approved by the Administrator, shall be liable for any civil damages as the result of any primary or continuing educational practice conducted under proper supervision, unless such university, college or other entity or faculty member or student is guilty of willful and wanton, reckless or grossly negligent conduct.
(d) Health facilities.
No health facility which assists a physician in giving instructions to a paramedic in accordance with this Chapter shall be liable for any civil damages as the result of such instructions, unless such health facility is guilty of willful and wanton, reckless or grossly negligent conduct."
Section 7. Section 6 of this Act shall become effective upon the specific appropriation of funds for such purposes.
Section 8. This Act shall be known, and may be cited, as the Delaware Paramedic Services Act.
Section 9. If any provision of this Act or the application thereof to any person or circumstance is held invalid, such invalidity shall not affect other provisions or applications of this Act which can be given effect without the invalid provision or application, and to that end the provisions of this Act are hereby declared severable.
Approved January 23, 1990.