The Paramedic Disciplinary Process Explained

California Emergency Medical Services Authority License Attorneys

EMSA Enforcement Unit

The California Emergency Medical Services Authority (EMSA) has an Enforcement Unit within its EMS Personnel Division. A number of investigators reporting to a chief investigator are assigned to the EMSA Enforcement Unit.

Paramedic Investigation Request Form

Complaints against paramedics are initiated using a Paramedic Investigation Request form. The Paramedic Investigation Request form can be completed by anyone, such as your employer, a co-worker, a physician, a nurse, a patient, a family member, the local emergency medical services agency, etc.

Although the form requires the complainant to certify that the information supplied is “true, correct, and complete” to the best of the complainant’s knowledge, there is no requirement that the form be signed under penalty of perjury.

The information submitted on the Paramedic Investigation Request form is routed to the chief investigator in the EMSA Enforcement Unit in Sacramento, and then delegated to an investigator for follow-up.

Causes for Discipline

California Health and Safety Code § 1798.200 enables the EMSA to deny, suspend, or revoke your paramedic license, or place your paramedic on probation because on- or off-duty conduct consisting of:

1. Fraud in the procurement of an EMT-I or EMT-II or paramedic license;
2. Gross negligence;
3. Repeated negligent acts;
4. Incompetence;
5. Commission of any fraudulent, dishonest, or corrupt act which is substantially related to the qualifications, functions, and duties of prehospital personnel;
6. Conviction of any crime which is substantially related to the qualifications, functions, and duties of prehospital personnel;
7. Violating or attempting to violate directly or indirectly, or assisting in or abetting the violation of, or conspiring to violate, any provision of Division 2.5 of the Health and Safety Code, Emergency Medical Services, §§ 1797 – 1799.207, or the EMSA regulations pertaining to prehospital personnel;
8. Violating or attempting to violate any federal or state statute or regulation which regulates narcotics, dangerous drugs, or controlled substances;
9. Addiction to the excessive use of, or the misuse of, alcoholic beverages, narcotics, dangerous drugs, or controlled substances;
10. Functioning outside the supervision of medical control in the field care system operating at the local level, except as authorized by another license or certification;
11. Demonstration of irrational behavior or occurrence of a physical disability to the extent that a reasonable and prudent person would have reasonable cause to believe that the ability to perform the duties normally expected may be impaired;
12. Unprofessional conduct exhibited by any of the following:
    • Mistreatment or physical abuse of any patient resulting from force in excess of what a reasonable paramedic would do under the circumstances (not intended to prohibit reasonable use of force to assist a peace officer in making an arrest);
    • The failure to maintain confidentiality of patient medical information, except as disclosure is otherwise permitted or required by law in Sections 56 to 56.6, inclusive, of the Civil Code; and
    • Commission of a sex offense under California Penal Code § 290.

Appeals Procedures

The appeals procedure from an adverse action instituted by the EMSA must conform to the requirements of Government Code §§ 11500 – 11529, which includes issuance of a charge against the paramedic, known as an “accusation,” explaining the reasons the EMSA intends to revoke or suspend the paramedic license, or place the paramedic on probation. In cases where the EMSA intends to deny issuance of a paramedic license or renewal, a “statement of issues” is issued instead of an accusation. In either case, to preserve the right to appeal the adverse decision, the paramedic must respond within 15 days to the accusation or statement of issues with a “notice of defense.”

As part of the notice of defense, the paramedic may request a hearing, raise certain objections, make certain admissions, and present new or additional information in his or her defense.

The EMSA and the accused paramedic are entitled to conduct discovery to obtain the names and addresses of witnesses, inspect and copy statements of persons, parties, and witnesses, and inspect and copy relevant documents and investigative reports.

The EMSA has its own in-house legal counsel who prosecutes the accusations against paramedics, but attorneys in the Office of the Attorney General are also used to prosecute cases against paramedics.

The standard of proof in an administrative hearing to revoke, suspend, or place a paramedic license on probation is “clear and convincing proof to a reasonable certainty.” Ettinger v. Board Of Medical Quality Assurance (1982) 135 Cal.App.3d 853. However, in cases where issuance or renewal of the paramedic license is denied the burden of proof is on the applicant.

If the case is heard by an Administrative Law Judge (rather than the EMSA Director him/herself), then the Administrative Law Judge must issue a proposed decision within 30 days. The decision can be accepted, rejected, or modified by the EMSA Director provided he or she does so within 100 days. If the EMSA Director takes no action for more than 100 days, the Administrative Law Judge’s decision becomes final.

Representation by a knowledgeable EMS attorney at these critical stages is imperative. A failure to raise appropriate legal objections, present mitigating evidence, and obtain necessary discovery can seriously harm your right to defend yourself and may badly endanger your career.

Hearing Locations

Hearings are typically held at the California Office of Administrative Hearings (OAH) in Los Angeles, Oakland, San Diego, or Sacramento. Usually, the hearing is held at the OAH office closest to where the paramedic lives or works, but sometimes the hearing can be heard at another office by agreement or when a change of venue motion is granted by the hearing judge.

Guidelines for Denial, Probation, Suspension, Revocation

The EMSA publishes guidelines for discipline, which include considerations for discipline:

1. Nature and severity of the acts, offenses or crimes;
2. Actual or potential harm to the public;
3. Actual or potential harm to patients;
4. Prior disciplinary record;
5. Prior warnings and remediation;
6. Number and/or variety of current violations;
7. Aggravating evidence;
8. Mitigating evidence;
9. Rehabilitation evidence;
10. Compliance with conditions of criminal sentencing and probation;
11. Overall criminal record;
12. Elapsed time since act, offense, or crime; and
13. Expungement proceedings pursuant to Penal Code 1203.4.

The published guidelines also describe standard penalties for various offenses and terms of probation.

The EMSA also publishes separate guidelines for denial of a paramedic license.

Investigation Statistics

Investigations and discipline of California paramedics is on the rise. In 2007, the number of complaints against paramedics equaled nearly 4 for every 100 licensed California paramedics. More than half of the complaints against paramedics in 2007 are believed to have resulted from off-duty conduct.

The following are examples of the kinds of real situations that have resulted in investigations or discipline of California paramedics. (The names, locales, and some of the details have been changed to protect the identities of the paramedics and their patients.) As can be seen, finding yourself under investigation and subject to discipline by the California Emergency Medical Services Authority (EMSA) can easily happen to you.

• Falsifying patient care reports, charts, or bills;
• Criminal convictions such as theft, vandalism, DUI, domestic violence, etc.;
• Juvenile criminal record;
• Failure to assess patients;
• Failure to transport patients to the hospital;
• “Irrational behavior;”
• “Unprofessional conduct;”
• Making false or misleading statements (including omissions) when applying for initial paramedic licensure or renewal;
• Gross negligence;
• Repeated negligent acts;
• Incompetence;
• Violations involving narcotics and other controlled substances;
• Physical disability;
• Performing outside the approved scope of practice;
• Performing without approved medical control;
• Cheating during examination process or continuing education;
• Violating statutes or regulations.