HOUSE OF REPRESENTATIVES

H.B. NO.

1281

THIRTY-FIRST LEGISLATURE, 2021

 

STATE OF HAWAII

 

 

 

 

 

 

A BILL FOR AN ACT

 

 

RELATING TO EMERGENCY MEDICAL SERVICES.

 

 

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF HAWAII:

 


SECTION 1. Chapter 46, Hawaii Revised Statutes, is amended by adding a new part to be appropriately designated and to read as follows:

"Part .

COUNTY EMERGENCY MEDICAL SERVICES SYSTEM

46- Definitions. As used in this part, unless the context clearly requires otherwise:

"Advanced life support" means initiating all basic life support care as well as invasive patient care designed to stabilize and support a patient's condition due to sudden illness or injury. The care rendered, excluding basic life support, constitutes the practice of medicine.

"Basic life support" means initiating noninvasive emergency patient care designed to optimize the patient's chances of surviving the emergency situation. The care rendered consists of all first-aid procedures needed, but does not include invasive procedures that constitute the practice of medicine; provided that state-approved basic life support personnel may use fully automatic external defibrillators, initiate intravenous lines, and perform manual external defibrillation under the direction and personal supervision of a mobile intensive care technician and in accordance with rules adopted by the department.

"Community paramedicine program" means an enhanced and expanded service in the county emergency medical services system that allows state-licensed health care professionals and community health workers to assist with public health, primary care, and prevention services, including services through telehealth.

"County" means any county having a population of five hundred thousand or more.

"County system" means the county pre-hospital emergency medical services system.

"Emergency aeromedical services" means a secondary response system that provides immediate critical care and transport by rotary-wing aircraft of a patient to a facility that provides specialized medical care.

"Emergency medical services for children" means emergency medical services including preventive, pre-hospital, hospital, rehabilitative, and other post-hospital care for children.

"Emergency medical services personnel" means any mobile intensive care technician or emergency medical technician who is certified or licensed by the State.

46- County emergency medical services system; establishment. Each county having a population of five hundred thousand or more shall establish, administer, and maintain a county emergency medical services system to serve the emergency health needs of the people in the county. The county, in the implementation of this part, shall plan, coordinate and provide assistance to all entities and agencies, public and private, involved in the county system. All emergency medical services or ambulance services conducted by or under the authority of the county shall be consistent with this part.

46- County, functions; duties. In addition to other functions and duties assigned under this part, the county shall:

(1) Establish emergency medical services in the county, including emergency aeromedical services, which shall meet the requirements of this part;

(2) Review and approve the curricula and syllabi of training courses offered to emergency medical services personnel who work in the county who provide basic, intermediate, and advanced life support, consult and coordinate with the university of Hawaii, or any other accredited community college, college, or university, or any professional organization that provides emergency medical services training, regarding the training for basic, intermediate, and advanced life support personnel, as provided in section 321-229;

(3) Establish, administer, and maintain a communication system for the county system;

(4) Implement public information and education programs to inform the public of the county system and its use, and disseminate other emergency medical information, including appropriate methods of medical self-help and first-aid, and the availability of first-aid training programs in the county;

(5) Establish standards and provide training for dispatchers in the county system, and maintain a program of quality assurance for dispatch equipment and operations;

(6) Establish a program that will enable emergency service personnel within the county to provide early defibrillation; and

(7) Establish within the department the emergency medical service system for children in the county.

46- Emergency medical services; fees. (a) The county may establish reasonable fees to be collected from individuals who are:

(1) Transported by emergency ground ambulance services to a health care facility within the county designated by the department for the care of the individual; or

(2) Provided health care by emergency medical services personnel within the county but not transported by ground ambulance to a health care facility.

(b) No ambulance services, or any other emergency medical services available from or under the authority of this chapter shall be denied to any person on the basis of the ability of the person to pay therefor or because of the lack of prepaid health care coverage or proof of the ability or coverage.

(c) The county may adopt rules pursuant to chapter 91 necessary to effectuate the purposes of this section.

46- Community paramedicine program; established. (a) The county shall establish and administer the community paramedicine program.

(b) The county shall:

(1) Develop guidelines for community paramedicine;

(2) Explore and develop partnerships with public and private health care entities, insurers, and community organizations; and

(3) Employ telehealth to enhance access and improve the patient experience.

(c) The county shall submit a report on the status of the community paramedicine program, including an accounting of expenses and source of funds, to the legislature no later than twenty days prior to the convening of each regular session of the legislature.

(d) The county shall adopt rules pursuant to chapter 91 to effectuate the purposes of this section.

46- Fall prevention and early detection coordinator. A fall prevention and early detection coordinator shall coordinate the provision of public and private fall prevention and early detection services for the elderly within the county.

46- Emergency medical services; levels of service; contracts. The county shall determine the levels of emergency medical services that shall be implemented throughout the county. The county may contract to provide emergency medical services, including emergency aeromedical services, or any necessary component of the county emergency services system. Any private agency contracting to provide emergency medical ambulance services under this section shall be required by the county to implement those services in a manner and at a level consistent with the levels determined under this section.

46- Grants. The county system may seek and accept any funds or property and other desirable support and assistance from any source whatsoever, whether gift, grant, services or any combination thereof, subject to applicable laws.

46- Immunity and limitation on liability for emergency aeromedical services. The county shall not be liable for any claim of injury or death based on a failure to establish or continue emergency aeromedical services in any part of the county.

46- Emergency medical services; use of latex gloves. The county may enact a county ordinance to prohibit the use of latex gloves by personnel providing ambulance services or emergency medical services pursuant to this part.

46- Rules. The county may adopt rules necessary for the implementation of this part, subject to chapter 91."

SECTION 2. Chapter 321, Hawaii Revised Statutes, is amended by adding a new section to part XVIII to be appropriately designated and to read as follows:

"321- Retention of relevant documentation. Notwithstanding any provision of this part or any other state or county law to the contrary, the department shall retain data repository, charts, patient information, data submission, and epidemiology information for all emergency medical services within the State, including emergency medical services provided within a county outside of the service area pursuant to part     of chapter 46."

SECTION 3. Section 321-221, Hawaii Revised Statutes, is amended to read as follows:

"321-221 Findings and purpose. The legislature finds that the establishment of a state comprehensive emergency medical services system [to include but not be limited to], including emergency medical services for children, is a matter of compelling state interest and necessary to protect and preserve [the] health [of the people of the State]. A system designed to reduce medical emergency deaths, injuries, and permanent long-term disability through the implementation of a fully integrated, cohesive network of components, the legislature further finds, will best serve [the] health needs [of the people]. Accordingly, the purpose of this part is to establish and maintain a state comprehensive emergency medical services system [throughout the] in communities that can be most effectively served by the State, and to fix the responsibility for the administration of this state system, which shall provide for the arrangement of personnel, facilities, and equipment for the effective and coordinated delivery of health care services under emergency conditions, whether occurring as the result of a patient's condition [or of], from natural disasters, or from other causes. The system shall provide for personnel, personnel training, communications, emergency transportation, facilities, coordination with emergency medical and critical care services, coordination and use of available public safety agencies, promotion of consumer participation, accessibility to care, mandatory standard medical recordkeeping, consumer information and education, independent review and evaluation, disaster linkage, mutual aid agreements, and other components necessary to meet the purposes of this part."

SECTION 4. Section 321-222, Hawaii Revised Statutes, is amended by adding a new definition to be appropriately inserted and to read as follows:

""Service area" means the State, excluding any county having a population of five hundred thousand or more."

SECTION 5. Section 321-223, Hawaii Revised Statutes, is amended to read as follows:

"[[]321-223[]] State comprehensive emergency medical services system, establishment. The department of health shall establish, administer, and maintain the state comprehensive emergency medical services system to serve the emergency health needs of the people [of] in the [State.] service area. The department [of health], in the implementation of this part, shall plan, coordinate, and provide assistance to all entities and agencies, public and private, involved in the state system. All emergency medical services or ambulance services conducted by or under the authority of the department [of health] or any county within the service area shall be consistent with this part."

SECTION 6. Section 321-224, Hawaii Revised Statutes, is amended by amending subsection (a) to read as follows:

"(a) In addition to other functions and duties assigned under this part, the department shall:

(1) Regulate ambulances and ambulance services[;] statewide;

(2) Establish emergency medical services throughout the [State,] service area, including emergency aeromedical services, which shall meet the requirements of this part, subject to section 321-228;

(3) Review and approve the curricula and syllabi of training courses offered to emergency medical services personnel who work in the service area and who provide basic, intermediate, and advanced life support, consult and coordinate with the University of Hawaii, or any other accredited community college, college, or university, or any professional organization that provides emergency medical services training, regarding the training for basic, intermediate, and advanced life support personnel, as provided in section 321-229;

(4) Collect and evaluate data for the continued evaluation of the [state system,] of emergency services within the State, including services provided within a county outside of the service area, subject to section 321‑230;

(5) Coordinate, on a statewide basis, emergency medical resources and the allocation of [the state system's] emergency services and facilities in the event of mass casualties, natural disasters, national emergencies, and other emergencies, ensuring linkage to local, state, and national disaster plans, and participation in exercises to test these plans;

(6) Establish, administer, and maintain a communication system for the state system;

(7) Assist each county in the development of a "911" emergency telephone system[;], regardless of whether the county is located within the service area;

(8) Secure technical assistance and other assistance and consultation necessary for the implementation of this part, subject to section 321-230;

(9) Implement public information and education programs to inform the public of the state system and its use, and disseminate other emergency medical information, including appropriate methods of medical self-help and first-aid, and the availability of first-aid training programs in the [State;] service area;

(10) Establish standards and provide training for dispatchers in the state system, and maintain a program of quality assurance for dispatch equipment and operations;

(11) Establish a program that will enable emergency service personnel working in the service area to provide early defibrillation;

(12) Establish within the department the emergency medical service system for children[;] in the service area;

(13) Consult with the advisory committee on matters relating to the implementation of this part; and

(14) Establish and maintain statewide standards for emergency medical services course instructor qualifications and statewide requirements for emergency medical services training facilities."

SECTION 7. Section 321-224.2, Hawaii Revised Statutes, is amended by amending subsection (a) to read as follows:

"(a) The department shall establish reasonable fees to be collected from individuals who are:

(1) Transported by emergency ground ambulance services to a health care facility within the service area designated by the department for the care of the individual; or

(2) Provided health care by emergency medical services personnel within the service area but not transported by ground ambulance to a health care facility."

SECTION 8. Section 321-224.4, Hawaii Revised Statutes, is amended by amending subsection (a) to read as follows:

"(a) The department [of health] shall establish and administer the community paramedicine program[.] within the service area."

SECTION 9. Section 321-225, Hawaii Revised Statutes, is amended by amending subsection (b) to read as follows:

"(b) The advisory committee shall be composed of [twenty] seventeen members: three nonvoting ex-officio members, who shall be the director of transportation, the adjutant general, and the administrator of the state health planning and development agency, or the designated representatives thereof, and [seventeen] sixteen members representing all counties [of the State] within the service area who shall be appointed by the governor subject to section 26-34 as follows:

(1) Five members who shall be physicians experienced in the conduct and delivery of emergency medical services; provided that at least two shall be engaged in the practice of emergency medicine and be board-eligible or board-certified by the American Board of Emergency Medicine, and provided further that at least one physician shall be engaged in the practice of pediatrics and be board-eligible or board-certified by the American Board of Pediatrics;

(2) [Four] Three members, one from each county within the service area, who shall be consumers of health care and who shall have no connection with or relationship to the health care system of the State [and who shall be representative of all counties];

(3) [Four] Three members [of], one from each county within the service area, who are in allied health professions related to emergency medical services; and

(4) [Four] Three members, one from each county[,] within the service area, who shall be mobile intensive care technicians or emergency medical technicians engaged in the practice of pre-hospital emergency medical service.

The members of the advisory committee shall serve without compensation, but shall be reimbursed for necessary expenses incurred in the performance of their duties, including travel expenses. The chairperson of the advisory committee shall be elected by the members from among their numbers. A majority of the members of the advisory committee shall constitute a quorum for the conduct of business of the advisory committee. A majority vote of the members present at a meeting at which a quorum is established shall be necessary to validate any action of the committee."

SECTION 10. Section 321-225.5, Hawaii Revised Statutes, is amended to read as follows:

"[[]321-225.5[]] Fall prevention and early detection coordinator. There is established within the emergency medical services and injury prevention system branch a fall prevention and early detection coordinator to coordinate the provision of public and private fall prevention and early detection services for the elderly[.] within the service area."

SECTION 11. Section 321-226, Hawaii Revised Statutes, is amended to read as follows:

"321-226 Emergency medical services and systems, standards. The department [of health] shall establish statewide standards for emergency medical services and for emergency medical service systems consistent with [the state system] this part and applicable federal guidelines for [such] those services, including a requirement that ambulance service providers licensed by the State establish and maintain an alcohol and substance abuse policy for employees that the department [of health] deems is equivalent to, or exceeds the provisions of, the safety and health standards established by the federal Department of Transportation for holders of commercial driver's licenses. In the event the standards are determined or regulated by any other law, or by applicable federal guidelines, standards required to be set by this section shall be at least equivalent to or exceed the other state and federal standards."

SECTION 12. Section 321-228, Hawaii Revised Statutes, is amended to read as follows:

"321-228 Emergency medical services; counties. The department shall determine, in consultation with the advisory committee under section 321-225, the levels of emergency medical services that shall be implemented in each county[.] within the service area. The department may contract to provide emergency medical services, including emergency aeromedical services, or any necessary component of [a county] the emergency services system of a county within the service area in conformance with the state system. [In the event] If any county within the service area shall apply to the department to operate emergency medical ambulance services within the respective county, the department may contract with the county for the provision of those services. The department shall operate emergency medical ambulance services or contract with a private agency in those counties [which] within the service area that do not apply to it under this section. Any county or private agency contracting to provide emergency medical ambulance services under this section shall be required by the department to implement those services in a manner and at a level consistent with the levels determined under this section."

SECTION 13. Section 321-229, Hawaii Revised Statutes, is amended by amending subsections (a) and (b) to read as follows:

"(a) The University of Hawaii shall provide training courses in basic, intermediate, and advanced life support for emergency medical services personnel. The curricula and syllabi of these courses shall be approved in advance by the department [of health.] and by any county operating a county emergency medical services system pursuant to part of chapter 46. The curricula and syllabi of courses for ambulance personnel shall be consistent with the scope and level of the practice of emergency medical services associated with emergency ambulance personnel certification defined by the Hawaii medical board under part II of chapter 453.

(b) The University of Hawaii, or other accredited community college, college, or university, or any professional organization that is approved by the department [of health] to provide emergency medical services training, shall consult with the department [of health] and any county operating a county emergency medical services system pursuant to part of chapter 46 to determine the number and type of emergency medical services courses necessary to support the staffing requirements for emergency medical services. The basic life support and advanced life support training programs shall be relevant to and consistent with the training course required for certification under chapter 453."

SECTION 14. Section 321-230, Hawaii Revised Statutes, is amended by amending subsections (a) and (b) to read as follows:

"(a) The department may contract for technical assistance and consultation, including [but not limited to] categorization, data collection, and evaluation appropriate to the needs of emergency services within the [state system.] State. The collection and analysis of statewide emergency medical services data, including pediatrics, trauma, cardiac, medical, and behavioral medical emergencies, shall be for the purpose of improving the quality of services provided.

The department may implement and maintain a trauma registry for the collection of information concerning the treatment of critical trauma patients at state designated trauma centers, and carry out a system for the management of that information. The system may provide for the recording of information concerning treatment received before and after a trauma patient's admission to a hospital or medical center. All state designated trauma centers shall submit to the department [of health] periodic reports of each patient treated for trauma in the state system in [such] the manner as the department shall specify.

For the purposes of this subsection, "categorization" means systematic identification of the readiness and capabilities of hospitals and their staffs to adequately, expeditiously, and efficiently receive and treat emergency patients.

(b) The department shall establish, administer, and maintain an aeromedical emergency medical services system designed to collect and analyze data to measure the efficiency and effectiveness of each phase of [an] the emergency aeromedical program[.] established by the department and any emergency aeromedical program that may be established by any county operating a county emergency medical services system pursuant to part of chapter 46.

The aeromedical emergency medical services system shall serve the emergency health needs of the people of the State by identifying:

(1) The [system's] strengths and weaknesses[;] of aeromedical emergency medical services with the State;

(2) The allocation of resources; and

(3) The development of rotary-wing emergency aeromedical services standards;

provided that emergency helicopter use, including triage protocols, shall be based on national aeromedical triage and transport guidelines established by the Association of Air Medical Services, the American College of Surgeons and the National Association of Emergency Medical Service Physicians. The department, in the implementation of this subsection, shall plan, coordinate, and provide assistance to all entities and agencies, public and private, involved in the system."

SECTION 15. Section 321-232, Hawaii Revised Statutes, is amended as follows:

1. By amending subsection (a) to read:

"(a) The department [of health] shall establish reasonable fees for services rendered to the public within the service area by the department [of health], any county[,] within the service area, or private agency under this part; provided that all [such] revenues [which shall be] collected by the department [of health] and the respective counties pursuant to this section shall be deposited into the state general fund, except [such] amounts necessary to provide for collection services for bad debt accounts. Fees required to be set by this section shall be established in accordance with chapter 91."

2. By amending subsection (c) to read:

"(c) In the event of nonpayment of any fees required to be assessed by this section, the department [of health] shall determine whether the recipient of [such] services is financially able to pay [such] the fees and make every reasonable effort to collect [such] the fees. In the event the department finds the person is without sufficient resources to pay for the services, no further action to collect the fees shall be taken. If the services are paid by a county or any other entity, and collection of [such] the fee is delegated by contractual agreement to the county or other agency [which] that provides the services, the county or other agency shall forward records relating to unpaid fees for action by the department [of health] under this subsection. No county or other entity shall make a final determination of the ability of a person to pay under this subsection. Any determination of ability to pay for purposes of this subsection shall be in accordance with rules [which] that the department [of health] shall adopt, subject to chapter 91, governing [such] the determinations."

SECTION 16. Section 321-236, Hawaii Revised Statutes, is amended to read as follows:

"[[]321-236[]] Emergency medical services; use of latex gloves prohibited. The use of latex gloves by personnel providing ambulance services or emergency medical services pursuant to this part shall be prohibited[.] within the service area."

SECTION 17. There is appropriated out of the general revenues of the State of Hawaii the sum of $ or so much thereof as may be necessary for fiscal year 2021-2022 for emergency medical services in the city and county of Honolulu.

The sum appropriated shall be expended by the city and county of Honolulu for the purposes of this Act.

SECTION 18. Notwithstanding section 321-234(b), Hawaii Revised Statutes, or any other law to the contrary, there is appropriated out of the emergency services special fund established pursuant to section 321-234, Hawaii Revised Statutes, the sum of $ or so much thereof as may be necessary for fiscal year 2021-2022 and the same sum or so much thereof as may be necessary for fiscal year 2022-2023 for the purpose of transferring half of the moneys in the special fund in each respective fiscal year to the city and county of Honolulu for emergency medical services in the city and county of Honolulu.

The sums appropriated shall be expended by the city and county of Honolulu for the purposes of this Act.

SECTION 19. Notwithstanding any other provision of this Act or other law to the contrary, any member of the state emergency medical services advisory committee who resides in the city and county of Honolulu pursuant to section 321-225(b)(2), (3), or (4), Hawaii Revised Statutes, in the form in which it read on the day before the effective date of this Act, may remain a member of the committee for the duration of the term for which the member was originally appointed; provided that if a member remaining on the committee pursuant to this section dies, resigns, or is otherwise removed from the committee, the member shall not be replaced.

SECTION 20. All rights, powers, functions, and duties of the department of health under part XVIII of chapter 321, Hawaii Revised Statutes, exercised within the island of Oahu are transferred to the city and county of Honolulu.

All employees who occupy civil service positions and whose functions are transferred to the city and county of Honolulu by this Act shall retain their civil service status, whether permanent or temporary. Employees shall be transferred without loss of salary, seniority (except as prescribed by applicable collective bargaining agreements), retention points, prior service credit, any vacation and sick leave credits previously earned, and other rights, benefits, and privileges, in accordance with state personnel laws and this Act; provided that the employees possess the minimum qualifications and public employment requirements for the class or position to which transferred or appointed, as applicable; provided further that subsequent changes in status may be made pursuant to applicable civil service and compensation laws.

Any employee who, prior to this Act, is exempt from civil service and is transferred as a consequence of this Act may retain the employee's exempt status, but shall not be appointed to a civil service position as a consequence of this Act. An exempt employee who is transferred by this Act shall not suffer any loss of prior service credit, vacation or sick leave credits previously earned, or other employee benefits or privileges as a consequence of this Act; provided that the employees possess legal and public employment requirements for the position to which transferred or appointed, as applicable; provided further that subsequent changes in status may be made pursuant to applicable employment and compensation laws. The city and county of Honolulu may prescribe the duties and qualifications of these employees and fix their salaries without regard to chapter 76, Hawaii Revised Statutes.

SECTION 21. All rules, policies, procedures, guidelines, and other material adopted or developed by the department of health to implement provisions of the Hawaii Revised Statutes that are reenacted or made applicable to the city and county of Honolulu by this Act shall remain in full force and effect until amended or repealed by the city and county of Honolulu pursuant to chapter 91, Hawaii Revised Statutes. In the interim, every reference to the department of health or director of health in those rules, policies, procedures, guidelines, and other material is amended to refer to the city and county of Honolulu.

SECTION 22. All deeds, leases, contracts, loans, agreements, permits, or other documents executed or entered into by or on behalf of the department of health, pursuant to the provisions of the Hawaii Revised Statutes, that are reenacted or made applicable to the city and county of Honolulu by this Act shall remain in full force and effect. Effective July 1, 2021, every reference to the department of health or the director of health in those deeds, leases, contracts, loans, agreements, permits, or other documents shall be construed as a reference to the city and county of Honolulu.

SECTION 23. All appropriations, records, equipment, machines, files, supplies, contracts, books, papers, documents, maps, and other personal property heretofore made, used, acquired, or held by the department of health relating to the functions transferred to the city and county of Honolulu shall be transferred with the functions to which they relate; provided that the department of health shall retain data repository, charts, patient information, data submission, and epidemiology information for all emergency medical services within the State.

SECTION 24. This Act does not affect rights and duties that matured, penalties that were incurred, and proceedings that were begun before its effective date.

SECTION 25. Statutory material to be repealed is bracketed and stricken. New statutory material is underscored.

SECTION 26. This Act shall take effect on July 1, 2021.

 

INTRODUCED BY:

_____________________________

 

 


 


 

Report Title:

Emergency Medical Services; Transfer of Duties; DOH; City and County of Honolulu; Appropriations

 

Description:

Transfers certain duties, functions, and powers relating to emergency medical services for the island of Oahu from the department of health to the city and county of Honolulu. Appropriates general funds to the city and county of Honolulu for emergency medical services for fiscal year 2021-2022. Appropriates half of the moneys in the emergency medical services special fund to the city and county of Honolulu for emergency medical services for fiscal years 2021-2022 to 2022-2023.

 

 

 

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