Arizona bill to hold paramedics accountable for counseling a patient on EMS transportation moves out of Senate HHS Committee

A bill concerning the regulation of emergency medical services (EMS) transporting patients recently crossed over from the House into the Senate Health and Human Services (HHS) Committee, and passed with an 8-0 vote.

 

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House Bill 2431, sponsored by Rep. Amish Shah (D– Phoenix) would prohibit an emergency medical care technician (EMCT) from counseling a patient to decline emergency medical services transportation and from providing a presumptive medical diagnosis, except as part of a specific alternate destination or treat-and-refer program that includes quality management and comprehensive medical direction oversight. 

The bill would also require an EMCT to comply with established standards and protocols relating to the consideration of emergency transportation, and would require an EMCT to explain to a patient the risks and consequences to the patient’s health of not being transported.

Shah cited several instances of EMCTs over the past year advising patients against going to the ER, causing the health conditions of those patients to worsen as a result of not being transported, at times leading to death of the patient. He said the transport rates in the city of Phoenix and many other places across the valley are significantly low compared to national standards.

“There is no rule or statute governing this kind of issue or incident, which means that people would show up and counsel people out of going to the ER, and there are no consequences for doing something that is far outside the standard of care,” Shah said. “No medical group will say that it’s okay to counsel somebody out of going to the ER, and yet it is happening a lot.”

Sen. Kelly Townsend (R–Mesa) brought up some concerns about clarity of language in the bill to avoid misunderstandings in situations where EMS informs a patient of their rights to refuse going to the emergency room. This situation falls under informed consent and is legal, but may be confused as counseling the patient not to be transported to the emergency room, Townsend said.

Shah clarified that the bill would not punish EMS professionals for informing patients of their right to refuse to be transported to the emergency room.

“This is actually directed not so much on civil litigation, but rather on the issue of AZDHS when they enforce standards on licenses, because right now there isn’t an accountability mechanism,” he said.

Drew Shafer, director of the William E. Morris Institute for Justice, testified in favor of the bill. He said this bill would particularly support people with disabilities and other marginalized communities that struggle in transporting themselves to a hospital. 

“We believe the bill provides safeguards for people in historically marginalized communities, people with disabilities who are not able to drive themselves, people living in poverty who do not have the means of transportation on demand at any given time and are not able to use technology tools to access ride share services … [We support] the right of all Arizonans to have accessibility, equity, fairness, inclusivity, and decency in their treatment when they seek emergency medical care,” Shafer said.

Chandra Goff, a physician assistant and former EMT, also spoke in favor of the bill from her own experience. She said that these were not isolated incidents, but a widespread problem occurring in the state over the last few years.

“I’ve seen many patients who belong in an ER but are coming into urgent care because they called 911 at home and the fire department told them they didn’t need to go to the hospital,” she said. “This bill supports all the excellent firefighters who want to treat their patients ethically.” 

Dr. Franco Castro-Marin, an emergency physician, also testified in favor of the bill, criticizing the lack of accountability for EMS professionals.

“In other states, these actions are classified as gross negligence, and can result in the revocation of a paramedic’s license,” he said. “But here, in my experience, not only has there been little transparency or communication about any remediation process for the paramedics involved, but also, there’s been no meaningful collaboration on system-wide solutions. It seems there is not even a meaningful process for state regulators to manage this effectively. What’s most troubling is that nobody knows just how pervasive this problem might be–we only find out about cases when they are reported to us by a patient or a physician.”

Sen. Raquel Teran (D–Phoenix) urged caution about the bill, citing concerns about many people in her district who she says would refuse to ride in an ambulance due to high costs. 

“People who do not have insurance, people who cannot afford it, will not ride on an ambulance,” she said.

Sen. Tyler Pace (R–Mesa) stated his support for the bill, saying that he doesn’t believe the bill is anti-EMS, and that it simply sets boundaries and clarifies the scope of practice for paramedics and EMS professionals. 

The bill passed both the HHS and Senate Rules Committee and then moved onto the Senate Committee of the Whole, where the bill has been retained.