By the NJ First Aid Council
ON THURSDAY, DEC. 8, 2011, the Senate Health and Senior Services Committee voted to release bill A2095/S818 to the full Senate.
If signed into law, the measure will have dire consequences on New Jersey’s volunteer emergency medical services (EMS) providers.
The bill originally was a wish list promulgated by the previous administration under the direction of then-DHSS Senior Assistant Commissioner David Gruber. Mr. Gruber told the stakeholders to design an ideal system for New Jersey, regardless of cost. Since then, a worldwide economic downturn occurred and we know what has happened to New Jersey.
OLS was unable to determine costs for A2095/S818, but indicated the bill would result in additional DHSS administrative costs and increased training costs. OLS also was unable to determine costs to New Jersey’s municipalities, existing EMS providers or residents and visitors in need of their services.
Our preliminary analysis indicates the bill would cost, at minimum, tens of millions of dollars. Not only would it increase bureaucracy within the DHSS, but also cost volunteer providers a minimum of $1,500 initial licensing fee, plus $100 for each ambulance. For our 325 member squads, this would equate to $325,000 for agency licensing and $110,000 for our 1,100 ambulances. Thereafter, it would cost each volunteer agency $300 every two years and $100 per ambulance every two years. Therefore, every two years our members would be required to pay $97,500 for agency relicensing and $110,000 in ambulance fees. Moreover, the DHSS has informed us it does not have the resources to inspect these additional ambulances, so additional staff would be needed to do these inspections.
This bill also requires individual volunteer EMS personnel to be licensed. Although the licensure fee would be waived for volunteer EMTs — but not for any other EMS providers — we question why DHSS will be doing the licensing. All other medical professions are licensed by their appropriate board within the Division of Consumer Affairs. If all EMS personnel are to be licensed, we ask that we be extended the same courtesy by having an independent board do the licensing, not the DHSS. However, we strongly recommend leaving the current system in place that provides for all EMTs to be certified rather than licensed. There is no difference in the care provided to patients, and this will eliminate a cost increase.
The legislation calls for criminal background checks for all EMS providers. The bill also exempts volunteers from paying for them. At an estimated $80 per EMT, this could result in a non-funded cost of $800,000 for approximately 10,000 volunteers belonging to our organization.
The legislation mandates that all ambulances be equipped with GPS units. Our organization is wary of this because many times we are already dispatched away from our jurisdictions to cover other areas, thereby leaving our home areas uncovered by EMS. Again this appears to be another unfunded mandate. Our 1,100 plus ambulances at a cost of $600 per unit would cost $660,000. Volunteer agencies not affiliated with us could equate to another $40,000 to $50,000.
The legislation creates a new Emergency Medical Care Advisory Board (EMCAB). We believe this is duplicative of the current Emergency Medical Services Advisory Council created by the Commissioner of Health. Geographically, volunteer EMS agencies answer 9-1-1 calls in well more than 70 percent of the state and respond to more than 50 percent of all EMS calls. We are represented on the current council by our president and northern, central and southern area executive vice presidents. In addition, a non-affiliated EMT sits on the council. The new EMCAB reduces volunteer representation to just the president of the New Jersey State First Aid Council. We believe this will severely diminish input from volunteer EMS providers in favor of agencies and individuals who receive their livelihood through full-time employment in the EMS field.
The legislation calls for the creation of a state medical director who shall be a certified emergency medicine physician. We are sure that this new position will require, at a minimum, an executive assistant, clerical support and office equipment. We estimate a cost of approximately $550,000 annually. Additionally, the state medical director is authorized to establish three regional medical directors. This is another $1,650,000; another non-funded mandate.
The legislation also removes language from the Highway Traffic Safety Act. The language changes would remove certain legal protections from volunteer EMTs, as well as First Responders and First Responder-Ds. The language requiring EMS agencies to submit to their governing body information regarding the names, qualifications and certifications of its members, as well as inspection reports on their ambulances will be removed.
A different portion of the legislation gives the Commissioner of Health the authority to replace an EMS provider for what he/she believes is good cause, without consulting the local governing body. The commissioner is given the power to set and enforce standards for dispatch agencies for EMS 9-1-1 calls. This language can override the standards set by the new Interoperability Council, which went into effect this year.
The New Jersey State League of Municipalities submitted testimony to the Senate Health and Senior Services Committee voicing its concerns about the legislation. Although the NJSLOM applauds the goals of improving the EMS system, it feels they may be unrealistic at this time due to the current economic conditions and the 2 percent CAP placed on municipalities.
On Dec. 7, 2011, the volunteer Emergency Medical Technician Training Fund Committee voted to adopt the recommended National EMT Curriculum, raising the basic EMT training program from 120 hours to between 150 to 240 hours, and raise the reimbursement from the training fund from $550 to $1,200 per student. At the same meeting, DHSS advised that the fund already was in the red by $61,614. Projected income for the fund would train only 1,450 new students next year. This year, 2,040 new students were trained. This would leave no funding for continuing education credits required for all EMTs to be recertified. In addition, the New Jersey State First Aid Council annual education symposium, the DHSS annual education symposium and the quarterly Gold Cross Magazine would not be funded. DHSS also announced it would be unable to transition existing EMTs into the new curriculum. This would create a situation that new EMTs would be permitted to provide new skills in rendering basic life support services, but existing EMTs would be precluded from doing so.
A2095/S818 does not address a definition of what a volunteer or volunteer EMS agency is, or should be. At present, the only definition of volunteer is found in the Highway Traffic Safety Act, which defines it as follows: A volunteer squad is one that does not bill for services; a paid squad is one that bills for services. Therefore, all existing squads that bill patients for their services are licensed by the DHSS. Their volunteer members are not eligible for free training from the EMT Training Fund. During the last two years, many municipalities have asked their volunteer squads to bill patients, thereby reducing the cost to the municipalities. Other squads have paid members during the day and volunteer members during evening and night hours. Many of them bill for services as well. We had asked that the definition of a volunteer squad be changed to: “A volunteer squad shall be one where 51 percent of coverage time is performed by volunteer crews.” This would permit the volunteer members to be eligible for free training from the EMT Training Fund.
It is disturbing that the DHSS does not have data regarding the total number of EMTs in the state, how many recertify and how many drop out each year. It is quite conceivable that by the end of 2013, more EMTs will leave the system than are being trained. Also disturbing is the apparent inability of the DHSS to track its expenditures. It would appear that it does not obligate funding to programs based on the projected income from the training fund. Therefore, vendors are not sure they will be reimbursed per their agreement with the DHSS. The DHSS stated that costs incurred in the current fiscal year would be paid out of funding from the next fiscal year. This is not in accordance with Nationally Accepted Governmental Accounting Practices.
Finally, the New Jersey Office of Homeland Security and Preparedness former Director Richard Canas and current Director Charley McKenna both have stated publicly that if the state were faced with another manmade or natural disaster such as 9/11, Hurricane Irene, Tropical Storm Lee or this year’s Halloween snow storm, New Jersey would not be able to respond appropriately without having the same number of volunteer EMS providers that currently exist.
Proponents of A2095/S818 stated from the beginning of the process that they believe the New Jersey State First Aid Council is obstructing the development of new EMS standards. This is incorrect. We support many sections of the legislation. We oppose other sections which would lead to a diminishing role for volunteers to the benefit of paid services. These changes will not provide any commensurate improvement in the EMS system. There exists the very real possibility that, without the EMS volunteers, the level of service will not be what it is today. The legislation calls for services that cannot be afforded in the current economy. The proponents continually state that our organization is only for me, me, me. We would point out that our members receive nothing for the services they provide to help their neighbors. The proponents of the legislation all receive compensation for their services. Just look at the makeup of the new EMCAB.
We respectfully request that you consider voting “No” on A2095/S818. It is anticipated that the bill may be posted as early as December 15, 2011.