BOARD OF DIRECTORS MEETING

AGENDA

March 18, 2002

Embassy Suites Hotel

100 Capitol Mall

Sacramento, CA  95814

(916) 326-5000

10:00 AM to 4:30 PM

The meeting charge (including lunch) will be $35.

 * Attachments

BOARD OF DIRECTORS MEETING

Marines’ Memorial Club

San Francisco, CA

Tuesday, December 3, 2002

10:00 a.m. to 4:30 p.m.

MINUTES

1.      Welcome and Introductions

Steve Andriese convened the meeting at approximately 10:03 a.m., with roundtable introductions.

2.      Approval of Agenda

Motion: Approve agenda as drafted. m/Lathrop  s/Inch – passed unanimously.

3.      Consent Calendar

Motion: Approve minutes from October 22 meeting. m/ Inch     s/ Lappola – passed unanimously.

Financial report was not distributed until last night.  Therefore, it was pulled from the consent calendar agenda.  Financial report will be presented for approval on the February/March 2003 agenda.

4.      Membership

Board of Directors liability and professional insurance.  Quote presented by Art.  Premium limit $750 per year (per motion).   $1 million liability insurance quote.  Board would prefer $2 million coverage limit, if possible.

Motion: Accept quote on insurance coverage. m/ Lathop  s/ Pletz– passed unanimously.

5.       Assemblywoman Helen Thompson Award

Letter and EMSAAC plaque presented by Steve.  Will present to Assemblywoman at a later date and a more convenient location. 

6.      EMSAAC Phone Address Update

New EMSAAC Address:

915 L Street, C-129

Sacramento,  CA 95814

(916) 760-4106

Phone Cost: $18.95 per month.  $40 installation one-time cost.  Now in place.

7.      Vision Conference Registration Income

Need about 80 people to break even.  Currently, 101 registrants.  Income to EMSAAC estimated to be $2,700. 

8.      Legislative Update

No new information to report.  Legislative platform for EMSAAC complete.  Will watch budget special session carefully for budget cutbacks related to EMS, public safety.

9.      EMSAAC committee structure, member assignments, and charge update.

Jim MacPherson has resigned his role in Santa Clara County and with EMSAAC.  Ethics committee position to be filled by the Board in a subsequent action.  Some changes to the draft ethic committee material were presented and discussed.

Motion for nominations: Carol Guenter.  m/ Inch  s/ Jones – approved to be on Ethics committee.

Further discussion pertaining to committee changes were discussed.  Modification to existing committee document will be undertaken as indicated. 

Doug, Troy and Carol to volunteer on steering committee of disaster preparedness.  Other members will be identified as needed.

10.  Letter to organizations/ RE: EMSAAC Representation

Steve will finalize the letters and send out ASAP.

11.  Prevention 2000 Grant Criteria – FY02/03

Met via conference call with Richard Watson.  Letters out to LEMA’s inviting grants for FY 03/04.  New categories for grants:  local and statewide.  Research projects on a local level ok if statewide applicability.  Should an EMDAC letter of support be required for all research grant project proposals?  Considerable discussion occurred on this matter.  Is research only “clinical”?  It was generally agreed that research projects must have affiliation with credible organization.  Proposals would not necessarily need EMDAC letter of support.  IRB approval was considered important.  Adding EMDAC representative to proposal review committee recommended. 

Motion:

a. VLT lead recommendations on projects that relate to vision projects.

b. Summarize discussion on EMSAAC list server regarding research projects and letters of support from affiliated groups (encouraged but not required).

m/ Inch  s/ Lappola – passed unanimously.

12.  Prevention 2000 Grant Projects FY 02/03

No recommendations for LEMA’s work on statewide projects at this time.

13.  Mission, Vision, Value Statements

Steve reviewed draft no. 5 version, as presented.  Discussion by Board. 

Motion: Amendment/Add: “we value the collective experience and diversity of the LEMAs in the State of California.” m/ Lathrop    s/ Iinch  – passed unanimously.

Other changes as discussed.  Final version adopted by the following motion.,

Motion: Adopt final version of document. m/ Inch   s/ Lappola – passed unanimously.

14.  EMSAAC Organization and Management Committee

Membership/Professional Development

Nancy presented a report on this item.  The mentoring program was discussed and input provided by the group.  A question was raised whether the mentorship would address only new administrators or members as a whole.  Networking of LEMSA staff is also highly recommended.  Roles and Responsibilities of LEMSA’s to be placed on the website. 

EMS Funding

Leonard reported on this topic area.  This will be the year of “maintaining funding at existing levels.”  Essential services will be emphasized.

Medical Director Standards

Leonard also reported on this topic.  Limited progress has been made in this area.  This issue will be revisited at a later date.

15.  CCLHO Affiliation Membership Update

Approved at the October 30 meeting of CCLHO.  Steve to be primary representative, and Nancy to be secondary representative.  Letter to be returned to CCLHO that states our liaison structure.

16.  Governance Vision Update

League of Cities/CSAC Report

Chuck discussed this item.  Presented an overview of the governance committee meeting with the League/CSAC about 2 weeks ago.  The following is a summary of this group’s key points of agreement.

a.       EMCC’s be mandatory statewide.

b.      Mandatory make-up of EMCCs (not to be appointed by local Board of Supervisors, but required make-up composition.)

c.       Body should be required to review EMS plans, etc.

d.      Appeal body for complaints within the system.  Appeal process to lead to State Commission.  None binding recommendations by Commission.

The question of whether EMS regions should have one or more EMCCs was raised.  Still unresolved.

Many questions and issues associated with “appeals process.”  Considerable discussion on this matter.  No clear consensus between parties.  Binding authority over local Board of Supervisors or local governing board of LEMSA is a major concern. 

What is the best procedural or mechanism for appeal, particularly by cities, for EMS policy or portion of EMS plan?

EMSA Director Qualifications

Chuck discussed this matter.  Administrative Director option, if Governor has not appointed by a certain time.  This option would require a part-time Medical Director to work with an administrative director. 

Matrix

Document not yet completed.  Still in draft form.  To be a reference document in the State EMS plan.  Issues of “primary” and “secondary”. 

LUNCH SERVED: Presentation by Richard Watson, Acting Director of State EMS Authority.  The following topics were discussed.

§                                                                                                                                                                                                                                               State budget issues

§                                                                                                                                                                                                                                               Airway policy/recommendations

§                                                                                                                                                                                                                                               EMD guidelines process

§                                                                                                                                                                                                                                               EMT-I Statewide test

§                                                                                                                                                                                                                                               Poison Control Centers

§                                                                                                                                                                                                                                               LA hospitals, trauma and EMS funding

§                                                                                                                                                                                                                                               Bioterrorism/Smallpox

§                                                                                                                                                                                                                                               Vision Governance Committee work

21.  EMS Commission Agenda (out of order)

Chuck provided an overview of the State Commission agenda.  Does not anticipate any item being pulled from the Consent Calendar.

EMD Guidelines – Steve started discussion on this issue.  It was clarified that the primary EMSAAC concern is that of legal authority.  Specifically, the primary concern of EMSAAC involves the issue of medical control over EMD dispatch centers.  The issue of legal protection of EMD service providers is also a concern.  In light of having this item on the Commission agenda tomorrow, Chuck asked for input and suggestions for his position on the matter.  Chuck brought forward the issue of standard of care, and how the State has worked hard to create a consistent standard of care process for EMS.  EMDAC’s position was also discussed at length.  It was decided that EMSAAC would respond to this matter after discussion has occurred at the Commission meeting and additional communication has occurred with EMDAC.

17.  Ethics Committee Report

Steve presented this discussion on behalf of Dan Lynch who was unable to attend the meeting.  Revised documents regarding ethics committee products were included in the agenda packet.  There was considerable discussion regarding the need for an appeals process and the need to assure confidentiality and privacy of process and actions. 

Consensus Recommendation: All the Ethics Committee to take actions and sanctions, as the Ethics Committee is a group representing the membership as a whole.  The Board of Directors would be the body to hear appeals.  Due process must be included in the policy.  The current draft does not reflect this language.  Also, define levels of discipline and action. 

Then, discussion changed to focusing on enforcement of the code of ethics.  It was agreed that the Board would not pursue the adoption of enforcement and actions taken to require sanctions for violations, etc. 

This issue to be sent back to committee for further review in regard to bylaw consistency.  It is hoped that this item will return to the February/March 2003 agenda.

18.    2003 Conference – Update

Nancy led discussion on the 2003 EMSAAC conference.  AMR has confirmed their donation of $8,000 for the conference sponsorship.  Hotel arrangements have been made.  At this time, the conference project as a whole is within budget.  Conference dates:  May 1 and 2, 2003, in San Diego. 

19.  Bylaws Committee Assignment

Mike Osur was assigned the task of scheduling a review and rewrite of the Association Bylaws.  Some of the areas that should be considered for change are:

- New address

- New committee structure

- Moving Budget, Nominations, and Bylaws Subcommittees under Organization and

  Management

- Clarify election of Ethics Committee is elected by general membership

- Clarify how association documents and policies templates will be maintained

- Review the dates on which membership renewal applications should be mailed out.  The

   current date may be too soon.

- Clarify which year dues are paid for when someone joins the association mid-year.  Should

   there be a pro-ration?

- other

20.  General Report – External Committees

Leonard led this discussion, committee by committee.  No new information to report.  It was felt that a leadership meeting between EMSAAC and EMDAC might be worthwhile. Additional discussion on EMSAAC / EMDAC coordination and communication.

21.  Moved up on agenda.

22.   EMT-P Task Force –QI Guidelines Draft

Larry and Bonnie from EMSA presented an update of the task force work.  Draft product to be available soon.

23.   EMSAAC Staffing and Training Committee

Debby Becker led a brief discussion on committee activities.  Considerable discussion on the cost of doing background checks and associated fees.

24.   General Report – External Committees (Staffing and Training)

25.   EMSAAC Communication Committee

Doug led the discussion on communications.  The group has had one meeting to date. Virginia mentioned a large amount of “interoperability” communications funding will be coming into the States soon. This money is primarily focused on law enforcement communication improvements.   It may be a good idea to look at this funding stream for improvements to EMS communication systems.  Doug to be sending out survey to LEMSA’s regarding system utilization on the local basis. 

26.   EMD Guidelines Update (see agenda item no. 21)

27.   General Report – External Committees (Communications)

28.   General Report - First Response Transport

No report.

29.  Nurse Ratio Regulation Comments

Steve and Leonard led the discussion and circulated a letter drafted for EMSAAC to comment on proposed ratio changes.  Jan was the author of the draft letter.  EMSAAC perspective and interest is primary limited to the “base hospital”.  Limited changes were made to the letter, as a result of the Board discussions. 

Motion: Approve letter as amended. m/ Pletz   s/ Ozur – passed unanimously.

30.  EMSAAC Facilities and Critical Care Committee

Diversion Policy – Troy Peterson to be added to committee.  Group will meet in January.

No other information to report.

31.  General Report

No other information to report.

32.  System Evaluation and Improvement HIPPA

Steve led the discussion.  Dan Smiley from the State EMSA reported that there does not appear to be a statewide direction forthcoming on the matter.  It was recommended that a small group of EMSAAC representatives work with staff at EMSA to address this issue.  It is desired to have the State take a position that LEMSA’s are in fact regulatory agencies and exempt from certain requirements of HIPPA, as a government regulatory agency.  However, it is clear that every county is individually looking at HIPPA impacts and local actions necessary for compliance.  It is desired to look for a statewide standard, if not a statement from the State regarding compliance.  Leonard will set up a meeting with EMSA to discuss.  EMSAAC members assigned; Barbara, Leonard, Gwen and county counsel, Nancy and IT person, Virginia and county counsel.

33.  General Report – System Evaluation and Improvement

No information.

34.   General Report – Public Education and Prevention

No information.

35.   EMSAAC Disaster Preparedness

Documents now posted on Website.

36.  HRSA Grant Committee Report

Nancy presented information on behalf of Isbell.

37.  General Report  -  External Committees

38.  Future Meeting Dates

It was suggested by Steve that the EMSAAC Board hold a meeting via conference call at some point in late January or February 2003.  Otherwise, the next EMSAAC Board meetings will be:

§         March 18, 2003

§         April 30, 2003 (General Membership Meeting)

§         June 10, 2003

39.  Roundtable

A general roundtable discussion was not held, except for the following update:

Trauma Care Fund Update – Bonny Sinz

Total for initial distribution:  $18,520,000 (minus State piece and reserve fund)

40. Adjournment

Members / Guests in Attendance

December 3, 2002

BOARD OF DIRECTORS MEETING

Teleconference

Friday, January 31, 2003

1:00PM – 2:15PM

MINUTES

1.      Welcome and Introductions

Steve Andriese convened the meeting via a telephone conference call at approximately

1:10 PM, with introductions of participants on the call.

2.      Approval of Agenda

There was no formal agenda published.  The meeting was convened for the purpose of discussing proposed EMD guidelines and developing an EMSAAC Board position on the matter.

3.      EMD Guidelines

Steve opened with a review of discussions at the last EMD Task Force meeting.  Steve was in attendance at the meeting on behalf of EMSAAC.  Steve stated that he described the EMSAAC Board position with the participants of the EMD Task Force.  Steve went on to say that there was a great deal of discussion on each policy point of the document. 

Steve then discussed the proposed compromise language that the EMD Task Force participants agreed to not oppose, as long as the language is agreed to by EMSAAC, EMDAC and CSAC.  This language was provided to the EMSAAC Board members in an attachment to an email sent prior to the conference call.  A second document was also attached to this email that contained language that the Access Group apparently approved, but never made it into the final EMD guideline. 

A roundtable type discussion with EMSAAC Board members was initiated with many participants weighing in with their opinion on the matter.  Nancy Lapolla and Barbara Pletz stated that they oppose the proposed compromise language because the new language is not consistent with State statue or case law.  Leonard Inch also stated that the language was not acceptable, primarily due to the word “coordinated” that is contained in the language. 

Art Lathrop, Chuck Baucom, and Bruce Lee stated that the proposed compromise language was acceptable to them, based on the assumption that the proposed guidelines could be implemented in most areas of the State without problem.  Generally, they felt that after many years of the Vision effort, compromise language was important to maintain a working relationship with the fire and law enforcement constituency groups. 

All EMSAAC Board member participants acknowledged that State law clearly establishes medical control for EMD with the EMS Agency Medical Director. 

The lawyers on the conference call, representing San Mateo and Los Angeles Counties, stated that they were very concerned that the proposed compromise language is not consistent with existing State law.  In this light, they were opposed to the proposed language. 

Steve stated that he was very concerned about the possible “side-effects” of not approving the compromised language.  He felt that the result would be very negative on the collaborative partnership that has been in existence with the other constituency groups. 

It was recommended that the State Attorney Generals Office be requested to provide an opinion on the matter.  However, it was not clarified as to who would be the “requesting organization” for the opinion.  The representatives from Los Angeles County stated that the AG opinion was the preferred approach at this time.

1^st Motion: “To support the proposed compromise language, as presented by Steve .”

m/ Inch, s/Jones  – failed to pass. (In favor: Lathrop, Lee, Jones, Andriese; Against: Inch, Lapolla, Pletz, Osur, La Venton; no vote received from Petrie)

2^nd Motion: “To draft a letter from EMSAAC to be presented during the 45 day comment period that makes the following statements:

The guidelines must recognize the responsibilities of the LEMSA EMS Medical Directors as stated in law, and that the LEMSA’s cannot give up medical control over EMD services. 

General statements regarding various elements of the proposed guidelines.”

m/Leonard, s/Lathrop—pass unanimously. 

It was agreed that Barbara Pletz would work with Steve Andriese in drafting a letter following the mandate of the motion to be sent by the President of EMSAAC.

The conference all was completed with no further discussion or action.

4.      Adjournment

Board Members / Guests in Attendance (Teleconference)

January 31, 2003