The board may establish by rule appropriate licensure levels for advanced emergency medical technicians and fix the qualifications for persons to hold those licenses.

Sec. 4. 32 MRSA §86, sub-§2, as amended by PL 1999, c. 182, §10, is further amended to read:

2. Care of patient. Whenever an ambulance transports a patient from the scene of an emergency, the patient must be cared for by a physician, by a flight nurse specialized medical team approved by the board or by a person licensed and authorized under this chapter to provide emergency medical care. Whenever an ambulance transports a patient from a hospital or other health care facility to another place, the patient must be cared for by:

A. The physician in charge of the patient's case, by a person licensed under this chapter or by a professional nurse; or

B. A licensed practical nurse, or other person appropriately trained to care for the patient, acting under orders from the patient's physician.

The person or team specified in this subsection as caring for the patient shall accompany the patient in the patient care portion of the ambulance where the patient rides.

Sec. 5. 32 MRSA §88, sub-§3 is enacted to read:

3.__Authority.__In addition to authority otherwise conferred, the board or, as delegated, its subcommittee or staff may, for each violation of applicable laws, rules or conditions of licensure or registration, take one or more of the following actions:

A.__Issue warnings, censures or reprimands to a licensee.__ Each warning, censure or reprimand issued must be based upon violations of different applicable laws, rules or conditions of licensure or must be based upon separate instances of actionable conduct or activity;

B.__Suspend a license or registration for up to 90 days for each violation of applicable laws, rules and conditions of licensure or registration or for each instance of actionable conduct or activity.__Suspensions may be set to run concurrently or consecutively and may not exceed one year in

total.__Execution of all or any portion of a term of suspension may be stayed pending successful completion of conditions of probation, although the suspension remains part of the licensee's record;

C.__Impose civil penalties of up to $1,500 for each violation of applicable laws, rules and conditions of licensure or for each instance of actionable conduct or activity;

D.__Impose conditions of probation upon an applicant or licensee.__Probation may run for that time period as the board, its subcommittee or staff determines appropriate.__ Probation may include conditions such as: additional continuing education; medical, psychiatric or mental health consultations or evaluations; mandatory professional or occupational supervision of the applicant or licensee; and other conditions as the board, its subcommittee or staff determines appropriate.__Costs incurred in the performance of terms of probation are borne by the applicant or licensee.__Failure to comply with the conditions of probation is a ground for disciplinary action against a licensee; or

E.__Execute a consent agreement that resolves a complaint or investigation without further proceedings.__Consent agreements may be entered into only with the consent of the applicant or licensee, the board, its subcommittee or staff and the Department of the Attorney General.__Any remedy, penalty or fine that is otherwise available by law, even if only in the jurisdiction of the District Court, may be achieved by consent agreement, including long-term suspension and permanent revocation of a professional license.__A consent agreement is not subject to review or appeal and may be modified only by a writing executed by all parties to the original consent agreement. A consent agreement is enforceable by an action in Superior Court.

Sec. 6. 32 MRSA §90-A, sub-§1, as amended by PL 1991, c. 588, §19, is further amended to read:

1. Disciplinary proceedings and sanctions. The board or, as delegated, its subcommittee or staff shall investigate a complaint, on the board's its own motion or upon receipt of a written complaint filed with the board, regarding noncompliance with or violation of this chapter or of any rules adopted by the board. Investigation may include an informal conference or a hearing or both before the board, its subcommittee or staff to determine whether grounds exist for suspension, revocation or denial of a license or as otherwise determined necessary by the

board to the fulfillment of its responsibilities under this chapter. Hearings must be conducted in conformity with the Maine Administrative Procedure Act, Title 5, chapter 375, subchapter IV, to the extent applicable. The board, its subcommittee or staff may subpoena witnesses, records and documents, including records and documents maintained by a health care facility or other service organization or person related to the delivery of emergency medical services, in any investigation or hearing it conducts.

Sec. 7. 32 MRSA §90-A, sub-§3, as amended by PL 1993, c. 600, Pt. A, §35, is further amended to read:

3. Informal conference. If, in the opinion of the board, the factual basis of the complaint is or may be true and the complaint is of sufficient gravity to warrant further action, the board or staff may request an informal conference with the licensee. The board shall provide the licensee with adequate notice of the conference and of the issues to be discussed. The conference must be conducted in executive session of the board, subcommittee or staff, pursuant to Title 1, section 405, unless otherwise requested by the licensee. Statements made at the conference may not be introduced at a subsequent formal administrative or judicial hearing unless all parties consent. The licensee may, without prejudice, refuse to participate in an informal conference if the licensee prefers to immediately hold a formal request an adjudicatory hearing. If the licensee participates in the informal conference, the licensee waives the right to object to a participant at the hearing who participated at the informal conference.

Sec. 8. 32 MRSA §90-A, sub-§4, as amended by PL 1999, c. 547, Pt. B, §58 and affected by §80, is further amended to read:

4. Further action. If the board, its subcommittee or staff finds that the factual basis of the complaint is true and is of sufficient gravity to warrant further action, the board it may take any of the following actions.

A. The board, its subcommittee or staff may enter into a consent agreement, with the consent of the licensee, that fixes the period and terms of probation necessary to protect the public health and safety and to rehabilitate or educate the licensee. A consent agreement may be used to terminate a complaint investigation, if entered into by the board, the licensee and the Department of the Attorney General.

B. If a licensee voluntarily surrenders a license, the board, its subcommittee or staff may negotiate stipulations necessary to ensure protection of the public health and

safety and the rehabilitation or education of the licensee. These stipulations may be set forth only in a consent agreement signed by the board, the licensee and the Department of the Attorney General.

C. If the board, its subcommittee or staff concludes that modification, nonrenewal or, nonissuance or suspension pursuant to section 88, subsection 3 of a license is in order, the board shall so notify the applicant-licensee and inform the applicant-licensee of the applicant-licensee's right to request an adjudicatory hearing. If the applicant- licensee requests an adjudicatory hearing in a timely manner, the adjudicatory hearing must be held by the board in accordance with the Maine Administrative Procedure Act, Title 5, chapter 375, subchapter IV. At the conclusion of the hearing, the board shall forward a written finding of facts and recommended decision to the commissioner. Opportunity must then be given for the applicant-licensee and the board to file comments on the findings of fact and recommended decision to the commissioner. The commissioner, after considering the findings, recommendations and comments, shall either adopt or reject the recommended decision within a reasonable period of time. If the commissioner rejects the recommendation or issues a modified decision, the commissioner's written decision must contain the specific reasons for modifying or rejecting the recommended decision. The commissioner's decision is the department's final decision. If the applicant-licensee wishes to appeal the final decision of the board, the applicant-licensee shall file a petition for review with the Superior Court within 30 days of receipt of the board's decision.__Review under this paragraph must be conducted pursuant to Title 5, chapter 375, subchapter VII.

D. Except in the specific circumstances where Title 5, section 10004 may be invoked, if the board or its staff concludes that suspension beyond the authority conferred by section 88 or revocation of the license is in order, the board or its staff shall hold a hearing or request the Attorney General to file a complaint in the District Court in accordance with Title 4, chapter 5 and the Maine Administrative Procedure Act to commence either full or emergency proceedings.

Sec. 9. 32 MRSA §90-A, sub-§5, as amended by PL 1993, c. 575, §3 and c. 600, Pt. A, §36, is further amended to read:

5. Grounds for licensing action. The board may suspend or revoke a license pursuant to Title 5, section 10004. Refusal to issue or renew a license or to modify, suspend or revoke take

disciplinary action against a license of a person, service or vehicle may be predicated on the following grounds:

A. Fraud or deceit in obtaining a license under this chapter or in connection with service rendered within the scope of the license issued;

B. Habitual substance abuse that has resulted or is foreseeably likely to result in the licensee performing services in a manner that endangers the health or safety of the licensee's patients;

C. A professional diagnosis of a mental or physical condition that has affected or is likely to affect the licensee's performance in a manner that endangers the health or safety of the licensee's patients;

D. Aiding or abetting the practice of emergency care by a person not duly licensed under this chapter who purports to be so;

E. Incompetent professional practice as evidenced by:

(1) Demonstrated inability to respond appropriately to a client, patient or the general public; or

(2) Inability to apply principles, skills or knowledge necessary to successfully carry out the practice for which the licensee is licensed;

F. Violation of any reasonable standard of professional behavior, conduct or practice that has been established in the practice for which the licensee is licensed;

G. Subject to the limitations of Title 5, chapter 341, conviction of a crime that involves dishonesty or false statement that relates directly to the practice for which the licensee is licensed, conviction of a crime for which incarceration for one year or more may be imposed or conviction of a crime defined in Title 17-A, chapter 11 or 45;

H. Any violation of this chapter or any rule adopted by the board; or

I. For other purposes as specified by rules or law.

Sec. 10. 32 MRSA §91-A, as amended by PL 1991, c. 588, §20, is further amended to read:

§91-A. Appeals

Any person or organization aggrieved by the decision of the staff or a subcommittee of the board in modifying or refusing to issue or renew a license or to waive application of a particular rule in the interpretation of this chapter or rules adopted pursuant to this chapter may appeal the board's decision to the commissioner board for a final decision. The board's staff's or subcommittee's decision stands until such time as the commissioner board issues a decision to uphold, modify or overrule the board's staff's or subcommittee's decision. In the case of nonrenewal, the person or organization must be afforded an opportunity for hearing in accordance with this chapter and the Maine Administrative Procedure Act.

Any person or organization aggrieved by a final decision of the commissioner board in refusing to issue or renew a license or to waive application of a particular in the interpretation of a rule may appeal the commissioner's board's decision to the Superior Court in accordance with the Maine Administrative Procedure Act, Title 5, chapter 375, subchapter VII.

Sec. 11. 32 MRSA §92, as amended by PL 1991, c. 588, §§21 and 22, is further amended to read:

§92. Confidentiality of information

Any reports, information or records provided to the board or department pursuant to this chapter must be provided to the licensee and are confidential insofar as the reports, information or records identify or permit identification of any patient, provided that the board may disclose any confidential information as follows:.

1. Hearings or proceedings. In Confidential information may be released in an adjudicatory hearing or informal conference before the board or in any subsequent formal proceeding to which information is relevant; and.

2. Consent agreements or settlement. In Confidential information may be released in a consent agreement or other written settlement, when the information constitutes or pertains to the basis of board action.

3.__ During investigation.__All complaints and investigative records of the board are confidential during the pendency of an investigation.__Those records become public records upon the conclusion of an investigation unless confidentiality is required by some other provision of law.__For purposes of this subsection, an investigation is concluded when:

A.__ A notice of an adjudicatory hearing as defined under Title 5, chapter 375, subchapter I has been issued;

B.__A consent agreement has been executed; or

C.__A letter of dismissal has been issued or the investigation has otherwise been closed.

4.__Exceptions.__Notwithstanding subsection 3, during the pendency of an investigation, a complaint or investigative record may be disclosed:

A.__To Maine Emergency Medical Services employees designated by the director;

B.__To designated complaint officers of the board;

C. By a Maine Emergency Medical Services employee or complaint officer designated by the board when, and to the extent, considered necessary to facilitate the investigation;

D.__To other state or federal agencies when the files contain evidence of possible violations of laws enforced by those agencies;

E.__When and to the extent considered necessary by the director to avoid imminent and serious harm.__The authority of the director to make such a disclosure may not be delegated;

F.__Pursuant to rules adopted by the department, when it is determined that confidentiality is no longer warranted due to general public knowledge of the circumstances surrounding the complaint or investigation and when the investigation would not be prejudiced by the disclosure; or

G.__To the person investigated on request of that person.__ The director may refuse to disclose part or all of any investigative information, including the fact of an investigation when the director determines that disclosure would prejudice the investigation.__The authority of the director to make such a determination may not be delegated.

Sec. 12. 32 MRSA §92-A, sub-§2, as amended by PL 1991, c. 588, §23, is further amended to read:

2. Confidentiality. All proceedings and records of proceedings concerning the quality assurance activities of any emergency medical services quality assurance committee approved

by the board are confidential and are exempt from discovery. All reports, information and records provided to any emergency medical services quality assurance committee approved by the board are confidential and exempt from discovery.

SUMMARY

This bill amends the Maine Emergency Medical Services Act of 1982 to:

1. Require that whenever a patient is transported by ambulance, the patient must be accompanied by a physician, person licensed to provide emergency care or a specialized medical team approved by the Emergency Medical Services' Board;

2. Allow the board to issue warnings, suspend licenses and impose civil penalties for violations of the Maine Emergency Medical Services Act of 1982;

3. Allow a decision of the board to be appealed to the Superior Court; and

4. Clarify the confidentiality of complaints and records of the board and the circumstances under which those records may be disclosed and to whom.