HB4451 H GO AM 2-13

Archibald 3192

The Committee on Government Organization moves to amend the bill by striking out everything after the enacting clause, and inserting in lieu thereof the following:

“That §16-4C-1, §16-4C-2, §16-4C-3, §16-4C-4, §16-4C-5, §16-4C-6, §16-4C-6a, §16-4C-6b, §16-4C-7, §16-4C-8, §16-4C-9, §16-4C-10, §16-4C-11, §16-4C-12, §16-4C-13, §16-4C-14, §16-4C-15, §16-4C-16, §16-4C-17, §16-4C-18, §16-4C-19, §16-4C-20, §16-4C-21, §16-4C-22 and §16-4C-23 of the code of West Virginia, 1931, as amended, be repealed; and that said code be amended by adding thereto a new article, designated §15-5C-1, §15-5C-2, §15-5C-3, §15-5C-4, §15-5C-5, §15-5C-6, §15-5C-7, §15-5C-8, §15-5C-9, §15-5C-10, §15-5C-11, §15-5C-12, §15-5C-13, §15-5C-14, §15-5C-15, §15-5C-16, §15-5C-17, §15-5C-18, §15-5C-19, §15-5C-20, §15-5C-21, §15-5C-22, §15-5C-23, and §15-5C-24; all to read as follows:

CHAPTER 15. PUBLIC SAFETY

ARTICLE 5C. DIVISION OF PRE-HOSPITAL EMERGENCY MEDICAL SERVICES.

§15-5C-1. Division created; purpose; short title.

(a) There is hereby created within the Department of Military Affairs and Public Safety a division to be known as the Office of Emergency Medical Services. Effective July 1, 2014, the office of emergency medical services created by former section four, article four-c, chapter sixteen of this code shall continue in existence as the office of emergency medical services established by this section.

(b) The purpose of the Office of Emergency Medical Services is to further the public policy of encouraging emergency medical service providers to do those things necessary to carry out the powers conferred in this article unless otherwise forbidden by law, to provide for the safe and efficient operation of life-saving and life-preserving emergency medical services within this state, and to establish and enforce minimum performance and training standards for emergency medical service personnel.

§15-5C-2. Applicability.

(a) This article applies to all persons or entities defined in this article or by rule promulgated pursuant to this article, and to all other persons or entities providing emergency medical services in this state, except as provided in this section.

(b) This article is not intended to limit the scope of practice of any person who is a duly licensed health care provider under other provisions of this code and who is acting within the scope of his or her license.

(c) This article and rules promulgated pursuant to it do not apply to the following vehicles and aircraft, and persons aboard them are not required to comply with the provisions of this article:

(1) Privately-owned vehicles and aircraft not ordinarily used in the business or service of transporting patients;

(2) Vehicles and aircraft used as ambulances in case of a catastrophe or emergency when the ambulances normally staffed by certified emergency medical service personnel based in the locality of the catastrophe or emergency are insufficient to render the service required;

(3) Ambulances based outside this state, except that emergency medical service personnel aboard any such ambulance receiving a patient within this state for transportation to a location within this state shall comply with the provisions of this article and the rules promulgated pursuant to it except in the event of a catastrophe or emergency when the ambulances normally staffed by certified emergency medical service personnel based in the locality of the catastrophe or emergency are insufficient to render the services required;

(4) Ambulances owned by or operated under the direct control of a governmental agency of the United States; and

(5) Vehicles and aircraft designed primarily for rescue operations which do not ordinarily transport patients.

§15-5C-3. Definitions.

As used in this article, unless the context clearly requires a different meaning:

(a) "Ambulance" means any privately or publicly-owned vehicle or aircraft which is designed, constructed or modified, equipped or maintained, and operated for the transportation of patients, including, but not limited to, emergency medical services vehicles; rotary and fixed wing air ambulances; and specialized multipatient medical transport vehicles operated by an emergency medical services agency;

(b)"Council" means the Emergency Medical Service Advisory Council created pursuant to section seven of this article;

(c)"Emergency Medical Services" means all services set forth in and made a part of the pre-hospital emergency medical services plan of the Department of Military Affairs and Public Safety, including, but not limited to, responding to the medical needs of an individual to prevent the loss of life or aggravation of illness or injury;

(d) "Emergency medical service agency" means any agency licensed under this article that provides emergency medical services;

(e) "Emergency medical service personnel" means any person certified by the executive director to provide emergency medical services as set forth by rule;

(f) "Emergency medical service provider" means any authority, person, corporation, partnership or other entity, public or private, which owns or operates a licensed emergency medical services agency providing emergency medical services in this state;

(g) "Executive Director" means the executive director of the Office of Emergency Medical Services.

(h) "Governing body" means a political subdivision of this state;

(i) "Line officer" means the emergency medical service personnel, present at the scene of an accident, injury or illness, who has taken the responsibility for patient care;

(j) "Medical command" means the issuing of orders by a physician from a medical facility to emergency medical service personnel for the purpose of providing appropriate patient care;

(k) “Medical Director” means the board-certified emergency medicine physician appointed by the executive director, in charge of formulating medical protocol for emergency medical service personnel within the Office of Emergency Medical Services;

(l) "Patient" means any person who is a recipient of emergency medical services;

(m) “Secretary” means the Secretary of the Department of Military Affairs and Public Safety;

(n) "Service reciprocity" means the provision of emergency medical services to citizens of this state by emergency medical service personnel certified by a neighboring state to render those services;

(o) "Small emergency medical service provider" means any emergency medical service provider with fewer than twenty emergency medical service personnel; and

(p) "Specialized multipatient medical transport" means a type of ambulance transport provided for patients with medical needs greater than those of the average population, which may require the presence of a trained emergency medical technician during the transport of the patient: Provided, That the requirement of "greater medical need" may not prohibit the transportation of a patient whose need is preventive in nature.

§15-5C-4. Appointment of executive director; powers and duties.

(a) On or before July 1, 2014, the Secretary shall appoint an executive director for the Office of Emergency Medical Services, who shall be a graduate of an accredited college or university with at least five years of administrative experience in pre-hospital emergency care.

(b) The executive director may employ any technical, clerical, stenographic and other personnel as may be necessary to carry out the purposes of this article.

(1) To propose rules for legislative approval in accordance with the provisions of article three, chapter twenty-nine-a of this code, which shall include:

(A) Standards and requirements for certification and recertification of emergency medical service personnel, including but not limited to:

(i) Age, training, testing and continuing education;

(ii) Procedures for certification and recertification, including procedures and timelines for incomplete applications;

(iii) Procedures for denying, suspending, revoking, reinstating and limiting a certification or recertification;

(iv) Levels of certification and the scopes of practice and standards of conduct for each level;

(v) The fee schedule for certification and recertification; and

(vi) Causes for disciplinary action and the sanctions which may be imposed;

(B) Standards and requirements for licensure and license renewals of emergency medical service agencies, including:

(i) Operational standards, levels of service, personnel qualifications and training, communications, public access, records management, reporting requirements, medical direction, quality assurance and review, and other requirements necessary for safe and efficient operation;

(ii) Inspection standards and establishment of improvement periods to ensure maintenance of the standards;

(iii) The fee schedule for licenses, renewal of licenses and other necessary costs;

(iv) Procedures for denying, suspending, revoking, reinstating or limiting a license;

(v) Causes for disciplinary action; and

(vi) Administrative penalties, fines and other disciplinary sanctions which may be imposed on agencies;

(D) Standards and requirements for institutions which provide training and education;

(E) Standards and requirements for a State Medical Direction System, including qualifications for regional medical directors, the establishment of a State Medical Policy and Care Committee and the designation of regional medical command centers;

(F) Standards and requirements for provision of services by emergency medical service personnel in hospital emergency rooms;

(G) An authorization to temporarily suspend the license or certification of an emergency medical service provider, an emergency medical service agency or emergency medical service personnel prior to a hearing or notice if the executive director finds probable cause that the conduct or continued service or practice of such a license or certificate holder has or may create a danger to public health or safety: Provided, That the executive director may rely on information received from a physician who serves as a squad medical director in finding that probable cause exists to temporarily suspend the license or certification; and

(H) Any other rules necessary to carry out the provisions of this article;

(2) To apply for, receive and expend advances, grants, contributions and other forms of assistance from the state or federal government or from any private or public agencies or foundations to carry out the provisions of this article;

(3) To design, develop and review a Statewide Emergency Medical Services Implementation Plan. The plan shall recommend aid and assistance to:

(A) Encourage local participation by area, county and community officials and regional emergency medical services boards of directors;

(B) Develop a system for monitoring and evaluating emergency medical services programs throughout the state; and

(4) To provide professional and technical assistance and to make information available to potential applicants or program sponsors of emergency medical services for purposes of developing and maintaining a statewide system of services;

(5) To assist local government agencies, regional emergency medical services boards of directors and other public or private entities in obtaining federal, state or other available funds and services;

(6) To cooperate and work with federal, state and local governmental agencies, private organizations and other entities as may be necessary to carry out the purposes of this article;

(7) To acquire in the name of the state by grant, purchase, gift, devise or any other appropriate methods real and personal property as may be reasonable and necessary to carry out the purposes of this article;

(8) To make grants and allocations of funds and property so acquired or which may have been appropriated to the division or to other governmental subdivisions as may be appropriate to carry out the purposes of this article;

(9) To expend and distribute all funds and property, which the Office of Emergency Medical Services may have acquired by grant or appropriation, to all state and local agencies for the purpose of performing the duties and responsibilities of the agency;

(10) To develop a program to inform the public concerning emergency medical services;

(11) To prepare and submit to the Governor and Legislature recommendations for legislation in the area of emergency medical services;

(12) To review, make recommendations for and assist in all projects and programs that provide for emergency medical services whether or not the projects or programs are funded through the Office of Emergency Medical Services. A review and advice shall be required for all emergency medical services projects, programs or services for which application is made to receive state or federal funds for their operation; and

(13) To take all necessary and appropriate action to encourage and foster the cooperation of all emergency medical service providers, emergency medical service agencies, emergency medical service personnel and facilities within this state.

§15-5C-5. Appointment of medical director; powers and duties.

(a) On or before September 1, 2014, the executive director shall appoint a medical director, a part-time employee who shall be a board-certified physician licensed to practice in West Virginia for at least five years, with at least five years of experience working with or in the field of pre-hospital emergency medical services.

(b) The medical director shall establish and update state medical protocols for emergency medical service agencies and emergency medical service personnel. The medical director shall formulate the state medical protocols with the advice of the Emergency Medical Service Advisory Council.

(c) The medical director, with the advice of the council, shall establish the basic state medical protocols which will become effective January 1, 2015.

(d) At least every five years after January 1, 2015, or within six months of a change in national medical standards for pre-hospital care, if any, the medical director, with the advice of the council, shall update the state medical protocols to meet such national medical standards.

§15-5C-6. Appointment of administrative director; powers and

duties.

(a) On or before September 1, 2014, the executive director shall appoint, and set the salary of, an administrative director, a full-time employee who shall be a graduate of an accredited college or university with at least five years of administrative experience in pre-hospital emergency care.

(b) The administrative director shall, under the direction of the executive director:

(1) Set office policy and manage the Office of Emergency Medical Services;

(2) Oversee the certification and licensing of emergency medical service agencies and emergency medical service personnel, including enforcing educational requirements;

(3) Investigate emergency medical service agencies and emergency medical service personnel;

(4) Serve as staff for the Council;

(5) Perform cost analyses for the Office of Emergency Medical Services; and

(6) Perform such other duties as directed.

§15-5C-7. Emergency Medical Services Advisory Council;

appointment; composition; powers and duties; meetings;

expenses.

(a) The Emergency Medical Services Advisory Council is hereby created for the purpose of developing standards, with the Executive Director.

(b) Effective July 1, 2014, the council shall be composed of the following twelve members appointed by the Governor, by and with the advice and consent of the Senate:

(1) One person representing the West Virginia Chapter of the American College of Emergency Physicians;

(2) One person representing the West Virginia Chapter of the American Heart Association;

(3) One person representing the West Virginia Chapter of the American Academy of Pediatrics;

(4) One person representing the West Virginia Chapter of the American College of Surgeons;

(5) One person representing West Virginia Community and Technical Colleges;

(6) One person representing Regional Educational Service Agencies;

(7) One person representing a teaching hospital in West Virginia;

(8) One person representing a rural hospital in West Virginia; and

(9) Two persons representing the Mountain State Emergency Medical Services Association, one of whom shall be a paramedic and one of whom shall be an emergency medical technician-basic;

(10) One person representing the Ambulance Association of West Virginia; and

(11) One citizen of West Virginia who is not licensed or certified under the provisions of this article and does not perform any services related to emergency medical services.

(d) Not more than four of the members may be appointed from any one congressional district. Each member must be a resident of this state during the appointment term.

(e) The initial appointment terms shall be staggered. After the initial appointment, each term is to be for three five years and no member may serve more than four two consecutive terms.

(f) The council shall annually choose its own chairperson.

(g) The council may:

(1) Advise the medical director when the medical director is formulating state medical protocols for emergency medical service agencies and emergency medical service personnel;

(2) Advise the executive director when the executive director is developing standards for emergency medical service agencies and the executive director personnel;

(3) Review and make recommendations for, and provide assistance to, the establishment and maintenance of adequate emergency medical services for all portions of this state; and

(4) Advise in all matters pertaining to carrying out the purposes of this article.

(h) The council shall meet quarterly and any other meetings may be held at the call of the executive director. The meetings may be held in person or by electronic means.

(i) The members of the council shall receive expense reimbursement in an amount not to exceed the expense reimbursement as is paid to members of the Legislature for their interim duties, as recommended by the Citizens Legislative Compensation Commission and authorized by law, for each day or substantial portion thereof engaged in the performance of official duties.

(j) The Governor may remove a council member for neglect of duty, incompetence or official misconduct.

(k) A majority of council members, regardless of any vacancy, constitutes a quorum.

§15-5C-7. Emergency medical services agency licensure.

(a) Any person who proposes to establish or maintain an emergency medical services agency shall file an application with the executive director which includes the identity of the applicant, any parent or affiliated entity, the proposed level of service and the number of emergency medical service response vehicles of the agency or proposed agency. The executive director may require that additional information be included on each application.

(b) Upon receipt and review of the application the executive director shall issue a license if he or she finds that the applicant meets the requirements and quality standards, to be established by the executive director, for an emergency medical services agency license, and if the applicant has certified under penalty of perjury that he or she is current with all lawful obligations owed the State of West Virginia, excluding obligations owed in the current quarter, including, but not limited to, payment of taxes and workers' compensation premiums: Provided, That the certification set forth in this paragraph is required for the original application and subsequent renewals.

§15-5C-8. Establishment of emergency medical services agency

licensure fund; authorized expenditures; annual report.

(a) There is established in the State Treasury a special revenue fund designated the "Emergency Medical Services Agency Licensure Fund", which shall be administered by the Executive director of the Bureau of Public Health.

(b) All application, personnel certification and recertification and agency licensing fees collected pursuant to the this article shall be deposited into the fund and expended in accordance with the agency licensure and personnel certification and recertification duties imposed in this article.

(c) Any remaining balance, including accrued interest, in the fund at the end of the fiscal year shall not revert to the General Revenue Fund, but shall remain in the account.

(d) On or before January 1 of each year, the executive director shall provide the Legislature with an annual fiscal year report on the emergency medical services agency licensure account including, but not limited to, the previous fiscal year's expenditures; projected expenditures for the current and next fiscal years; the number of agency licenses and personnel certifications and recertifications issued, denied, suspended or revoked; and, the status of licensure and certification hearings and court actions.

§15-5C-9. Standards for emergency medical service personnel.

(a) Every ambulance operated by an emergency medical service agency shall carry at least two personnel. At least one person shall be certified in cardiopulmonary resuscitation or first aid and the person in the patient compartment shall be certified as an emergency medical technician-basic at a minimum except that in the case of a specialized multipatient medical transport, only one staff person is required and that person shall be certified, at a minimum, at the level of an emergency medical technician-basic. The requirements of this subsection will remain in effect until revised by legislative rule.

(b) Any person desiring emergency medical service personnel certification shall apply to the executive director using forms and procedures prescribed by the executive director. Upon receipt of the application, the executive director shall determine whether the applicant meets the certification requirements and may examine the applicant, if necessary to make that determination.

(c) The applicant shall submit to a national criminal background check, the requirement of which is declared to be not against public policy.

(1) The applicant shall meet all requirements necessary to accomplish the national criminal background check, including submitting fingerprints, and authorizing the West Virginia Office of Emergency Medical Services, the West Virginia State Police and the Federal Bureau of Investigation to use all records submitted and produced for the purpose of screening the applicant for certification.

(2) The results of the national criminal background check may not be released to or by a private entity.

(3) The applicant shall submit a fee of $75 for initial certification and a fee of $50 for recertification. The fees set forth in this subsection remain in effect until modified by legislative rule.

(d) An application for an original, renewal or temporary emergency medical service personnel certificate or emergency medical services agency license, shall be acted upon by the executive director and the certificate or license delivered or mailed, or a copy of any order of the executive director denying any such application delivered or mailed to the applicant, within fifteen days after the date upon which the complete application including test scores and background checks, if applicable, was received by the executive director.

(e) Any person may report to the executive director information he or she may have that appears to show that a person certified by the executive director may have violated the provisions of this article or legislative rules promulgated pursuant to this article. A person who is certified by the executive director, who knows of or observes another person certified by the executive director violating the provisions of this article, or legislative rules promulgated pursuant to this article, has a duty to report the violation to the executive director. Any person who reports or provides information in good faith is immune from civil liability.

(f) The executive director may issue a temporary emergency medical service personnel certificate to an applicant, with or without examination of the applicant, when he or she finds that issuance to be in the public interest. Unless suspended or revoked, a temporary certificate shall be valid initially for a period not exceeding one hundred twenty days and may not be renewed unless the executive director finds the renewal to be in the public interest.

§15-5C-10. Complaints; investigations; due process procedure;

grounds for disciplinary action.

(a) The executive director may at any time upon his or her own motion, and shall, upon the written complaint of any person, cause an investigation to be conducted to determine whether grounds exist for disciplinary action under this article or legislative rules promulgated pursuant to this article.

(b) An investigator or other person who, under the direction of the executive director, gathers or reports information in good faith to the executive director is immune from civil liability.

(c) After reviewing any information obtained through an investigation, the executive director shall determine if probable cause exists that the licensee or certificate holder has violated any provision of this article or rules promulgated pursuant to this article.

(d) Upon a finding that probable cause exists that the licensee or certificate holder has violated any provision of this article or rules promulgated pursuant to this article, the executive director shall provide a copy of the complaint and notice of hearing to the licensee or certificate holder. Upon a finding of probable cause that the conduct or continued service or practice of any individual certificate holder may create a danger to public health or safety, the executive director may temporarily suspend the certification prior to a hearing or notice: Provided, That the executive director may rely on information received from a physician that serves as a medical director in finding that probable cause exists to temporarily suspend the certification: Provided, however, That the executive director shall simultaneously institute proceedings for a hearing in accordance with section eleven of this article.

(e) The executive director may enter into a consent decree or hold a hearing for the suspension or revocation of the license or certification or the imposition of sanctions against the licensee or certificate holder.

(f) The executive director may issue subpoenas and subpoenas duces tecum to obtain testimony and documents to aid in the investigation of allegations against any person or agency regulated by the article.

(g) The executive director may sign a consent decree or other legal document related to the complaint.

(h) The executive director shall suspend or revoke any certificate, temporary certificate or license when he or she finds the holder has:

(1) Obtained a certificate, temporary certificate or license by means of fraud or deceit; or

(2) Been grossly incompetent, and/or grossly negligent as defined by the executive director in accordance with rules or by prevailing standards of emergency medical services care; or

(3) Failed or refused to comply with the provisions of this article or any legislative rule promulgated by the executive director or any order or final decision of the executive director; or

(4) Engaged in any act during the course of duty which has endangered or is likely to endanger the health, welfare or safety of the public.

(i) The executive director may, after notice and opportunity for hearing, deny or refuse to renew, suspend or revoke the license or certification of, impose probationary conditions upon or take disciplinary action against, any licensee or certificate holder for any violation of this article or any rule promulgated pursuant to this article, once a violation has been proven by a preponderance of the evidence.

(j) Disciplinary action may include:

(1) Reprimand;

(2) Probation;

(3) Administrative penalties and fines;

(4) Mandatory attendance at continuing education seminars or other training;

(5) Practicing under supervision or other restriction;

(6) Requiring the licensee or holder of a certificate to report to the executive director for periodic interviews for a specified period of time;

(7) Other disciplinary action considered by the executive director to be necessary to protect the public, including advising other parties whose legitimate interests may be at risk; or

(8) Other sanctions as set forth by legislative rule promulgated pursuant to this article.

(k) The executive director shall suspend or revoke any certificate, temporary certificate or license if he or she finds the existence of any grounds which would justify the denial of an application for the certificate, temporary certificate or license if application were then being made for it.

§15-5C-11. Procedures for hearing; right of appeal; judicial

review.

(a) Hearings are governed by the provisions of article five, chapter twenty-nine a of this code.

(b) The executive director may conduct the hearing or elect to have an administrative law judge conduct the hearing.

(c) If the hearing is conducted by an administrative law judge, the administrative law judge shall prepare a proposed written order at the conclusion of a hearing containing findings of fact and conclusions of law. The proposed order may contain proposed disciplinary actions if the executive director so directs. The executive director may accept, reject or modify the decision of the administrative law judge.

(d) The executive director has the authority to administer oaths, examine any person under oath and issue subpoenas and subpoenas duces tecum.

(e) If, after a hearing, the executive director determines that the licensee or holder of a certificate has violated any provision of this article or the legislative rules promulgated pursuant to this article, a formal written decision shall be prepared which contains findings of fact, conclusions of law and a specific description of the disciplinary actions imposed.

(f) The order of the Executive director is final unless vacated or modified upon judicial review.

(g) Any licensee or certificate holder adversely affected by a final order made and entered by the executive director is entitled to judicial review. All pertinent provisions of section four, article five, chapter twenty-nine-a of this code apply to and govern the review with like effect as if the provisions of the section were set forth herein.

(h) The judgment of the circuit court is final unless reversed, vacated or modified on appeal to the Supreme Court of Appeals in accordance with the provisions of section one, article six, chapter twenty-nine-a of this code.

§15-5C-12. Liability for cost of emergency medical service.

(a) Any patient who receives an emergency medical service and who is unable to give his or her consent to or contract for the service, whether or not he or she has agreed or consented to liability for the service, shall be liable in implied contract to the entity providing the emergency medical service for the cost thereof.

(b) Any person who receives an emergency medical service upon his or her request for the service shall be liable for the cost thereof.

§15-5C-13. Violations; criminal penalties.

(a) When, as a result of an investigation under this article or otherwise, the executive director has reason to believe that a licensee or certificate holder has committed a criminal offense, the executive director may bring the information to the attention of an appropriate law-enforcement official.

(b) Any person who violates any law or rule or operates an ambulance with an insufficient number of emergency medical service personnel aboard when not lawfully permitted to do so, or who represents himself or herself as a certified emergency medical service personnel knowing the representation to be untrue, is guilty of a misdemeanor and, upon conviction thereof, shall be fined not less than $100 nor more than $5,000.

§15-5C-14. Actions to enjoin violations; injunctive relief.

(a) Whenever it appears to the executive director that any person has been or is violating or is about to violate any provision of this article or any final order of the executive director, the executive director may apply in the name of the state, to the circuit court of the county in which the violation or any part thereof has occurred, is occurring or is about to occur, for an injunction against the person and any other persons who have been, are or are about to be, involved in, or in any way participating in, any practices, acts or omissions, so in violation, enjoining the person or persons from any such violation. The application may be made and prosecuted to conclusion whether or not any such violation has resulted or shall result in prosecution or conviction under the provisions of section twelve of this article.

(b) Upon application by the executive director, the circuit courts of this state may by mandatory or prohibitory injunction compel compliance with the provisions of this article and all final orders of the executive director.

(c) The circuit court may issue a temporary injunction in any case pending a decision on the merits of any application filed.

(d) The judgment of the circuit court upon any application permitted by the provisions of this section shall be final unless reversed, vacated or modified on appeal to the supreme court ofappeals. Any such appeal shall be sought in the manner and within the time provided by law for appeals from circuit courts in other civil cases.

§15-5C-15. Services that may be performed by emergency medical

service personnel.

(a) Notwithstanding any other provision of law, emergency medical service personnel may provide the services as determined by the executive director by legislative rule pursuant to the provisions of article three, chapter twenty-nine-a of this code. Legislative rules governing provision of these services in a hospital emergency room setting shall be developed by the executive director and shall include provisions allowing paramedics to function under the direct supervision of a registered professional nurse in a hospital emergency room setting. Any rule so promulgated shall provide that paramedics are under the jurisdiction of the executive director. The West Virginia Board of Registered Professional Nurses may propose legislative rules, pursuant to article three, chapter twenty-nine-a of the code relating to the scope of practice for nurses as those practices relates to overseeing these paramedics.

(b) The provisions of this section and any rules promulgated thereunder may not be construed to alter in any manner the duties, role or responsibilities of attending physicians regarding the providing and oversight of patient care.

§15-5C-16. Powers of emergency medical service attendants,

emergency medical technicians-basic and emergency

medical technicians-paramedic during emergency

communications failures and disasters.

(a) In the event of a communications failure between the certified emergency medical service personnel and the physician during an emergency situation, the certified emergency medical service personnel is authorized to deliver the services as authorized in section fifteen of this article.

(b) In the event of a disaster or other occurrence which renders the communication system ineffective for purposes of adequate individual direction between the physician and the certified emergency medical service personnel, the emergency medical service personnel may perform the services as authorized by section fifteen and may release immediate control of the patient to any other emergency medical service personnel in order to provide immediate services to other patients affected by the disaster or other occurrence.

(c) In the event that services are provided under subsection (a) or (b) of this section, the emergency medical service personnel shall, within five days, provide a report to the executive director, on the forms prescribed by him or her, of the services performed, the identity of the patient and the circumstances justifying the provision of the services. The executive director may require any other information deemed necessary.

§15-5C-17. Limitation of liability; mandatory errors and omissions

insurance.

(a) Every person, corporation, ambulance service, emergency medical service provider, emergency ambulance authority, emergency ambulance service or other person which employs emergency medical service personnel with or without wages for ambulance service or provides ambulance service in any manner, shall obtain a policy of insurance insuring the person or entity and every employee, agent or servant, against loss from the liability imposed by law for damages arising from any error or omission in the provision of emergency medical services as described in this article, in an amount no less than $1 million per incident.

(b) No emergency medical service personnel or emergency medical service provider is liable for civil damages or injuries in excess of the amounts for which the person or entity is actually insured, unless the damages or injuries are intentionally or maliciously inflicted.

(c) Every person or entity required by this section to obtain a policy of insurance shall furnish proof of the existence of the policy to the executive director on or before January 1 of each calendar year.

(d) Any person or entity that fails to secure a policy of insurance before providing emergency medical services is not entitled to the limited liability created by subsection (b) of this section: Provided, That any physician who gives instructions to emergency medical service personnel without being compensated, or who treats any patient transported in an ambulance or treats any patient prior to the transport, without being compensated, is entitled to the limited liability provided in subsection (b) of this section.

§15-5C-18. Limitation of liability for failure to obtain consent.

(a) No emergency medical service personnel may be subject to civil liability, based solely upon failure to obtain consent in rendering emergency medical services to any individual regardless of age where the patient is unable to give his or her consent for any reason, including minority, and where there is no other person reasonably available who is legally authorized to consent to the providing of such care or who is legally authorized to refuse to consent to the providing of such care.

(b) Nothing in this article may be construed to require medical treatment or transportation for any adult in contravention of his or her stated objection thereto upon religious grounds or pursuant to any living will or do not resuscitate orders: Provided, That the emergency medical service provider is actually aware of the living will or do not resuscitate order.

§15-5C-19. Authority of emergency medical service personnel in

charge of emergency medical services.

(a) When any department, agency or entity which provides emergency medical services under the authority of this article is responding to, operating at or returning from an emergency medical service, any emergency medical service personnel serving in the capacity of an emergency medical service line officer in charge shall control and direct the providing of emergency medical services. The emergency medical service personnel serving in the capacity of an emergency medical service line officer shall determine whether a patient shall be transported from the emergency scene, determine what care shall be rendered prior to the transport, determine the appropriate facility to which the patient shall be transported, and otherwise fully direct and control the providing of emergency medical services and patient care under the direction of medical command.

(b) Nothing in in this section may be construed to restrict or interfere with the authority of a fire officer in charge to supervise or direct those fire department personnel under his or her command or to restrict any person from entering a hazardous area for which the fire officer has assumed the responsibility.

§15-5C-20. Obstructing or causing bodily injury to emergency

medical service personnel; criminal penalties.

(a) It is unlawful for any person to intentionally obstruct or interfere with any emergency medical service agency personnel engaged in the act of delivering or administering emergency medical services. Any person violating the provisions of this subsection is guilty of a misdemeanor and, upon conviction thereof, shall be fined not more than one thousand dollars or confined in the county or regional jail for a period not more than one year, or both fined and confined.

(b) It is unlawful for any person to willfully cause bodily injury to any person designated to be an emergency medical personnel engaged in the act of delivering or administering emergency medical services. Any person violating the provisions of this subsection is guilty of a felony and, upon conviction thereof, shall be confined in a state correctional facility not less than one nor more than ten years or fined not more than five thousand dollars, or both fined and confined.

(c) Nothing in this section may be construed to prevent law-enforcement officials from controlling traffic and otherwise maintaining order at the scene of an accident, injury or illness where an emergency medical service agency is rendering services.

(d) No person may willfully fail or refuse to comply with a lawful order or direction of any emergency medical service agency personnel engaged in the act of delivering or administering emergency medical services, relating to directing, controlling or regulating traffic, so long as such order or direction is conveyed by a retro-reflective hand signing device. Any person violating the provisions of this subsection is guilty of a misdemeanor and, upon conviction thereof: (1) For a first offense shall be fined not more than one hundred dollars; (2) for a second offense occurring within one year of a previous conviction shall be fined not more than two hundred dollars; and (3) for a third and subsequent offense shall be fined not more than five hundred dollars.

§15-5C-21. Service reciprocity agreements for mutual aid.

(a) Any persons or entities providing lawful emergency medical services under the provisions of this article are hereby authorized in their discretion to enter into and renew service reciprocity agreements, for any period as they may deem advisable, with the appropriate emergency medical service providers, county, municipal or other governmental units or in counties contiguous to the state of West Virginia, in the state of Ohio, the commonwealth of Pennsylvania, the state of Maryland, the commonwealth of Virginia or the commonwealth of Kentucky, in order to establish and carry into effect a plan to provide mutual aid across state lines, through the furnishing of properly certified personnel and equipment for the provision of emergency medical services in this state and the counties contiguous to this state upon written approval by the executive director.

(b) No person or entity may enter into any such agreement unless the agreement provides that each of the parties to the agreement shall waive any and all claims against the other parties thereto, which may arise out of their activities outside of their respective jurisdictions under the agreement and shall indemnify and save harmless the other parties to the agreement from all claims by third parties for property damages or personal injuries which may arise out of the activities of the other parties to the agreementoutside their respective jurisdictions under the agreement.

(c) The executive director is hereby authorized to enter into service reciprocity agreements with appropriate officials in other states for the purpose of providing emergency medical services to the citizens of this state by emergency medical service personnel properly certified in their respective state or states. A formal agreement between the executive director and an authorized official of another state shall be in effect prior to the service being provided. Individual certification of other state emergency medical service personnel is not required for purposes of providing services to West Virginia citizens following the creation of the agreement by the responsible officials.

§15-5C-22. Restriction for provision of emergency medical services

by out-of-state emergency medical service personnel

or providers of emergency medical services.

The executive director may issue an order on his or her own motion upon written request of any emergency medical service provider or county commission in this state, to restrict an out-of-state provider of emergency medical services or an out-of-state emergency medical service personnel to a particular geographic area of thi state or prohibit the provider or personnel from providing emergency medical services within the borders of this state when in the opinion of the executive director the services are not required or do not meet the standards set forth herein or those established by rules as authorized by this article.

§15-5C-23. Transportation of unconscious or otherwise

uncommunicative patients.

(a) Emergency medical service personnel shall transport critically ill or injured, unconscious or otherwise uncommunicative patients to the medical facility designated by the medical command physician.

(b) No person may have the right to direct emergency medical service personnel to transport a patient to a specific medical facility unless the person is the legal guardian, parent of a minor or has power of attorney for the critically injured or ill patient.

§15-5C-24. Authority of the executive director to promulgate rapid

response rules relating to fire departments.

In addition to the rules promulgated pursuant to subsection (c), section four of this article, the executive director shall propose for promulgation a legislative rule regulating fire department rapid response services, pursuant to article three, chapter twenty-nine-a of this code, which: (1) Establishes licensure and certification requirements for fire department rapid response services who do not charge for their services or transport patients; (2) incorporates necessary applicable emergency medical services requirements for licensure for "emergency medical services" as the requirements apply to fire departments and as defined in subsection (c), section three of this article; and (3) creates an exemption from license and inspection fees for fire departments that do not charge fees for their services and which authorizes such fire departments to conduct self inspections of their emergency vehicles in accordance with any applicable state or federal requirements for emergency medical service vehicles.”