Paramedic Model Disciplinary Orders

1 1 2 3 4 5 6 7 8 9 RECOMMENDED GUIDELINES FOR 10 DISCIPLINARY ORDERS AND 11 CONDITIONS OF PROBATION 12 13 JULY 26, 2008 14

16 17 18 19 20 21 22 23 24 25 26 1 EMERGENCY MEDICAL SERVICES AUTHORITY 2 RECOMMENDED GUIDELINES FOR DISCIPLINARY ORDERS 3 AND CONDITIONS OF PROBATION 4 5 6 1 TABLE of CONTENTS 2 3Section No. and Subject Page 4 5I. Foreword 1 6 7II. Disciplinary Consideration Factors 1 8 9III. Violations and Recommended Disciplinary Actions 2 10 11 A. Administrative Fines 3 12 13 B. Denial, Probation, Suspension, Revocation 4 14 15 Fraud in the Procurement of Any License or Certificate 5 16 17 Gross Negligence 5 18 19 Repeated Negligent Acts 5 20 21 Incompetence 5 22 23 Commission of Any Fraudulent, Dishonest, or Corrupt Act 6 24 25 Conviction of Any Crime 6 26 27 Violating, Attempting to Violate, or Abetting Violation of this Statute 6 28 29 Violating, Attempting to Violate, or Abetting Violation of Statutes 30 Regulating Narcotics, Dangerous Drugs or Controlled Substances 6 31 32 Addiction to, Excessive Use of, or Misuse of Alcoholic Beverages, 33 Narcotics, Dangerous Drugs, or Controlled Substances 7 34 35 Functioning Outside the Supervision of Medical Control 7 36 37 Irrational Behavior or Physical/Mental Disability which Impairs the 38 Paramedic’s Abilities 7 39

7 - i - 1 EMERGENCY MEDICAL SERVICES AUTHORITY 2 RECOMMENDED GUIDELINES FOR DISCIPLINARY ORDERS 3 AND CONDITIONS OF PROBATION 4 5 6 1 Unprofessional Conduct 8 2 3IV. Detoxification/Diversion Program Criteria 9 4 5V. Mitigating Evidence 9 6 7VI. Language for Model Disciplinary Orders 10 8 9 Standard Revocation Orders 10 10 11 Standard Stay Order 11 12 13 Standard Fine Order 11 14 15 Standard Suspension Orders 11 16 17 Standard Conditions of Probation 12 18 19 Standard Conditions 12 20 #1- Probation Compliance 12 21 #2- Personal Appearances 12 22 #3- Quarterly Report Requirements 12 23 #4- Employment Notification 12 24 #5- Notification of Termination 13 25 #6- Functioning as a Paramedic 13 26 #7- Obey All Related Laws 13 27 #8- Completion of Probation 14 28 #9- Violation of Probation 14 29 30 Optional Conditions of Probation 14 31 #1- Abstinence from Drug Possession and Use 14 32 #2- Abstinence from the Use of Alcoholic Beverages 15 33 #3- Biological Fluid Testing 15 34 #4- Drug/Detoxification/Diversion Program 15 35 #5- Educational Course Work 16 36 #6- Ethical Practice of EMS 16 37 #7- Stress/Anger Management 16 38 #8- Practical Skills Examination 16 39 #9- Oral Skills Examination 17

7 - ii - 1 EMERGENCY MEDICAL SERVICES AUTHORITY 2 RECOMMENDED GUIDELINES FOR DISCIPLINARY ORDERS 3 AND CONDITIONS OF PROBATION 4 5 6 1 #10- Psychiatric/Medical Evaluation 17 2 #11- Performance Improvement Plan 18 3 4VII. Review Board 19 5 6

7 - iii - 1 EMERGENCY MEDICAL SERVICES AUTHORITY 2 RECOMMENDED GUIDELINES FOR DISCIPLINARY ORDERS 3 AND CONDITIONS OF PROBATION 4 5 1 2 Section I: FOREWORD 3The following Model Disciplinary Orders have been developed by the Emergency 4Medical Services Authority (EMSA) in consultation with EMS (Emergency Medical 5Services) constituent groups from across the state. The purpose of the Model 6Disciplinary Orders is to provide a consistent and equitable discipline in cases dealing 7with violations of the Health and Safety Code, Division 2.5, Section 1798.200. 8 9The EMSA shall use this document as a standard in settling disciplinary matters when a 10respondent wishes to resolve the allegations through a negotiated settlement. 11However, the settlement may be on any terms the parties determine are appropriate 12pursuant to Section 11415.60 of the California Administrative Procedure Act. 13 14Should the respondent invoke his/her privilege to contest the allegations through the 15Administrative Procedure Act, the administrative law judge shall use this document as a 16guide in making his/her recommendations for discipline (if needed) to the EMSA. 17The respondent shall be allowed representation of his/her choice through all processes 18of the investigation, filing of an accusation, negotiation of a settlement, and during an 19administrative hearing pursuant to the California Administrative Procedure Act 20(Government Code, Title 2, Division 3, Part 1). Any such representation shall be at the 21respondent’s expense. 22 23 Section II: DISCIPLINARY CONSIDERATION FACTORS 24The following factors shall be considered when determining the appropriate discipline: 25 26 1. Nature and severity of the act(s), offense(s), or crime(s) under 27 consideration; 28 2. Actual or potential harm to the public; 29 3. Actual or potential harm to any patient; 30 4. Prior disciplinary record; 31 5. Prior warnings on record or prior remediation; 32 6. Number and/or variety of current violations; 33 7. Aggravating evidence; 34 8. Mitigating evidence; 35 9. Any discipline imposed by the paramedic's employer for the same 36 occurrence of that conduct; 37 10. Rehabilitation evidence; 38 11. In case of a criminal conviction, compliance with terms of the sentence 39 and/or court-ordered probation;

6 7 - 1 - 1 EMERGENCY MEDICAL SERVICES AUTHORITY 2 RECOMMENDED GUIDELINES FOR DISCIPLINARY ORDERS 3 AND CONDITIONS OF PROBATION 4 5 1 12. Overall criminal record; 2 13. Time that has elapsed since the act(s) or offense(s) occurred; 3 14. If applicable, evidence of expungement proceedings pursuant to Penal 4 Code 1203.4. 5 6 Section III: VIOLATIONS and RECOMMENDED DISCIPLINARY ACTIONS 7Health & Safety Code Section 1798.200 specifies the offenses for which the EMSA may 8take disciplinary action against a paramedic. When filing an accusation, EMSA may also 9cite additional related statutes and regulations as a basis for discipline. 10 11These disciplinary guidelines provide progressive discipline, unless the facts and 12circumstances of a particular case warrant more substantive discipline. A fine is 13considered the least intrusive discipline that can be imposed followed by probation, 14suspension, and then revocation. 15 16In determining the appropriate discipline, the EMSA or an administrative law judge shall 17give credit for discipline imposed by the employer and for any immediate suspension 18imposed by the local EMS agency for the same conduct, pursuant to Section 1798.211. 19 20The recommended discipline should be imposed in the absence of any aggravating or 21mitigating evidence. The administrative law judge may propose any discipline between 22the minimum discipline and maximum discipline for a particular violation. When the 23administrative law judge recommends discipline that is less than the minimum or which 24exceeds the maximum, a full explanation shall be included as to the nature of the act 25that warrants unusual consideration. The director of the EMSA has the final 26determination as to the discipline to be imposed. 27 28Section 1798.210 allows EMSA to impose an administrative fine of up to two thousand 29five hundred dollars ($2,500) per violation on any licensed paramedic found to have 30committed any of the actions described by subdivision (c) of Section 1798.200 that did 31not result in actual harm to a patient. Fines may not be imposed if a paramedic has 32previously been disciplined by the authority for any other act committed within the 33immediately preceding five-year period. 34 35The administrative fine shall not be imposed in conjunction with a suspension for the 36same violation, but may be imposed in conjunction with probation for the same violation 37except when the conditions of the probation require a paramedic's personal time or 38expense for training, clinical observation, or related corrective instruction. 39

6 7 - 2 - 1 EMERGENCY MEDICAL SERVICES AUTHORITY 2 RECOMMENDED GUIDELINES FOR DISCIPLINARY ORDERS 3 AND CONDITIONS OF PROBATION 4 5 1Disciplinary options include the following: 2 3 1. Administrative Fine of up to $2,500 per violation- provided the violation did not 4 result in actual harm to the patient and the paramedic had not been 5 disciplined by the authority for any other act committed within the immediately 6 preceding five-year period 7 2. Denial 8 3. Probation 9 4. Suspension 10 5. Revocation 11 12A. Administrative Fines 13 14For a minor offense that did not result in actual harm to a patient, EMSA may assess a 15fine only, or may assess a fine in conjunction with probation. 16 17In assessing the fine, the authority shall give due consideration to the appropriateness 18of the fine with respect to factors that include the gravity of the violation, the good faith 19of the paramedic, the history of previous violations, any discipline imposed by the 20paramedic’s employer for the same occurrence of that conduct and the totality of the 21discipline to be imposed. 22 23The fines shall be assessed in the amount as specified below, for the following 24violations of the Health and Safety Code: 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39

6 7 - 3 - 1 EMERGENCY MEDICAL SERVICES AUTHORITY 2 RECOMMENDED GUIDELINES FOR DISCIPLINARY ORDERS 3 AND CONDITIONS OF PROBATION 4 5 Minimum Maximum Violation $2,000 $2,500 Health and Safety Code 1798.200 (c)(1), Fraud in the procurement of any certificate or license under this division. $500 $2,500 Health and Safety Code 1798.200(c)(3), Repeated negligent acts. $1,000 $2,500 Health and Safety Code 1798.200 (c)(5), The commission of any fraudulent, dishonest, or corrupt act which is substantially related to the qualifications, functions, and duties of prehospital personnel. $1,000 $2,500 Health and Safety Code 1798.200 (c)(7), Violating or attempting to violate directly or indirectly, or assisting in or abetting the violation of, or conspiring to violate, any provision of this division or the regulations adopted by the authority pertaining to prehospital personnel. $1,000 $2,500 Health and Safety Code 1798.200 (c)(8), Violating or attempting to violate any federal or state statute or regulation which regulates narcotics, dangerous drugs, or controlled substances. $250 $2,500 Health and Safety Code 1798.200 (c)(10), Functioning outside the supervision of medical control in the field care system operating at the local level, except as authorized by any other license or certification. $500 $2,500 Health and Safety Code 1798.200 (c)(12), Unprofessional Conduct - The failure to maintain confidentiality of patient medical information, except as disclosure is otherwise permitted or required by law in Sections 56 and 56.6, inclusive of the Civil Code. 1 2 3Fines shall be paid within 60 days from the date of the EMSA’s notice of administrative 4fine, unless the respondent has demonstrated a financial hardship and has entered into 5a formal agreement with EMSA to pay the fine within one year from the date of the 6EMSA’s notice of administrative fine. 7 8B. Denial, Probation, Suspension, Revocation 9 10When used below, the numbers following the "Minimum Conditions of Probation" refer 11to the Optional Conditions of Probation in Section VI. These conditions may vary 12according to the nature and circumstances of the offense. 6 7 - 4 - 1 EMERGENCY MEDICAL SERVICES AUTHORITY 2 RECOMMENDED GUIDELINES FOR DISCIPLINARY ORDERS 3 AND CONDITIONS OF PROBATION 4 5 1 21. Fraud in the procurement of any certificate or license under this division. 3 # Maximum Discipline: Revocation or denial. 4 # Recommended Discipline: Revocation or denial. 5 # Minimum Discipline: Revocation stayed, and 60 day suspension/denial. 6 72. Gross negligence - An extreme departure from the standard of care which, 8 under similar circumstances would have ordinarily been exercised by a 9 reasonable and prudent person trained and acting in a similar capacity while 10 engaged in the performance of his or her duties if confronted with a similar 11 circumstance. 12 # Maximum Discipline: Revocation 13 # Recommended Discipline: Revocation stayed, 60 day suspension, and 3 years 14 probation with terms and conditions. 15 # Minimum Discipline: Revocation stayed, and 3 years probation with terms and 16 conditions. 17 # Minimum Conditions of Probation: All Standard Conditions and Optional 18 Conditions: 5, 8, 9 and 11. 19 203. Repeated negligent acts - A repeated failure to use such care as a reasonable 21 and prudent person trained and acting in a similar capacity while engaged in the 22 performance of his or her duties would use if confronted with a similar 23 circumstance. 24 25 # Maximum Discipline: Revocation 26 # Recommended Discipline: Revocation stayed, 30 day suspension, and 3 years 27 probation with terms and conditions. 28 # Minimum Discipline: Revocation stayed, and 1 year probation with terms and 29 conditions. 30 # Minimum Conditions of Probation: All Standard Conditions and Optional 31 Conditions: 5, 8, 9 and 11. 32 334. Incompetence - The lack of possession of that degree of knowledge, skill, and 34 ability ordinarily possessed and exercised by a licensed and accredited 35 paramedic. 36 # Maximum Discipline: Revocation 37 # Recommended Discipline: Revocation stayed, 30 day suspension, and 3 years 38 probation with terms and conditions. 6 7 - 5 - 1 EMERGENCY MEDICAL SERVICES AUTHORITY 2 RECOMMENDED GUIDELINES FOR DISCIPLINARY ORDERS 3 AND CONDITIONS OF PROBATION 4 5 1 # Minimum Discipline: Revocation stayed, and 1 year probation with terms and 2 conditions. 3 # Minimum Conditions of Probation: All Standard Conditions and Optional 4 Conditions: 5, 8, 9 and 11. 5 65. The commission of any fraudulent, dishonest, or corrupt act which is 7 substantially related to the qualifications, functions, and duties of 8 prehospital personnel. 9 # Maximum Discipline: Revocation. 10 # Recommended Discipline: Revocation stayed, 60 day suspension, and 3 years 11 probation with terms and conditions. 12 # Minimum Discipline: Revocation stayed, and 3 years probation with terms and 13 conditions. 14 # Minimum Conditions of Probation: All Standard Conditions and Optional 15 Condition: 6 16 176. Conviction of any crime which is substantially related to the qualifications, 18 functions, and duties of prehospital personnel. The record of conviction or 19 certified copy of the record shall be conclusive evidence of such 20 conviction. 21 # Maximum Discipline: Revocation. 22 # Recommended Discipline: Variable depending on the nature of the crime with 23 terms and conditions. 24 # Minimum Discipline: Revocation stayed, and 1 year probation with terms and 25 conditions. 26 # Minimum Conditions of Probation: All Standard Conditions. 27 287. Violating or attempting to violate directly or indirectly, or assisting in or 29 abetting the violation of, or conspiring to violate, any provision of this 30 division or the regulations adopted by the authority pertaining to 31 prehospital personnel. 32 # Maximum Discipline: Revocation 33 # Recommended Discipline: Revocation stayed, 60 day suspension, and 3 years 34 probation with terms and conditions. 35 # Minimum Discipline: Revocation stayed, and 3 years probation with terms and 36 conditions. 37 # Minimum Conditions of Probation: All Standard Conditions and Optional 38 Condition: 6. 6 7 - 6 - 1 EMERGENCY MEDICAL SERVICES AUTHORITY 2 RECOMMENDED GUIDELINES FOR DISCIPLINARY ORDERS 3 AND CONDITIONS OF PROBATION 4 5 1 2 38. Violating or attempting to violate any federal or state statute or regulation 4 which regulates narcotics, dangerous drugs, or controlled substances. 5 # Maximum Discipline: Revocation 6 # Recommended Discipline: Revocation stayed, 60 day suspension, and 3 years 7 probation with terms and conditions. 8 # Minimum Discipline: Revocation stayed, and 3 years probation with terms and 9 conditions. 10 # Minimum Conditions of Probation: All Standard Conditions and Optional 11 Conditions: 1, 2, 3, 4, and 10. 12 139. Addiction to the excessive use of, or the misuse of, alcoholic beverages, 14 narcotics, dangerous drugs, or controlled substances. 15 # Maximum Discipline: Revocation 16 # Recommended Discipline: Revocation stayed, suspension until assessment 17 and successful completion of drug/alcohol detoxification diversion program, 18 and 5 years probation with terms and conditions. 19 # Minimum Discipline: Revocation stayed, and 3 years probation with terms and 20 conditions. 21 # Minimum Conditions of Probation: All Standard Conditions and Optional 22 Conditions: 1, 2, 3, 4, and 10. 23 2410. Functioning outside the supervision of medical control in the field care 25 system operating at the local level, except as authorized by any other 26 license or certification. 27 # Maximum Discipline: Revocation 28 # Recommended Discipline: Revocation stayed, 15 day suspension, and 1 year 29 probation with terms and conditions. 30 # Minimum Discipline: Revocation stayed, and 1 year probation with terms and 31 conditions. 32 # Minimum Conditions of Probation: All Standard Conditions and Optional 33 Conditions: 5 and 8. 34 3511. Demonstration of irrational behavior or occurrence of a physical disability 36 to the extent that a reasonable and prudent person would have reasonable 37 cause to believe that the ability to perform the duties normally expected 38 may be impaired. 6 7 - 7 - 1 EMERGENCY MEDICAL SERVICES AUTHORITY 2 RECOMMENDED GUIDELINES FOR DISCIPLINARY ORDERS 3 AND CONDITIONS OF PROBATION 4 5 1 # Maximum Discipline: Revocation 2 # Recommended Discipline: Revocation stayed, and suspension until resolution 3 of the physical or mental disability. 4 # Minimum Discipline: Revocation stayed, and 1 year probation with terms and 5 conditions. 6 # Minimum Conditions of Probation: All Standard Conditions and Optional 7 Conditions: 8, 9, and 10. 8 912. Unprofessional Conduct- 10 (A) The mistreatment or physical abuse of any patient resulting from force 11 in excess of what a reasonable and prudent person trained and acting 12 in a similar capacity while engaged in the performance of his or her 13 duties would use if confronted with a similar circumstance. Nothing in 14 this section shall be deemed to prohibit an EMT-I, EMT-II, or EMT-P from 15 assisting a peace officer, or a peace officer who is acting in the dual 16 capacity of peace officer and EMT-I, EMT-II, or EMT-P, from using that 17 force that is reasonably necessary to effect a lawful arrest or detention. 18  Maximum Discipline: Revocation/Denial 19 # Recommended Discipline: Revocation stayed, 60 day suspension, and 3 years 20 probation with terms and conditions. 21  Minimum Discipline: Revocation stayed, and 3 years probation with terms and 22 conditions. 23 # Minimum Conditions of Probation: All Standard Conditions and Optional 24 Conditions: 7 and 10. 25 26 (B) The failure to maintain confidentiality of patient medical information, 27 except as disclosure is otherwise permitted or required by law in Sections 28 56 and 56.6, inclusive of the Civil Code. 29  Maximum Discipline: Revocation/Denial 30 # Recommended Discipline: Revocation stayed, 30 day suspension, and 1 year 31 probation with terms and conditions. 32  Minimum Discipline: Revocation stayed and 1 year probation with terms and 33 conditions. 34 # Minimum Conditions of Probation: All Standard Conditions and Optional 35 Conditions: 6 and 9. 36 37 (C) The commission of any sexually related offense specified under 38 Section 290 of the Penal Code. 39  Maximum Discipline: Revocation/ Denial 6 7 - 8 - 1 EMERGENCY MEDICAL SERVICES AUTHORITY 2 RECOMMENDED GUIDELINES FOR DISCIPLINARY ORDERS 3 AND CONDITIONS OF PROBATION 4 5 1  Recommended Discipline: Revocation/Denial 2  Minimum Discipline: Revocation/Denial 3 4 Section IV: DETOXIFICATION/DIVERSION PROGRAM CRITERIA 5The criteria to be considered in determining rehabilitation for alcohol/drug abuse 6offenses include, but are not limited to: 7 8 Successful completion of a drug/alcohol treatment program (a minimum of 6 months 9 duration). The treatment program may be a combined in-patient/out-patient and 10 aftercare program. The program shall include at least the following elements: 11 12 1. Chemical-free treatment philosophy; 13 2. Individual and/or group counseling; 14 3. Random, documented biological fluid testing; 15 4. Participation in support groups; 16 5. Education about addictive disease; 17 6. Adherence to a 12-step recovery program philosophy or equivalent; 18 7. Written documentation of participation in a 12-step recovery group or 19 equivalent. 20 21 Employment with a pre-hospital care provider, for a minimum of six (6) months, with 22 documentation from the employer that the employer was aware of the previous drug 23 or alcohol abuse problems. The documentation must substantiate that while 24 employed, there was no evidence of continued alcohol or drug use and that the 25 respondent performed paramedic functions in a safe and competent manner. 26 27 If the respondent is seeking reinstatement of his/her license, employment for a 28 minimum of six (6) months with documentation from the employer that while 29 employed, there was no evidence of alcohol or drug use. 30 31 A minimum of one (1) year must have elapsed between the time of the second 32 offense and the effective date of the prior order. 33 34 Section V: MITIGATING EVIDENCE 35The respondent is permitted to present mitigating circumstances at a hearing. The same 36opportunity is provided in the settlement process. 37 38The following documents are examples of appropriate evidence the respondent may 39submit to demonstrate his/her rehabilitative efforts and competency:

6 7 - 9 - 1 EMERGENCY MEDICAL SERVICES AUTHORITY 2 RECOMMENDED GUIDELINES FOR DISCIPLINARY ORDERS 3 AND CONDITIONS OF PROBATION 4 5 1 2 A. Dated written statements from persons in positions of authority who have on- 3 the-job knowledge of the respondent's current paramedic competence. Each 4 statement should include the period of time and capacity in which the person 5 worked with the respondent and should contain the following sentence at the 6 end: "I declare, under penalty of perjury, under the laws of the State of 7 California, that the foregoing is true and correct to the best of my 8 knowledge." The statement should be signed and dated by the person 9 making the statement; 10 11 B. Dated letters from counselors regarding the respondent's participation in a 12 rehabilitation or recovery program, where appropriate. The letters should 13 include a description of the program, the number of sessions that the 14 respondent has attended, the counselor's diagnosis of the respondent's 15 condition, the respondent's prognosis for recovery, the respondent's current 16 state of rehabilitation (or improvement), the counselor's basis for determining 17 improvement, and the credentials of the counselor; 18 19 C. Dated letters describing the respondent's participation in support groups; 20 21 D. Dated laboratory analyses or drug screen reports, where appropriate; 22 23 E. Dated performance evaluation(s) from the respondent's employer; 24 25 F. Dated physical examination or assessment report by a licensed physician; 26 27 G. Certificates or transcripts of courses related to paramedic duties that the 28 respondent might have completed since the date of the violation. A 29 paramedic whose license has been revoked does not possess a 30 paramedic license. Therefore, the individual cannot use his/her former 31 license number to obtain continuing education credit/hours or for any 32 other purpose. However, he or she may take continuing education 33 courses so long as a paramedic license is not used. 34 35 H. Evidence of community service or other educational experiences. 36 37 Section VI: LANGUAGE FOR MODEL DISCIPLINARY ORDERS 38

6 7 - 10 - 1 EMERGENCY MEDICAL SERVICES AUTHORITY 2 RECOMMENDED GUIDELINES FOR DISCIPLINARY ORDERS 3 AND CONDITIONS OF PROBATION 4 5 1Standard Revocation Orders 2 3 Revocation - Single Cause: 4 License Number issued to the respondent, , is 5 revoked. 6 7Revocation - Multiple Causes: 8 License Number issued to the respondent, , is 9 revoked pursuant to legal conclusions: , jointly and separately. 10 11Standard Stay Order 12 13 Standard Stay Order: 14 However, such revocation is stayed and the respondent is placed on probation 15 for year(s) upon the following terms and conditions: 16 17 (List of terms and conditions.) 18 19Standard Fine Order 20 21 An administrative fine of $______is imposed on the respondent,______, 22 License Number______for______. 23Standard Suspension Orders 24 25Suspension - Single Cause: 26 License Number issued to the respondent, , 27 is suspended for . 28 29 Suspension - Multiple Causes: (Concurrent) 30 License Number issued to the respondent, , 31 is suspended for pursuant to legal conclusions: , jointly 32 and separately. All suspensions shall run concurrently. 33 34 Suspension - Multiple Causes: (Consecutive) 35 License Number issued to the respondent, , 36 is suspended for pursuant to legal conclusions: , jointly 37 and separately. All suspensions shall run consecutively. 38 39

6 7 - 11 - 1 EMERGENCY MEDICAL SERVICES AUTHORITY 2 RECOMMENDED GUIDELINES FOR DISCIPLINARY ORDERS 3 AND CONDITIONS OF PROBATION 4 5 1 2 3Standard Conditions of Probation 4It is the responsibility of the EMSA to monitor paramedics placed on probation 5consistent with the terms and conditions of the probationary order. 6 71. Probation Compliance: 8 The respondent shall fully comply with all terms and conditions of the 9 probationary order. The respondent shall fully cooperate with the EMSA in its 10 monitoring, investigation, and evaluation of the respondent's compliance with the 11 terms and conditions of his/her probationary order. 12 13 The respondent shall immediately execute and submit to the EMSA all Release 14 of Information forms that the EMSA may require of the respondent. 15 162. Personal Appearances: 17 As directed by the EMSA, the respondent shall appear in person for interviews, 18 meetings, and/or evaluations of the respondent's compliance with the terms and 19 conditions of the probationary order. The respondent shall be responsible for all 20 of his/her costs associated with this requirement. 21 223. Quarterly Report Requirements: 23 During the probationary period, the respondent shall submit quarterly reports 24 covering each calendar quarter which shall certify, under penalty of perjury, and 25 document compliance by the respondent with all the terms and conditions of 26 his/her probation. If the respondent submits his/her quarterly reports by mail, it 27 shall be sent as Certified Mail. 28 294. Employment Notification: 30 During the probationary period, the respondent shall notify the EMSA in writing of 31 any EMS employment. The respondent shall inform the EMSA in writing of the 32 name and address of any prospective EMS employer prior to accepting 33 employment. 34 35 Additionally, the respondent shall submit proof in writing to the EMSA of 36 disclosure, by the respondent, to the current and any prospective EMS employer 37 of the reasons for and terms and conditions of the respondent's probation. 38 39 The respondent authorizes any EMS employer to submit performance

6 7 - 12 - 1 EMERGENCY MEDICAL SERVICES AUTHORITY 2 RECOMMENDED GUIDELINES FOR DISCIPLINARY ORDERS 3 AND CONDITIONS OF PROBATION 4 5 1 evaluations and other reports which the EMSA may request that relate to the 2 qualifications, functions, and duties of prehospital personnel. 3 4 Any and all notifications to the EMSA shall be by certified mail. 5 65. Notification of Termination: 7 The respondent shall notify the EMSA within seventy-two (72) hours after 8 termination, for any reason, with his/her prehospital medical care employer. The 9 respondent must provide a full, detailed written explanation of the reasons for 10 and circumstances of his/her termination. 11 12 Any and all notifications to the EMSA shall be by certified mail. 13 146. Functioning as a Paramedic: 15 The period of probation shall not run anytime that the respondent is not practicing 16 as a paramedic within the jurisdiction of California. 17 18 If the respondent, during his/her probationary period, leaves the jurisdiction of 19 California to practice as a paramedic, the respondent must immediately notify the 20 EMSA, in writing, of the date of such departure and the date of return to 21 California, if the respondent returns. 22 23 Any and all notifications to the EMSA shall be by certified mail. 24 257. Obey All Related Laws: 26 The respondent shall obey all federal, state and local laws, statutes, regulations, 27 written policies, protocols and rules governing the practice of medical care as a 28 paramedic. The respondent shall not engage in any conduct that is grounds for 29 disciplinary action pursuant to Section 1798.200. To permit monitoring of 30 compliance with this term, if the respondent has not submitted fingerprints to the 31 EMSA in the past as a condition of licensure, then the respondent shall submit 32 his/her fingerprints by Live Scan or by fingerprint cards and pay the appropriate 33 fees within 45 days of the effective date of this decision. 34 35 Within 72 hours of being arrested, cited or criminally charged for any offense, the 36 respondent shall submit to the EMSA a full and detailed account of the 37 circumstances thereof. The EMSA shall determine the applicability of the 38 offense(s) as to whether the respondent violated any federal, state and local 39 laws, statutes, regulations, written policies, protocols and rules governing the

6 7 - 13 - 1 EMERGENCY MEDICAL SERVICES AUTHORITY 2 RECOMMENDED GUIDELINES FOR DISCIPLINARY ORDERS 3 AND CONDITIONS OF PROBATION 4 5 1 practice of medical care as a paramedic. 2 3 Any and all notifications to the EMSA shall be by certified mail. 4 58. Completion of Probation: 6 The respondent's license shall be fully restored upon successful completion 7 of probation. 8 99. Violation of Probation: 10 If during the period of probation the respondent fails to comply with any term of 11 probation, the EMSA may initiate action to terminate probation and implement 12 actual license suspension/revocation. Upon the initiation of such an action, or 13 the giving of a notice to the respondent of the intent to initiate such an action, the 14 period of probation shall remain in effect until such time as a decision on the 15 matter has been adopted by the EMSA. An action to terminate probation and 16 implement actual license suspension/revocation shall be initiated and conducted 17 pursuant to the hearing provisions of the California Administrative Procedure Act. 18 19 The issues to be resolved at the hearing shall be limited to whether the 20 respondent has violated any term of his/her probation sufficient to warrant 21 termination of probation and implementation of actual suspension/revocation. At 22 the hearing, the respondent and the EMSA shall be bound by the admissions 23 contained in the terms of probation and neither party shall have a right to litigate 24 the validity or invalidity of such admissions. 25 26Optional Conditions of Probation 27 281. Abstinence from Drug Possession and Use: 29 The respondent shall abstain from the possession, injection or consumption by 30 any route of all controlled substances, dangerous drugs, or any drugs requiring a 31 prescription unless prescribed under federal or state law as part of a documented 32 medical treatment. Within fourteen days of obtaining such a prescription, 33 respondent shall ensure that the prescribing professional provides the EMSA a 34 written report identifying the medication, dosage, the date the medication was 35 prescribed, the respondent’s diagnosis, and the date the medication will no 36 longer be required. This report must be provided to the EMSA directly by the 37 prescribing professional. 38 39 If the respondent has a lawful prescription when initially placed on probation, this

6 7 - 14 - 1 EMERGENCY MEDICAL SERVICES AUTHORITY 2 RECOMMENDED GUIDELINES FOR DISCIPLINARY ORDERS 3 AND CONDITIONS OF PROBATION 4 5 1 same report must be provided within fourteen days of the commencement of 2 probation. 3 4 Any and all notifications to the EMSA shall be by certified mail. 5 62. Abstinence from the Use of Alcoholic Beverages: 7 The respondent shall abstain from the use of alcoholic beverages. 8 93. Biological Fluid Testing: 10 The respondent shall submit to routine and random biological fluid testing or 11 drug/alcohol screening as directed by the EMSA or its designee. Respondent 12 may use a lab pre-approved by the EMSA or may provide to the EMSA the name 13 and location of an independent laboratory or licensed drug/alcohol testing facility 14 for approval by the EMSA. The EMSA shall have sole discretion for lab approval 15 based on criteria regulating professional laboratories and drug/alcohol testing 16 facilities. When the EMSA requests a random test, the respondent shall provide 17 the required blood/urine sample by the time specified, or within 12 hours of the 18 request if no time is specified. When the EMSA requests a random test, the 19 respondent shall ensure that any positive test results are conveyed telephonically 20 by the lab to the EMSA within 48 hours, and all written positive or negative 21 results are provided directly by the lab to the EMSA within 10 days. The 22 respondent shall be responsible for all costs associated with the drug/alcohol 23 screening. 24 25 At the EMSA’s sole discretion, the EMSA may allow the random drug testing to 26 be conducted by the respondent’s employer to meet the requirement of random 27 drug testing as set forth above. The results of the employer’s random drug 28 testing shall be made available to the EMSA in the time frames described above. 29 304. Drug/Detoxification/Diversion Program: 31 Within days of the effective date of this decision, the respondent shall enroll 32 and participate in a drug/detoxification/diversion program approved by the EMSA. 33 The respondent shall participate in the program until appropriate medical 34 supervision determines that further treatment and rehabilitation is no longer 35 necessary. 36 37 If the respondent voluntarily withdraws from the drug/detoxification/diversion 38 program or the respondent is expelled from the program, such withdrawal or 39 expulsion shall constitute a violation of probation by the respondent. The

6 7 - 15 - 1 EMERGENCY MEDICAL SERVICES AUTHORITY 2 RECOMMENDED GUIDELINES FOR DISCIPLINARY ORDERS 3 AND CONDITIONS OF PROBATION 4 5 1 respondent shall be responsible for all costs associated with such 2 drug/detoxification/diversion program. 3 4 5 5. Educational Course Work: 6 Within days of the effective date of this decision, the respondent shall 7 submit to the EMSA proof of completion of hours of education in areas 8 substantially related to the offense as stated in the accusation and to the 9 satisfaction of the EMSA. 10 Any educational program may include community service to reinforce the 11 learning objectives of the educational program. 12 13 All courses must be approved by the EMSA. Within thirty-five days after 14 completing the course work, the respondent shall submit evidence of 15 competency in the required education. Submittal of a certificate or letter from the 16 instructor attesting to the respondent’s competency shall suffice. 17 18 Any and all notifications to the EMSA shall be by certified mail. 19 20 6. Ethical Practice of EMS: 21 Within days of the effective date of this decision, the respondent shall 22 submit to the EMSA, for its prior approval, a course in Ethics. The respondent 23 must complete this course during his/her probation period. 24 25 Upon completion by the respondent of the Ethics course, the respondent shall 26 submit proof to the EMSA that he/she fulfilled all course requirements. 27 28 Any and all notifications to the EMSA shall be by certified mail. 29 30 7. Stress/Anger Management: 31 Within days of the effective date of this decision, the respondent shall enroll 32 and participate in a local, court approved, stress/anger management program, 33 which the respondent shall complete during his/her probation. Upon completion 34 of the approved program, the respondent shall submit proof to the EMSA that 35 he/she has fulfilled all course requirements. 36 37 Any and all notifications to the EMSA shall be by certified mail. 38 39 8. Practical Skills Examination:

6 7 - 16 - 1 EMERGENCY MEDICAL SERVICES AUTHORITY 2 RECOMMENDED GUIDELINES FOR DISCIPLINARY ORDERS 3 AND CONDITIONS OF PROBATION 4 5 1 Within ____ days of the effective date of this decision, the respondent shall 2 submit to and pass a skills examination in subjects substantially related to the 3 accusation based upon the U. S. Department of Transportation (DOT) and/or the 4 National Registry of Emergency Medical Technicians (NREMT) skills 5 examination, when applicable. If not addressed in the DOT or NREMT, an 6 approved local standard shall be identified and utilized. The skills examination 7 shall be administered by a board selected by the EMSA using the pre- 8 established criteria (See Section VII: Review Board for criteria). 9 10 If the respondent fails the examination, the respondent may function as a 11 paramedic only while under the direct supervision of a preceptor. The 12 respondent shall not be allowed to function as a sole paramedic until the 13 respondent passes the examination. The respondent has the option and right to 14 repeat the examination. There shall be at least a two-week period between 15 examinations. No more than three attempts to pass the examination shall be 16 allowed. If the respondent fails to pass the exam after three attempts, or 17 chooses not to retake the examination, the respondent’s license shall be 18 revoked. 19 20 9. Oral Skills Examination: 21 Within days of the effective date of this decision, the respondent 22 shall submit to and pass an oral exam in subjects substantially related to the 23 accusation. The oral exam shall be administered by an examination board 24 selected by the EMSA using pre-established criteria (See Section VII: Review 25 Board for criteria). 26 27 If the respondent fails the examination, the respondent may function as a 28 paramedic only while under the direct supervision of a preceptor. The 29 respondent shall not be allowed to function as a sole paramedic until the 30 respondent passes the examination. The respondent has the option and right to 31 repeat the examination. There shall be at least a two-week period between 32 examinations. No more than three attempts to pass the examination shall be 33 allowed. If the respondent fails to pass the exam after three attempts, or 34 chooses not to retake the examination, the respondent’s license shall be 35 revoked. 36 37 10. Psychiatric/Medical Evaluation: 38 Within days of the effective date of this decision, and on a periodic basis as 39 specified by a psychiatrist certified by the American Board of Psychiatry and

6 7 - 17 - 1 EMERGENCY MEDICAL SERVICES AUTHORITY 2 RECOMMENDED GUIDELINES FOR DISCIPLINARY ORDERS 3 AND CONDITIONS OF PROBATION 4 5 1 Neurology, or other specialist as determined by the director of the EMSA, the 2 respondent shall submit to a psychiatric evaluation. The psychiatrist must be 3 approved by the EMSA prior to the evaluation. The respondent shall be 4 responsible for all costs associated with the evaluation. 5 6 Within days of the effective date of this decision, and on a periodic basis as 7 specified by a licensed physician, or other specialist as determined by the 8 director of the EMSA, the respondent shall submit to a medical evaluation. The 9 physician must be approved by the EMSA prior to the evaluation. The 10 respondent shall be responsible for all costs associated with the evaluation. 11 12 The EMSA shall have the sole discretion to determine if the respondent may 13 continue to practice as a paramedic until such time that the psychiatrist or 14 physician evaluates and determines that the respondent is mentally and/or 15 physically fit to practice safely as a paramedic. 16 17 11. Performance Improvement Plan: 18 The respondent shall function as a practicing paramedic while on probation, 19 except during the time when the respondent’s license is suspended by a term or 20 condition of the disciplinary order. 21 22 The respondent shall submit to the EMSA periodic Performance Improvement 23 Plan reports compiled by his/her employer, local EMS agency, or approved 24 education provider. These reports shall document improvement as desired in the 25 plan in order to satisfy this condition. The Performance Improvement Plan shall 26 be developed by the EMSA in conjunction with the respondent’s employer(s), 27 and with input from the local EMS agency(ies). Performance Improvement Plan 28 reports shall be submitted to the EMSA every ____ days for a period of _____. 29 30 A Performance Improvement Plan may include, but not be limited to, education 31 and/or evaluation of the respondent in areas substantially related to the 32 accusation as follows: 33 34 1. Remedial training by a preceptor in a field or clinical setting. 35 2. Remedial training with performance demonstration by the respondent. 36 3. Policy review by the respondent. 37 4. Participation by the respondent in Quality Assurance/Quality Improvement 38 review audits. 39

6 7 - 18 - 1 EMERGENCY MEDICAL SERVICES AUTHORITY 2 RECOMMENDED GUIDELINES FOR DISCIPLINARY ORDERS 3 AND CONDITIONS OF PROBATION 4 5 1 Any and all notifications to the EMSA shall be by certified mail. 2 3 Section VII: REVIEW BOARD 4The EMSA shall convene a Review Board to meet the requirements of Optional 5Conditions 9 and 10 of the Conditions of Probation. The board would be responsible for 6testing the respondent per the terms and conditions of probation. The board shall 7submit to the EMSA its recommendation as to whether the respondent has successfully 8completed the exam. 9 10Each board shall consist of an EMS physician, a paramedic, and an EMS educator. All 11board members must be currently active in California in an EMS clinical or 12administrative capacity. 13 14Any individual that meets the minimum criteria to serve on the board may apply to the 15EMSA for a position on the board. The EMSA shall review the applications for eligibility 16and establish a list of qualified individuals. 17 18When it is necessary to convene a board, the EMSA shall select individuals from the list 19to serve on the board. The EMSA shall make reasonable attempts to convene a 20regional board based upon the location of the respondent. Each board member shall be 21required to sign a document advising that he/she does not have a conflict with the 22respondent (i.e. personal friend, employer, EMS oversight, etc.). 23 24The term for any board member shall be two years. At the conclusion of the term, a 25board member may reapply.

6 7 - 19 - 1 EMERGENCY MEDICAL SERVICES AUTHORITY 2 RECOMMENDED GUIDELINES FOR DISCIPLINARY ORDERS 3 AND CONDITIONS OF PROBATION 4 5 1 2Board Member Qualifications 3 4Physician 5 Must be certified by the California Medical Board. 6 Must have five or more years of experience in EMS. 7 Must not have had any discipline brought against him/her by the Medical Board of 8 California. 9 Must not have any criminal convictions. 10 11Paramedic 12 Must be currently licensed by the EMSA without any restrictions. 13 Must not have been disciplined by the EMSA for violations of the Health and Safety 14 Code, Division 2.5, Section 1798.200. 15 Must qualify as a field preceptor as that term is defined by EMSA regulation (Section 16 100149(e)(1)-(4), Chapter 4, Division 9, Title 22, California Code of Regulations). 17 Must not have any criminal convictions. 18 19Educator 20 Must qualify as a course director or principal instructor for a Paramedic Training 21 Program as that term is defined in California Code of Regulations, Title 22, Division 22 9, Chapter 4, Section 100149. 23 Must have five or more years of experience in EMS with at least two years as an 24 EMS educator in a primary paramedic training program. 25 Must not have been disciplined by their Professional Licensing/Certification Board. 26 Must not have any criminal convictions. 27

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