1. QA/QI Process Maryland Institute for Emergency Medical Services Systems

2. Overview Presentation developed to provide understanding of: Presentation developed to provide understanding of: QA Process Maryland QA Process Maryland Regulations that affect QA & EMS Providers Regulations that affect QA & EMS Providers How Regulations affect day to day EMS operations How Regulations affect day to day EMS operations Actual Case Studies - Actual Case Studies - demonstrate impact of Regulations EMS in Maryland. demonstrate impact of Regulations EMS in Maryland. EMS Board has issued Noncompliance Notices &/or Final Decisions for all Cases reviewed EMS Board has issued Noncompliance Notices &/or Final Decisions for all Cases reviewed Noncompliance Notices &r Final Decisions are Public Documents Noncompliance Notices &r Final Decisions are Public Documents

7. Overview QA Process Overview QA Process Trigger - Identify Issue Trigger - Identify Issue 5 Day Report 5 Day Report QA Officer Investigation QA Officer Investigation Medical Review Committee Medical Review Committee Remediation Remediation 35 Day Report 35 Day Report Request MIEMSS Action or Request MIEMSS Action or Request Case Closure Request Case Closure

8. PCQA IN-5 PCQA IN-5 5-days of notice 5-days of notice Suspend Privileges? Contact State EMS Medical Director Suspend Privileges? Contact State EMS Medical Director

9. PCQA IN- 35 PCQA IN- 35 Suspend Privileges? Contact State EMS Medical Director Suspend Privileges? Contact State EMS Medical Director

10. Privileges Limited!

11. Overview QA Process Overview QA Process MIEMSS IRC MIEMSS IRC Investigator, AG and EMS Medical Director Investigator, AG and EMS Medical Director Summary Suspension Summary Suspension Provider Review Panel Provider Review Panel FR FR EMT-B EMT-B EMT-I EMT-I EMT-P EMT-P EMS Medical Director Med Chi MD Board of Physicians

12. PRP Recommendation/Action Dismiss Complaint (if patient care related) Dismiss Complaint (if patient care related) Deny Application Deny Application Reprimand Reprimand Remediation Remediation Probation Probation Suspension Suspension Revocation Revocation

13. EMS Board Process Dismiss Complaint Dismiss Complaint Additional Investigation Additional Investigation Proposes Discipline Proposes Discipline Issues Noncompliance Notice Issues Noncompliance Notice Applicant/Provider Applicant/Provider Accepts Proposal Accepts Proposal Requests Hearing Requests Hearing

14. EMS Board Process Applicant/Provider Accepts Proposal Applicant/Provider Accepts Proposal EMS Board Issues Final Action/Public Order EMS Board Issues Final Action/Public Order Reports Discipline Reports Discipline Healthcare Integrity & Protection Data Bank (HIPDB) Healthcare Integrity & Protection Data Bank (HIPDB) NREMT NREMT EMSOP Medical Directors EMSOP Medical Directors

15. EMS Board Process Applicant/Provider requests hearing Applicant/Provider requests hearing MIEMSS notifies OAH MIEMSS notifies OAH OAH Schedules Hearing OAH Schedules Hearing MIEMSS Schedules Case Resolution Conference MIEMSS Schedules Case Resolution Conference

16. Case Resolution Conference (CRC) CRC accepts resolution CRC accepts resolution Results presented EMS Board Results presented EMS Board EMS Board accepts CRC resolution EMS Board accepts CRC resolution OAH Hearing canceled OAH Hearing canceled EMS Board Final Action EMS Board Final Action Reports Discipline Reports Discipline

17. Case Resolution Conference (CRC) CRC panel rejects resolution CRC panel rejects resolution IRC Complaint to OAH Hearing IRC Complaint to OAH Hearing Administrative Law Judge (ALJ) issues decision 90 days Administrative Law Judge (ALJ) issues decision 90 days Decision non-binding on EMS Board Decision non-binding on EMS Board EMS Board considers Administrative Law Judge (ALJ) findings EMS Board considers Administrative Law Judge (ALJ) findings Issues final action Issues final action

18. EMS Board Process EMS Board issues Final Action/Public Order EMS Board issues Final Action/Public Order Report to Healthcare Integrity and Protection Data Bank (HIPDB) Report to Healthcare Integrity and Protection Data Bank (HIPDB) Provider must exhaust administrative remedies Provider must exhaust administrative remedies Applicant/Provider may appeal EMS Board decision to the Circuit Court Applicant/Provider may appeal EMS Board decision to the Circuit Court

19. EMS Board Process EMS Provider may not surrender certificate or license during an investigation of IRC Complaint unless EMS Board wishes to accept it EMS Provider may not surrender certificate or license during an investigation of IRC Complaint unless EMS Board wishes to accept it EMS Board may not allow certification or license to lapse during disciplinary process EMS Board may not allow certification or license to lapse during disciplinary process

21. Noteworthy Cases

22. Typical Case Closure Administration of Epinephrine instead of Lasix IV Administration of Epinephrine instead of Lasix IV Esophageal Intubation Esophageal Intubation Important to get even minor complaints so can look for trends and make system changes Important to get even minor complaints so can look for trends and make system changes EMT-B giving ALS provider NTG EMT-B giving ALS provider NTG

24. Atypical Case Closure Case closure requested by EMS Jurisdiction Case closure requested by EMS Jurisdiction MIEMSS documented other Incident Reports MIEMSS documented other Incident Reports Consolidated cases Consolidated cases Issues IRC Complaint Issues IRC Complaint

26. Criminal Conviction Self-reported criminal conviction Self-reported criminal conviction Discovered criminal history Discovered criminal history Not reported to MIEMSS Not reported to MIEMSS Prohibited Conduct because of lying on application Prohibited Conduct because of lying on application Discovery/Report EMS Provider convicted new crime Discovery/Report EMS Provider convicted new crime

27. Criminal Conviction Child Sex Offender Child Sex Offender Why it is so important to identify and report criminal convictions Why it is so important to identify and report criminal convictions

29. EMS Provider Credentials Jurisdictional Medical Director Limits credentials Jurisdictional Medical Director Limits credentials Clinical competence Clinical competence Medical decision making Medical decision making

30. PCQA IN-5 PCQA IN-5 5-days of notice 5-days of notice Suspend Privileges? Contact State EMS Medical Director Suspend Privileges? Contact State EMS Medical Director

31. EMS Provider Suspended EMS Provider Suspended Local Local During investigation (State considers public threat) During investigation (State considers public threat) Summary Suspension Summary Suspension Threat to Health and Welfare of the public (call State EMS Medical Director) Threat to Health and Welfare of the public (call State EMS Medical Director) Opportunity for Immediate hearing Opportunity for Immediate hearing CASE review CASE review Parallel Regular Investigation Parallel Regular Investigation NREMT notification NREMT notification

33. Questions Provider “due process” Provider “due process” Protects public and provider Protects public and provider

34. Case Review ? ? ? ? ?

35. EMS Board Actions FY 2006 & 2007

36. Compliance Office FY 2006 ACTIVITY REPORT OF THE INCIDENT REVIEW COMMITTEE (IRC), EMS PROVIDER REVIEW PANEL (PRP), AND THE EMS BOARD FY 2006 ACTIVITY REPORT OF THE INCIDENT REVIEW COMMITTEE (IRC), EMS PROVIDER REVIEW PANEL (PRP), AND THE EMS BOARD Incidents Reported to IRC 312 Incidents Reported to IRC 312 IRC Investigations Initiated 235 IRC Investigations Initiated 235 IRC Investigations Conducted 207 IRC Investigations Conducted 207 IRC Investigations Continued FY 2007 28 IRC Investigations Continued FY 2007 28 IRC Complaints Forwarded to PRP 30 IRC Complaints Forwarded to PRP 30 Complaints Dismissed by PRP 0 Complaints Dismissed by PRP 0 Complaints Forwarded to EMS Board 30 Complaints Forwarded to EMS Board 30

37. Compliance Office FY 2006 EMS Board Action FY 2006 EMS Board Action Reprimands 8 Reprimands 8 Probation 12 Probation 12 Suspensions 5 Suspensions 5 Revocations 6 Revocations 6 Remedial training 3 Remedial training 3 Surrenders 1 Surrenders 1 Evaluation 1 Evaluation 1 Applications Denied 9 Applications Denied 9 Case Resolution Conferences 7 Case Resolution Conferences 7 Dismissed 0 Dismissed 0 Counseling 1 Counseling 1

38. Compliance Office FY 2007 ACTIVITY REPORT OF THE INCIDENT REVIEW COMMITTEE (IRC), EMS PROVIDER REVIEW PANEL (PRP), AND THE EMS BOARD FY 2007 ACTIVITY REPORT OF THE INCIDENT REVIEW COMMITTEE (IRC), EMS PROVIDER REVIEW PANEL (PRP), AND THE EMS BOARD Incidents Reported to IRC 295 Incidents Reported to IRC 295 IRC Investigations Initiated 215 IRC Investigations Initiated 215 IRC Investigations Conducted 200 IRC Investigations Conducted 200 IRC Investigations Continued FY 2007 15 IRC Investigations Continued FY 2007 15 IRC Complaints Forwarded to PRP 32 IRC Complaints Forwarded to PRP 32 Complaints Dismissed by PRP 1 Complaints Dismissed by PRP 1 Complaints Forwarded to EMS Board 31 Complaints Forwarded to EMS Board 31

39. Compliance Office FY 2007 EMS Board Action FY 2007 EMS Board Action Reprimands 3 Reprimands 3 Probation 4 Probation 4 Suspensions 3 Suspensions 3 Revocations 7 Revocations 7 Remedial training 3 Remedial training 3 Surrenders 0 Surrenders 0 Evaluation 1 Evaluation 1 Applications Denied 3 Applications Denied 3 Case Resolution Conferences 7 Case Resolution Conferences 7 Dismissed 1 Dismissed 1 Counseling 1 Counseling 1

40. More Information MIEMSS’ contact MIEMSS’ contact Richard Alcorta, MD Richard Alcorta, MD Sarah Sette, AAG Sarah Sette, AAG Ron Schaefer, CCO(410) 706-2339 Ron Schaefer, CCO(410) 706-2339

41. Work Safe! Play Safe! Work Safe! Play Safe!