Overview of QA/QI Process in Maryland's EMS: Regulations, Cases, and Compliance Actions

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

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

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

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

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

10. Privileges Limited!

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

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

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

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

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

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

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

18. EMS Board Process • EMS Board issues Final Action/Public Order • Report to Healthcare Integrity and Protection Data Bank (HIPDB) • Provider must exhaust administrative remedies • 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 Board may not allow certification or license to lapse during disciplinary process

21. NoteworthyCases

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

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

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

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

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

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

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

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

34. Case Review ? ? ? ? ?

35. EMS Board Actions FY 2006 & 2007

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

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

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

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

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

41. Work Safe! Play Safe!