The following opinion is presented on-line for informational use only and does not replace the official version. (Mich Dept of Attorney General Web Site - www.ag.state.mi.us)
STATE OF MICHIGAN
JENNIFER M. GRANHOLM, ATTORNEY GENERAL
Jurisdiction of medical control authority over emergency medical services
An emergency medical service, when transporting a person from one health facility to another, must follow protocols adopted by a local medical control authority established under Part 209 of the Public Health Code, regardless of the transported person's status as an emergency or non-emergency patient.
Opinion No. 7072
January 18, 2001
Honorable Michael Switalski
Lansing, Michigan 48913
You have asked if an emergency medical service, when transporting a non-emergency patient from one health facility to another, must follow protocols adopted by a local medical control authority established under Part 209 of Michigan's Public Health Code.
Information supplied with your request indicates that a local medical control authority has adopted a guideline governing inter-facility transfers of patients by an emergency medical service. The guideline establishes detailed procedures to be followed by emergency medical services in transferring non-emergency patients.
The Public Health Code (Code), 1978 PA 368, MCL 333.1101 et seq; MSA 14.15 (1101) et seq, protects and promotes the public health and provides for the regulation of health services and activities. Part 209, titled Emergency Medical Services, regulates the transportation of patients between health facilities. Code section 20918 et seq authorizes establishment of local medical control authorities as part of a statewide emergency medical services system "to supervise emergency medical services" in their designated geographical regions. In DenBoer v Lakola Medical Control Authority, 240 Mich App 498, 501; 618 NW2d 8 (2000), the Court of Appeals upheld a local medical control authority's decision permanently suspending a paramedic's privilege to practice "pre-hospital (i.e., paramedic) care" within the medical control authority region and summarized the powers of a local medical control authority as follows:
The statewide emergency medical services system is governed by local MCAs [medical control authorities], which are organized and administered by local hospitals within each geographic region. Each person licensed under the . . . act is accountable to their local MCA in the provision of emergency medical services. . . . The MCAs have statutory power and authority to supervise emergency medical services, and to govern the practice of licensed medical services personnel.
240 Mich App at 500-501. (Statutory citations omitted.)
Your question involves a non-emergency patient who is transferred from one health facility to another health facility. Code section 20908(1) defines a "[n]on emergency patient" as one not in imminent danger of loss of life or significant health impairment. An individual who meets this definition may nevertheless need transportation by vehicles and personnel trained and equipped to provide life support services. Such a patient may, and often does, require emergency medical services while being transported between health care facilities.
The term "emergency medical services" is defined as follows:
"Emergency medical services" means the emergency medical services personnel, ambulances, nontransport prehospital life support vehicles, aircraft transport vehicles, medical first response vehicles, and equipment required for transport or treatment of an individual requiring medical first response life support, basic life support, limited advanced life support, or advanced life support.
As defined by the Code, the term "emergency medical services" includes vehicles, personnel, and equipment required to transport or treat any individual requiring life support services, regardless of the transported person's status as an emergency or non-emergency patient.
Code section 20919(1) requires local medical control authorities to establish written protocols for emergency medical services personnel.
(1) A local medical control authority shall establish written protocols for the practice of life support agencies and licensed emergency medical services personnel within its region. The protocols shall be developed and adopted in accordance with procedures established by the department and shall include all of the following:
(a) The acts, tasks, or functions that may be performed by each type of emergency medical services personnel licensed under this part.
(b) Medical protocols to ensure the appropriate dispatching of a life support agency based upon medical need and the capability of the emergency medical services system.
The term "protocol" is defined by the Code as "a patient care standard, standing orders, policy, or procedure for providing emergency medical services that is established by a medical control authority and approved by the department1 under section 20919." Section 20908(9). Thus, local medical control authorities must adopt protocols governing the "acts, tasks or functions that may be performed by . . . emergency medical services personnel." Nothing in the Code, however, limits the application of these protocols to emergency personnel only when they are engaged in the transport of emergency patients.
An ambulance operation, defined in Code section 20902(5) as a provider of "emergency medical services and patient transport," must "[o]perate under the direction of" the medical control authority with jurisdiction over the ambulance operation. Section 20921(1)(c). Life support agencies, including emergency medical services personnel, must adhere to and operate in accordance with duly adopted and approved protocols governing the use of emergency medical services. See Code sections 20918(6), 20920(5), 20941(3), 20956(1).
In addition, section 1867 of Title XVIII of the Social Security Act, 42 USC 1395 et seq, imposes special responsibilities on Medicare participating hospitals in emergency cases. The so-called Anti-Dumping Act (42 USC 1395dd) and its supporting regulations (42 CFR 489.24) prohibit hospitals that participate in the Medicare program from transferring patients with an emergency medical condition before certain steps are taken, including medical screening, stabilization treatment, and providing medically appropriate life support measures during the transfer. Neither this act nor its supporting regulations conflict with Part 209 of the Public Health Code or preempt a medical control authority from adopting protocols governing the transport of an individual from one health facility to another.
It is my opinion, therefore, that an emergency medical service, when transporting a person from one health facility to another, must follow protocols adopted by a local medical control authority established under Part 209 of the Public Health Code, regardless of the transported person's status as an emergency or non-emergency patient.
JENNIFER M. GRANHOLM
1 The term "department" means the Michigan Department of Consumer & Industry Services. See section 1104(5) of the Code; Executive Order 1996-1 and Executive Order 1996-2.