SB 443 Prehospital EMS - Letter of Opposition

Dear Assembly Member Wood: 

On behalf of Tulare County, I am writing in opposition to Senate Bill (SB) 443. 

While the stated intent of SB 443 is to clarify SB 438 (Hertzberg, Chapter 389, Statute of 2019), which was specific to 9-1-1 dispatch services, SB 443 far exceeds clarification and makes substantial changes to California's EMS Act that can have significant impact on established County-wide EMS systems. 

Should SB 443 become law, local municipal agencies would be permitted to act outside of the medical control of the County's Local EMS Agency (LEMSA) physician medical director and the State Emergency Medical Services Authority (EMSA) in the response and delivery of prehospital emergency care. SB 443 fragments the EMS system and may result in considerable variation and inequality of care provided to patients in rural and smaller urban areas. It also would risk patient safety, as deviations from LEMSA policies and procedures can and will occur without LEM SA and EMSA oversight. 

The EMS system of today, which provides equitable access and delivery of high-quality pre-hospital care, is the intentional result of the implementation of the Emergency Medical Services System and the Prehospital Emergency Medical Care Personnel Act (EMS Act). The EMS Act created a neutral comprehensive two-tiered system governing virtually every aspect of prehospital emergency medical services. The Legislature's intent was to achieve coordination and integration in a service that is vitally important to all of our communities. SB 443 will cause changes in EMS systems throughout the state that promote less integration and coordination and leave some communities with limited paramedic ambulance services. 

The intent of SB 443 is to undermine several lawsuits that have affirmed county control over its local emergency medical services systems and oversight of "medical control". SB 443 proposes to abrogate or repeal the California Supreme Court in the case of County of San Bernardino v. City of San Bernardino (1997 15.Cal. 4th 909), which explained that "the Legislature conceived of 'medical control' in fairly expansive terms, encompassing matters directly related to regulating the quality of emergency medical services, including policies and procedures governing dispatch and patient care." Other subjects of medical control include those policies designed to improve the "speed and effectiveness" of emergency response as well as "how the various providers will interact at the emergency scene." SB 443 also seeks to repeal other court cases filed on the basis of medical control and HSC 1797.201 rights including cases between the City of Oxnard v. County of Ventura and S. San Joaquin County Fire Authority,, v. San Joaquin EMS Agency, Again, neither case seeks to clarify the intent of SB 438, which was about the dispatch of EMS services. Rather, both court cases ruled against cities and fire districts attempting to undermine county medical control through their ".201 rights." 


For the reasons stated above, we oppose SB 443 and respectfully request your NO vote. If you should have any questions, please contact Tulare County Health Services Manager John Pomaski at (559) 624-8046 or 



Eddie Valero, Chair 

Tulare County Board of Supervisors