Maryland Institute for Emergency Medical Services Systems

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Diagram. Presentation created to give understanding of:QA Process MarylandRegulations that influence QA

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QA/QI Process Maryland Institute for Emergency Medical Services Systems

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Overview Presentation created to give comprehension of: QA Process Maryland Regulations that influence QA & EMS Providers How Regulations influence everyday EMS operations Actual Case Studies - exhibit effect of Regulations EMS in Maryland. EMS Board has issued Noncompliance Notices &/or Final Decisions for all Cases explored Noncompliance Notices &r Final Decisions are Public Documents

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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

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

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

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Privileges Limited!

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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

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

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

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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

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EMS Board Process Applicant/Provider asks for hearing MIEMSS informs OAH Schedules Hearing MIEMSS Schedules Case Resolution Conference

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Case Resolution Conference (CRC) CRC acknowledges determination Results displayed EMS Board EMS Board acknowledges CRC determination OAH Hearing drop EMS Board Final Action Reports Discipline

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Case Resolution Conference (CRC) CRC board rejects determination IRC Complaint to OAH Hearing Administrative Law Judge (ALJ) issues choice 90 days Decision non-official on EMS Board EMS Board considers Administrative Law Judge (ALJ) discoveries Issues last activity

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EMS Board Process EMS Board issues Final Action/Public Order Report to Healthcare Integrity and Protection Data Bank ( HIPDB ) Provider must fumes managerial cures Applicant/Provider may offer EMS Board choice to the Circuit Court

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EMS Board Process EMS Provider may not surrender endorsement or permit amid an examination of IRC Complaint unless EMS Board wishes to acknowledge it EMS Board may not permit confirmation or permit to slip by amid disciplinary process

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Noteworthy Cases

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Typical Case Closure Administration of Epinephrine rather than Lasix IV Esophageal Intubation Important to get even minor protests so can search for patterns and roll out framework improvements EMT-B giving ALS supplier NTG

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Atypical Case Closure Case conclusion asked for by EMS Jurisdiction MIEMSS archived other Incident Reports Consolidated cases Issues IRC Complaint

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Criminal Conviction Self-detailed criminal conviction Discovered criminal history Not answered to MIEMSS Prohibited Conduct in view of lying on application Discovery/Report EMS Provider sentenced new wrongdoing

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Criminal Conviction Child Sex Offender Why it is so vital to distinguish and report criminal feelings

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EMS Provider Credentials Jurisdictional Medical Director Limits certifications Clinical capability Medical basic leadership

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

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EMS Provider Suspended Local During examination (State considers open risk) Summary Suspension Threat to Health and Welfare of the general population (call State EMS Medical Director) Opportunity for Immediate hearing CASE audit Parallel Regular Investigation NREMT warning

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Questions Provider "due process" Protects open and supplier

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Case Review ? ? ? ? ?

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EMS Board Actions FY 2006 & 2007

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Compliance Office FY 2006 ACTIVITY 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

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Compliance Office FY 2006 EMS 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

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Compliance Office FY 2007 ACTIVITY 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

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Compliance Office FY 2007 EMS 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

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

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Work Safe! Play Safe!

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