Rhode Island physicians groups are sounding alarms about legislation moving through the General Assembly that they say would strip the authority of the state health director over  emergency medical services. 

The legislation (H-6282 and S-860) would prevent the health director from enacting EMS regulations, protocols and licensing requirements without the approval of a 25-member board that currently serves in an advisory capacity. The single-largest constituency of the Ambulance Service Coordinating Advisory Board are municipal fire departments, which run almost all of the state’s EMS agencies.

The Rhode Island State Association of Fire Fighters and the Rhode Island League of Cities and Towns are supporting the legislation. The Rhode Island Medical Society, the American College of Cardiology, the American Heart Association, Rhode Island Chapter of the American College of Emergency Physicians, the Rhode Island Academy of Physician Assistants and the Rhode Island Emergency Nurses Association are among those opposing the bill.

The legislation follows years of tensions on the board over attempts by state health officials, often supported by emergency medical doctors, to change practices around emergency care to align with national standards. Among the more divisive issues, reported in 2019 by The Public’s Radio and ProPublica, was a proposal to restrict the practice of placing breathing tubes in patients to paramedics after the discovery by an emergency physician that patients had been arriving by ambulance in the ER with misplaced breathing tubes. (The vast majority of EMS providers in the state are licensed as Advanced EMTs, also known as EMT-Cardiacs, not as paramedics.) 

The proposal was shot down. And Jason M. Rhodes, the Health Department’s EMS chief and then-member of the ambulance advisory board who proposed the restriction, along with a department colleague, were removed from the board. The 2019 legislation to eliminate the two Health Department seats on the board was backed by the same coalition that is supporting the latest bills to curb the powers of the Health Department over emergency medical services.

The latest bills would require all minimum standards for EMS set by the Health Director  -- including training, licensing and equipment for ambulances -- to be subject to board approval. The director also would be required to submit a “financial impact statement” of any proposed regulation, protocol, licensing fees, mandatory restocking of supplies or other action prior to the board’s approval.

The legislation would give the board “incredibly broad” powers, Health Director Dr. Nicole Alexander-Scott said in written testimony to the Senate Committee on Health & Human Services. “Giving a board this much unfettered authority could potentially cripple the ability for the Director of Health and the Center for Emergency Medical Services (CEMS) to act effectively at critical times and would inevitably harm public health.”

Massachusetts and Connecticut both have similar ambulance service boards that serve an advisory role, rather than as the final decision-making authority. 

Johnston Mayor Joseph M. Polisena testified in support of the Senate bill before the Senate Health & Human Services Committee on Monday. “This in no way, no way is gonna take the power away from the director,” Polisena said. “I swear to you, this is not what it appears to be.”

 A former state senator and retired firefighter, Polisena, a licensed EMT-Cardiac, was re-appointed to the board to replace one of the two health department officials removed in 2019. (He had previously served on the board.) Polisena said members of the Health Department “have an agenda,” and some emergency medicine physicians “are in this to make money.” 

Some emergency physicians have part-time positions as directors of municipal EMS departments. 

Dr. Otis Warren, president of the Rhode Island chapter of the American College of Emergency Physicians, said in an interview that “an emergency doctor is decidedly making less money being a EMS medical director than they would make by being an emergency doctor in a hospital seeing patients.”

The Senate bill is sponsored by Sen. Frank S. Lombardi (D-Cranston), was held for further study.  An identical House bill introduced by Rep. Deborah A. Fellela (D-Johnston), was scheduled for a hearing on Wednesday in the Health and Human Services Committee.  The House bill also has been held for further study.

Health reporter Lynn Arditi can be reached at larditi@thepublicsradio.org. Follow her on Twitter @LynnArditi.

correction: a previous version of this article incorrectly reported Rep. Lombardi's district.

this story has been updated 05/06/21