One of the most important components of Maryland’s statewide EMS system is ensuring that clinicians function at a level of skill, competence, and professionalism that is consistent with the traditions of the Maryland EMS system and with the current standard of EMS practice. In order to meet these needs, EMS clinicians must successfully complete necessary educational and training programs, pass licensure or certification examinations, and complete continuing education requirements.
Another critical component to ensuring the high quality of the EMS system is the quality assurance process that protects the public by ensuring that allegations of misconduct by EMS clinicians are thoroughly reviewed and appropriately addressed. Quality assurance occurs at both the jurisdiction and the state levels.
Jurisdictional Quality Assurance
Maryland regulations require each jurisdictional program to develop and implement a quality assurance plan. Each plan must include a review of patient care rendered, remedial action to resolve any patient care issues involving EMS clinicians, and identification of incidents, protocol variations, or trends that might have resulted in harm to a patient or which suggest a need for changes in the statewide EMS system. For more information on COMAR regulations, please go to Regulations.
State Level Quality Assurance
Prior to January 1999, the Board of Physician Quality Assurance, now the Maryland Board of Physicians, was responsible for clinician quality assurance issues at the state level. The state level quality assurance process is now the responsibility of the MIEMSS Provider Review Panel (PRP) and the EMS Board.
The PRP is a 13-member committee required by state law to review incidents involving patient care and other allegations of misconduct against EMS clinicians and recommend any necessary disciplinary action to the EMS Board. The PRP has 11 voting members and two non-voting members. Each Maryland clinician level, from First Responder to EMT-P is represented on the panel. The PRP is an important part of the statewide initiative to ensure high quality prehospital care in Maryland. Together with the quality assurance programs developed by each EMS Operational Program , the PRP strengthens the state level quality assurance program by bringing the clinician perspective to the peer review process.
In order for the PRP to take action, at least six voting members must be present, including a PRP member at the same level and type as the individual who is the subject of the complaint.Disciplinary action cannot be taken against a clinician without a PRP recommendation for such action. The PRP also ensures that the perspective of peer clinicians is included and that those who are familiar with the standard of care and the circumstances EMS clinicians face in providing patient care determine the need for disciplinary action. All discussions, deliberations, and information shared during the course of the PRP’s activities are confidential. Additionally, much of the information considered by the PRP is confidential and protected by law because it contains medical or psychological information about individuals or constitutes a hospital record.
Prior to the PRP considering a case, the MIEMSS Incident Review Committee (IRC) reviews the allegations of misconduct. The IRC consists of the MIEMSS Chief of Compliance, the State EMS Medical Director, and one of the agency’s Assistant Attorneys General. The IRC is required to send to the PRP any allegations of misconduct, unless the IRC review determines that the allegations are serious enough to warrant a summary suspension pending review by the PRP, or the allegations are not serious enough to require possible action at the state level.
If the case is forwarded to the PRP, a complaint outlining the allegations and the findings of the investigation is prepared for the PRP and is also sent to the individual who is the subject of the complaint. The individual has the option of providing to the PRP a statement in response to the complaint. The PRP meets and reviews the complaint and any response from the individual. The PRP recommends to the EMS Board any action it considers necessary, which may include one or more of the following:
- Dismissal of the complaint
- Suspension of a license or certificate
- Revocation of a license or certificate
- Denial of a license or certificate
- Refusal to renew a license or certificate
- Remedial action (e.g., additional training or counseling)
The EMS Board will review the matter and may then dismiss the complaint, settle the matter (generally, with required remedial measures, but without disciplinary action), or issue a noncompliance notice. If the PRP does not recommend disciplinary action in cases concerning patient care, however, the EMS board must dismiss the complaint where it relates to patient care. A noncompliance notice specifies the proposed disciplinary action and provides the individual the opportunity to request a hearing, which may be before the EMS Board or the Office of Administrative Hearings. If an individual does not request a hearing, the proposed action becomes final.
After service of the noncompliance notice and upon receipt of a request for a hearing, the EMS Board will offer the respondent an opportunity to resolve the matter through a case resolution conference. If the matter is resolved through a case resolution conference, the EMS Board and the respondent shall enter into a disposition agreement setting forth the terms and conditions of the resolution. If a resolution is not achieved after opportunity for a case resolution conference, the matter shall proceed to hearing.
MIEMSS may notify appropriate EMS operational programs of incident reports, noncompliance notices, or hearings.