563

ENFORCEMENT OF VIOLATIONS

563.1 Any person who violates or participates in the violation of a provision of this chapter shall be subject to civil and criminal penalties in accordance with the Emergency Medical Services Act of 2008, effective March 25, 2009 (D.C. Law 17-357; D.C. Official Code §§ 7-2341.01, et seq. (2012 Repl.)) (Act).

563.2 The DOH may audit, inspect, or investigate an EMS provider or agency, at any time, with or without prior notification, to confirm compliance with the regulations contained in this chapter or any other relevant District regulation or law.

563.3 A complaint against an EMS provider or agency shall:

(a) Be submitted in writing on a form specified by the District EMS Officer;

(b) State the facts or circumstances that form the basis of the complaint; and

(c) Be submitted to the District EMS Officer.

563.4 The District EMS Officer shall establish a record upon receipt of a complaint or incident report alleging facts which, if proven, would constitute sufficient grounds for denial, suspension, or revocation of a certification to, or reprimand of a holder of a certification to:

(a) Operate an Emergency Medical Services Agency;

(b) Operate an emergency response vehicle;

(c) Operate an emergency medical services educational institution;

(d) Perform the duties of an emergency medical services provider; or

(e) Perform the duties of an emergency medical services instructor under Sections 16, 17, 18, and 25(c) of the Act.

563.5 The record of all complaints or incident reports shall be maintained in a confidential database exclusively for the purposes of tracking and monitoring compliance with EMS laws, regulations, and protocols and for the improvement of emergency medical services in the District.

563.6 The records of all complaints and incident reports collected by the District EMS Officer and shall be maintained for at least ten (10) years.

563.7 The Director shall refer each complaint and incident report to the medical director of the applicable Emergency Medical Services Agency or educational institution.

563.8 The medical director of each responsible agency shall be responsible for the investigation of each complaint or incident report to determine whether the agency, vehicle, provider, instructor, or educational institution has failed to comply with the provisions of the Act, rules promulgated pursuant to the Act, protocols established pursuant to the Act, or regulations promulgated pursuant to the Act.563.9 The results of each investigation shall be reported by the emergency medical services agency or educational institution to the District EMS Officer upon completion of the investigation by the agency's medical director.563.10 The District EMS Officer may conduct an independent investigation of a complaint or incident report. The Emergency Medical Services Agency or educational institution shall cooperate fully in such an investigation.563.11 The District EMS Officer shall refer the complaint or incident report, together with the results of the investigation, to the Director and shall make a recommendation to the Director for proposed action, if any.563.12 The Director shall make a determination of any actions to be taken.563.13 Sufficient grounds for denial, suspension, or revocation of a certification granted to an Emergency Medical Services Agency or reprimand of an Emergency Medical Services Agency shall include:- (a) Fraudulently or deceptively obtaining or attempting to obtain a certificate or license for itself or for another;

- (b) Fraudulently or deceptively using a certificate or license;

- (c) Abandoning a patient;

- (d) Willfully making or filing a false report or record related to the provision of emergency medical services;

- (e) Willfully failing to file or record, willfully impeding or obstructing the filing or recording, or willfully destroying a report or record related to the provision of emergency medical services required to be filed by statute or regulation;

- (f) Knowingly providing emergency medical services with an unauthorized individual or knowingly aiding an unauthorized individual in providing emergency medical services;

- (g) Being disciplined by a licensing or disciplinary authority, or convicted

or disciplined by a court of any state or country, or disciplined by any branch of the United States government for an act that would be grounds for disciplinary action under this regulation;

1. (h) Failing to meet or violating appropriate protocols or standards of care for the delivery of emergency medical services;
2. (i) Willfully submitting a false statement to collect a fee;- (j) Surrendering a certificate or license issued by another jurisdiction as a result of an investigation or disciplinary action by a certifying, licensing, or disciplinary authority or by a court of another jurisdiction for an act that would be grounds for disciplinary action under this chapter;
3. (k) Knowingly failing to report suspected child abuse or neglect in violation of the Prevention of Child Abuse and Neglect Act of 1977, effective September 23, 1977 (D.C. Law 2-22; D.C. Official Code § 4-1301.02(3) (2012 Supp.));
4. (l) Selling, prescribing, giving away, or administering drugs for illegal purposes;
5. (m) Breaching patient confidentiality in violation of HIPAA or any other applicable privacy law or regulation;
6. (n) Providing emergency medical services beyond the agency's authorized scope of practice;
7. (o) Refusing, withholding from, denying, or discriminating against an individual in need of emergency medical services, with regard to the provision of services which the licensee or certificate holder is licensed or certified and qualified to render due to race, color, religion, national origin, sex, age, marital status, personal appearance, sexual orientation, gender identity or expression, familial status, family responsibilities, matriculation, political affiliation, genetic information, disability, source of income, status as a victim of an intrafamily offense, or place of residence or business;
8. (p) Failing to comply with the District of Columbia EMS guidelines on standard protocols;
9. (q) Intentionally misrepresenting the level of emergency medical services certification held by individuals or the agency;
10. (r) Failure to maintain required levels of insurance and liability coverage;

(s) Failure to have a medical director;

(t) Failure to have an operational director;

(u) Failure to submit or have an approved Quality Assurance and Improvement Plan;

(v) Failure to report to DOH the incidents outlined in the Quality Assurance and Improvement Plan;

(w) Failure to maintain records in accordance with this chapter or DOH policy;

(x) Withdrawal by the District government of the Certificate of Need (CON) for the ambulance service;

(y) Failure to submit an annual report to DOH; or

(z) Failure to notify DOH of changes in medical director, agency, or program.

563.14 Sufficient grounds for denial, suspension, or revocation of a certification granted to an emergency medical response vehicle shall include:

(a) The ground ambulance was not in compliance with:

(1) Federal Specification for the Star-of-Life Ambulance KKK-A-1822 at the time of its manufacture; or

(2) National Fire Protection Association (NFPA) 1917 “Standard for Automotive Ambulances” at the time of its manufacture.

(b) The ground ambulance is not equipped with the mandatory items specified in the American College of Surgeons’ (ACS) Equipment for Ambulances joint document;

(c) The ground or air ambulance is not covered by the insurance required in this chapter;

(d) The ground ambulance is not registered by the motor vehicle agency for the jurisdiction from which the vehicle will operate;

(e) The sponsoring Emergency Medical Services Agency’s certification has been revoked or has not been renewed;

(f) The ground ambulance is unable to pass a motor vehicle agency inspection;

(g) The air ambulance is unable to pass a FAA inspection;

(h) The motor vehicle agency registration for the ground ambulance has been revoked;

(i) The FAA registration for the air ambulance has been revoked;

(j) Failure to maintain adequate records on the ground or air ambulance;

(k) Failure to maintain the emergency medical response vehicle according to CDC recommendations;

(l) Failure to report an air or ground ambulance collision to the Director; or

(m) Failure to provide proof of a safety inspection performed by the state in which the emergency medical response vehicle is registered.

563.15

Sufficient grounds for denial, suspension, or revocation of a certification granted to an educational institution shall include:

(a) Fraudulently or deceptively obtaining or attempting to obtain a certificate or license for itself or for another;

(b) Fraudulently or deceptively using a certificate or license;

(c) Willfully making or filing a false report or record related to the provision of emergency medical services instruction;

(d) Willfully failing to file or record, willfully impeding or obstructing the filing or recording, or willfully destroying a report required to be filed by statute or regulation;

(e) Knowingly providing emergency medical services instruction through an individual who is not certified to provide instruction or is not authorized to provide instruction in the area in which he or she is providing instruction, or knowingly aiding an uncertified or unauthorized individual in providing emergency medical services instruction;

(f) Being disciplined by a licensing or disciplinary authority, or adjudicated by a court of any state or country, or disciplined by any branch of the United States government for an act that would be grounds for disciplinary action under this regulation;

(g) Willfully submitting a false statement to collect a fee;

(h) Surrendering the certificate or license issued by another jurisdiction as a

result of an investigation or disciplinary action by a certifying, licensing, or disciplinary authority or by a court of another jurisdiction for an act that would be grounds for disciplinary action under this chapter;

1. (i) Providing emergency medical services instruction beyond the institution's authorized scope of instruction;
2. (j) Providing emergency medical services instruction beyond the instructor's authorized scope of instruction;
3. (k) Refusing, withholding from, denying, or discriminating against an individual requesting emergency medical services instruction due to race, color, religion, national origin, sex, age, marital status, personal appearance, sexual orientation, gender identity or expression, familial status, family responsibilities, matriculation, political affiliation, genetic information, disability, source of income, status as a victim of an intrafamily offense, or place of residence or business;
4. (l) Intentionally misrepresenting the level of emergency medical services instructional certification held by individuals or the institution;
5. (m) Failure to maintain required levels of insurance and liability coverage;
6. (n) Failure to have a medical director;
7. (o) Failure to have a program director;
8. (p) Failure to submit an annual report to DOH;
9. (q) Failure to maintain records in accordance with this chapter or DOH policy;
10. (r) Failure to teach the appropriate curriculum or according to the National Educational Standards;
11. (s) Failure to pass a site visit inspection;
12. (t) Failure to notify DOH of changes in medical director, agency, or program;
13. (u) Failure to conduct at least one (1) full length certification course every two (2) years;
14. (v) Failure to obtain, revocation of, or failure to renew licensure through the ELC for those institutions required to be licensed by ELC;
15. (w) Failure to make necessary improvements to an educational program when an institution has been placed in a one (1) year probation period; or

(x) Failure to maintain Committee on Accreditation of Educational Programs for the Emergency Medical Services Professions (CoAEMSP) accreditation for paramedic education programs.

563.16

Sufficient grounds for denial, suspension, or revocation of a certification granted to an emergency medical service instructor, or reprimand of an instructor, shall include:

1. (a) Fraudulently or deceptively obtaining or attempting to obtain a certificate or license for oneself or for another;
2. (b) Fraudulently or deceptively using a certificate or license;
3. (c) Providing instruction in an area for which the instructor is not certified;
4. (d) Failure to obtain satisfactory teaching evaluations;
5. (e) Failure to maintain an adequate number of teaching hours during the instructor's certification period;
6. (f) Failure to maintain provider certification equal to the instructor's level of instruction;
7. (g) Loss of certification by the sponsoring EMS educational institution;
8. (h) Failure to attend instructor workshops when required;
9. (i) Failure to maintain an associated instructional certification for EMS and CE instructors;
10. (j) Failure to maintain an associated ALS instructional certification, for AEMS instructors;
11. (k) Failure to maintain paramedic certification, for AEMS instructors;
12. (l) Willfully making or filing a false report or record related to the provision of emergency medical services instruction;
13. (m) Willfully failing to file or record, willfully impeding or obstructing the filing or recording, or willfully destroying a report required to be filed by statute or regulation;
14. (n) Knowingly providing emergency medical services instruction with an unauthorized individual, or knowingly aiding an unauthorized individual in providing emergency medical services instruction;

(o) Being disciplined by a licensing or disciplinary authority, or convicted or disciplined by a court of any state or country, or disciplined by any branch of the United States government for an act that would be grounds for disciplinary action under this regulation;

(p) Willfully submitting a false statement to collect a fee;

(q) Refusing, withholding from, denying, or discriminating against an individual requesting emergency medical services instruction due to race, color, religion, national origin, sex, age, marital status, personal appearance, sexual orientation, gender identity or expression, familial status, family responsibilities, matriculation, political affiliation, genetic information, disability, source of income, status as a victim of an intrafamily offense, or place of residence or business; or

(r) Intentionally misrepresenting the level of emergency medical services instructional certification held by the individual.

563.17 Sufficient grounds for denial, suspension, or revocation of a certification granted to an emergency medical services provider, or reprimand of the provider, shall include:

(a) Fraudulently or deceptively obtaining or attempting to obtain a certificate or license for himself or herself or for another;

(b) Fraudulently or deceptively using a certificate or license;

(c) Engaging in unprofessional or illegal conduct while providing emergency medical services;

(d) Being adjudicated incompetent;

(e) Abandoning a patient;

(f) Providing emergency medical services while:

(1) Under the influence of alcohol; or

(2) Using a narcotic or controlled dangerous substance, as defined in District of Columbia law, that is in excess of therapeutic amounts or without valid medical indication or a valid prescription or abusing any other drug or substance in a manner that is harmful;

(g) Willfully making or filing a false report or record related to the provision of emergency medical services;

1. (h) Willfully failing to file a report or record, willfully impeding or obstructing the filing or a report or record, or willfully destroying a report or record required to be filed by statute or regulation;
2. (i) Knowingly providing emergency medical services with an unauthorized individual, or knowingly aiding an unauthorized individual in providing emergency medical services;
3. (j) Being disciplined by a licensing or disciplinary authority, or convicted or disciplined by a court of any jurisdiction, or disciplined by any branch of the United States government for an act that would be grounds for disciplinary action under this regulation;
4. (k) Failure to meet or violating appropriate protocols or standards of care for the delivery of emergency medical services;
5. (l) Willfully submitting a false statement to collect a fee;
6. (m) Surrendering a certificate or license issued by another jurisdiction as a result of an investigation or disciplinary action by a certifying, licensing, or disciplinary authority or by a court of another jurisdiction for an act that would be grounds for disciplinary action under this chapter;
7. (n) Knowingly failing to report suspected child abuse or neglect in violation of the Prevention of Child Abuse and Neglect Act of 1977, effective September 23, 1977 (D.C. Law 2-22; D.C. Official Code § 4-1301.02(3) (2012 Supp.));
8. (o) Selling, prescribing, giving away, or administering drugs for illegal purposes;
9. (p) Breaching patient confidentiality in violation of HIPAA or any other applicable privacy law or regulation;
10. (q) Providing emergency medical services beyond the individual's authorized scope of practice;
11. (r) Conviction of, pleading guilty or nolo contendere to, or receiving probation before judgment with respect to a felony, a serious crime of violence against a person, a crime involving controlled dangerous substances, a serious crime against property, a crime involving sexual misconduct, a crime in which the victim is a patient or other individual entrusted to the care or protection of the applicant or EMS provider, or a crime involving moral turpitude, whether any appeal or other proceeding is pending to have the conviction or plea set aside, except that the

individual may apply for reinstatement upon any successful appeal or upon the conviction being set aside;

1. (s) Providing or attempting to provide a medical procedure without having received the required education, internship, or experience in the use of the procedure;
2. (t) Refusing, withholding from, denying, or discriminating against an individual in need of emergency medical services, with regard to the provision of services which the certificate holder is certified and qualified to render due to race, color, religion, national origin, sex, age, marital status, personal appearance, sexual orientation, gender identity or expression, familial status, family responsibilities, matriculation, political affiliation, genetic information, disability, source of income, status as a victim of an intrafamily offense, or place of residence or business;
3. (u) Failing to comply with the District of Columbia EMS guidelines on standard protocols except when the District EMS Officer determines it is impractical or not feasible;
4. (v) Intentionally misrepresenting the level of emergency medical services certification held by the individual;
5. (w) Failure to comply with the terms of a probation, suspension, or disposition agreement;
6. (x) Failure to maintain NREMT certification;
7. (y) Failure to maintain affiliation with a District EMS Agency; or
8. (z) Withdrawal of sponsorship by the sponsoring medical director.

SOURCE: Final Rulemaking published at 60 DCR 16569 (December 6, 2013).