Critical Care Endorsement Bill Pending in Colo. Senate

On January 22, 2013, in a crowded committee meeting room in the basement of the Colorado state capitol building, members of the EMS Association of Colorado, the president of the Colorado Chapter of ACEP, the president of the Colorado Chapter of the AMA and the deputy director for the Colorado Department of Public Health & Environment all came together to testify in support of House Bill 13-1063.

The committee was the House Health, Insurance and Environment Committee, and freshman Representative Leroy Garcia needed the committee’s approval of his very first piece of proposed legislation so it could move forward to a vote by the full House of Representatives before going through a similar process in the state Senate and eventually being signed into law.

Who is Rep. Garcia and just what was so important about his first proposed piece of legislation that it garnered such a heavy support from all spectrums of Colorado EMS? A newly elected state representative, Garcia, 31, is a part-time paramedic for AMR Pueblo and a full-time faculty member for the EMS training program at Pueblo Community College.

Garcia got his start in EMS like many folks—by accident. In 2000, the Marine Corps reservist was pursuing a nursing degree and looking for a summer elective when someone suggested an EMT course. “It turned out to be one of those fortuitous ‘seemed like a good idea at the time’ kind of things. I took the course and, as you can see, the EMS bug bit hard and deep,” Garcia says. So much so that the nursing student switched majors and began pursuing a degree in EMS.

“Like many area EMTs I worked part-time for American Medical Response (AMR) Pueblo while continuing my studies and meeting my Marine Corps obligations.” In 2003, Garcia—now an EMT—was in the middle of taking the paramedic training course when his Marine Corps unit was activated. Garcia withdrew from the program to serve six months in Iraq and Kuwait.

On his return, the paramedic program’s lead instructor, Randy Kuykendall, worked out a program with his former student to reintegrate and successfully resume his studies with the next paramedic class. The former Marine was successful and as a newly minted paramedic sought not one, but two full-time positions on graduation. The first was as a paramedic with AMR Pueblo. The second job resulted in his meeting, and ultimately marrying, his wife, Michelle.

Garcia’s second job was medical supervisor for the Pueblo County Jail, overseeing the medical staff who provided primary care for the jail’s inmates. He got to see both sides of the primary healthcare issue, from the prehospital and the institutional points of view. His wife went on to become a successful legislative aide, including serving for Colorado Rep. John Salazar and U.S. Senator Michael Bennet.

Leroy eventually cut back his time on the ambulance to accept a full-time faculty position in the EMS training section at Pueblo Community College. Well, that and to marry Michelle, run for a position on the Pueblo City Council and pursue a master’s degree in organizational management. And then, “with support from my family and community, I decided to run for state representative,” he says.

The voters liked what the hard-working medic, EMS instructor and city councilman had to say and last November they selected him to be their representative in Denver. Being a state representative is only a part-time job; the legislature meets for four months of the year. Garcia plans to continue his employment as a part-time paramedic for AMR to keep his skills and certification up and as full-time faculty member at Pueblo Community College during the remainder of the year.

Critical Care Endorsement

Colorado has a scope of practice for each level of EMS provider, known as “Chapter Two” of the state rules. Currently, systems wishing to provide skills or services outside of that scope of practice must file for a waiver for their system. Additionally, there is at present no such thing as a critical care paramedic certification or practice in a state that has great distances and large terrain features—the Rocky Mountains—along with weather extremes that frequently ground air ambulances, between outlying hospitals and the critical care receiving specialty hospitals, most of which are located in and around the Denver metro area.

Garcia’s solution to this hit-or-miss problem is House Bill 13-1063. He contacted Kuykendall, his former mentor and paramedic instructor, who had gone on to become the chief of the Emergency Medical and Trauma Services Section for the Colorado Department of Public Health and Environment (CDPHE) and had since moved up to a deputy director’s position for CDPHE overseeing the EMTS Section, among others. From that conversation, Rep. Garcia crafted his bill to authorize the CDPHE to create a critical care endorsement for paramedics and develop a recommended training program of knowledge and skill requirements.

The first hurdle was getting the bill out of committee to the full House for a vote. On that Tuesday in January, members of the EMS Chiefs and Directors Division of the EMS Association of Colorado testified before the committee. They explained the current hardships and limitations faced by EMS providers transferring critical patients who have been stabilized at an outlying hospital and now require transport to a specialty receiving facility, frequently many miles and a mountain range or two away, often in inclement weather, and with medications running that the medics are not authorized to monitor or administer.

Support and additional testimony for this need was provided by Dr. David Ross, representing the Colorado Chapter of ACEP, and Dr. Jan Kief, a former EMT who went on to medical school and became the president of the Colorado Medical Society. These thoughts were echoed by representatives from Children’s Hospital Colorado, a multi-state regional Level I pediatric receiving facility.

The testimony was concluded by a presentation by Kuykendall, who spelled out how the program would have minimal financial impact on the state, while providing a tremendous advance to the level of care and service that would be provided. He answered a number of questions from the committee on how this certification would be created and implemented.

Everyone in the room felt good about the successful united front, testimony and support for the bill. And then the rug was pulled out from under virtually everyone in attendance, especially Rep. Garcia, as his bill was put to vote and one after another the committee members voted against it. A stunning, and unanimous, defeat.

There was stunned silence in the committee room as the committee chair gravely announced the vote was 10 nays and zero ayes. But that was as long as the chairwoman could keep a straight face before announced she it was tradition at the capitol to unanimously vote down a freshman legislator’s first bill. She asked if anyone on the committee would like to revisit the vote, which was quickly motioned and seconded.

House Bill 13-1063 passed unanimously out of committee and again in the state House of Representatives, 63-0, with two absences. Now the bill is pending in the state Senate, where supporters hope it will soon pass and ultimately be signed into law by the governor. Not a bad start for a new representative in his first month.

“I would like to voice my thanks for all the support that came from across the state to testify and lobby to improve the level of EMS care we can provide,” Garcia says. “Not just for the urban/suburban areas but statewide, including the super-rural/frontier areas where this is needed the most. The word went out and we had people showing up and signing up to testify in support of this bill whom I had no idea were coming. That meant more to me than words can say.

“Secondly, while the success of this bill is great, I don’t want to be known as ‘just the EMS legislator,’” he continues. “I—we—need to be representing all the residents of this fantastic state. I am looking forward to finding ways to best help small businesses, as they provide the majority of the employment in the state, along with farmers and ranchers. And I want to do what I can help to help my brother service men and women through re-entry and job transition programs, along with family support. It is the least we can do for our warriors who gave up so much to protect and serve us.”

If what has transpired so far in just the first month of Garcia’s freshman term as a state representative is any indication, there’s a lot of good that could come from having a few more EMS providers in their respective state legislatures.

Norm Rooker has been involved in EMS since 1973. He and his wife, Vicki, a paramedic with 22 years on the job, were part of the effort to successfully get House Bill 13-1063 through committee, where they also got to experience first-hand the Health, Insurance and Environment Committee’s little bit of legislative humor at Rep. Garcia’s expense.