Dealing With Regulatory Oversight

You’re reading through the report a state inspector handed you. The results aren’t perfect, but they aren’t as bad as you feared. Your staff is on edge every time the inspector comes around. Most have a sense of dread when that vehicle pulls into the parking lot. But the regulatory personnel who ensure your appropriate operations need not be viewed as the enemy. Here’s what to know about them. 

The Job

Regulatory officials have a role to play. Their job is to make sure emergency medical service agencies are doing their job, which involves making sure their personnel perform their duties properly. Often their roles have them dealing with ambulances, medical helicopters, nonemergency transport vehicles, and first-response agencies in the course of a day.

Field staff and managers alike may perceive regulators as “big brother” watching everything they do. The reality is that they’re more like a quality assurance or continuous quality improvement program. The function of inspectors and regulatory personnel isn’t to chastise operators who don’t meet expectations. Supervisory staff is there to ensure rules and guidelines are being met. 

Though some oversight functions are done by digging through electronic records and hard copies, much verification requires handling in person. Where compliance is lacking, inspectors are available to assist. They do this by providing guidance and options to help meet the governing body’s requirements. Officials can assist with interpreting rules and explaining the intent of laws and regulations (which may not always be apparent).

Inspectors and auditors do not benefit from writing citations. In most instances failing inspections result in more work. Another visit is usually required to verify compliance after an agency submits documentation of necessary changes and pays a reinspection fee.

EMS providers commonly have little interaction with their state or local EMS oversight agency. Routine vehicle inspections and agency audits are the only contact most will ever have. 

State EMS agency representatives have different titles: consultant, inspector, auditor, investigator, etc. Regardless of their official title, they represent the state agency or regulatory board and verify compliance with its rules and laws. 

Sources of Information

Regulatory agency personnel are great resources for information. Their demeanor may seem offputting at times, but most of that is probably your imagination. They are open to questions about EMS in their jurisdiction and may provide details on pending rules, legislation, or scheduled meetings. No one gets into EMS without being a people person—they likely look forward to inquiries and enjoy sharing what they know.

As officials observe many operations within their jurisdictions and others, they can often provide ideas for compliance and other matters. These best practices can often be tailored by agencies to meet their specific needs.

The Secrets Behind Audits and Inspections

If you’re unsure what to expect when an inspection is about to happen, ask. Most officials are more than glad to review their processes and allow you to watch as they go about their work. They can explain what they’re looking for and why.

It is beneficial to have a staff member tag along during inspections and audits. Besides asking questions and extracting guidance on how things can be done more efficiently, they can also answer the inspector’s questions and help them locate needed items. 

Contrary to some beliefs, the “secret” things inspectors are trying to find or verify are generally published and available in the public domain. Most officials can provide you a copy of or link to what is expected. 

Regulatory bodies must investigate complaints. When one is received they have a duty to verify the existence or nonexistence of any violation. Conducting such investigations is a thankless job but necessary. 

Being an investigator requires training, experience, and levelheadedness. Investigations must be conducted fairly, without bias or preconceived notions of wrongdoing. Investigators will be looking for facts; however, it doesn’t hurt to shed some additional light for them on nuances that may help their understanding of the situation. 

Most have learned not to accept complaints at face value—they get many that don’t actually represent violations of regulations or laws—but instead work to gather facts. As with patient care reports, they need to know what happened and what didn’t—as most providers learned in documentation class, pertinent negatives must be covered. 

An investigation requires obtaining statements from all parties involved, relevant records or certified copies, and comparing them. When discrepancies arise, investigators will search more profoundly and reinterview people until they are comfortable with the findings surrounding the complaint.

Their report will detail how the facts fit together and be forwarded to decision-makers within the oversight agency. Most investigators are not part of investigations’ penalty phases but will take part in complaint reviews to answer questions about their findings.

Making Life Easier

Besides being available for questions both in their office and while on site, state regulatory inspectors may work as consultants. In this role they advise local governments and private entities about starting and operating services, providing insight into what’s allowed and not. 

There is enough autonomy in most regional offices to allow inspectors and auditors to work around the busy schedules inherent to EMS. Though the standard 9–5 office hours are a fallacy for most regulators, it allows them enough leeway to get through a license period without much fanfare and special meetings after hours. 

As you work with those who govern and regulate the industry within your jurisdiction, remember the work that’s gone into the profession. Those in oversight capacities were almost always in the same shoes you fill today. Many spent years on the streets, in the backs of ambulances. They know where you’re coming from and appreciate the many masters you serve day to day. 

Inspectors also have masters to serve. Your agency may be administered as part of a state department of health, safety, or transportation. Rulemaking often falls to a commission or board of emergency medical services with representatives from different jurisdictions and stakeholders throughout the state. 

While the state or other enforcing entity often bears the brunt of criticisms for rules and regulations passed, don’t shoot the messenger. These professionals are merely there to enforce the rules and provide information about them. In most instances they have no part in writing the standards. 

One person compared inspectors to their in-laws: They are generally fine people whom you usually like, but it becomes harder when they keep pointing out your faults. However, unlike your in-laws, an inspector is paid to find your faults, so you can work on correcting them.  

John M. Dabbs  is a consultant and investigator for the Tennessee Department of Health–Office of EMS.