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SECOND REGULAR SESSION
SENATE BILL NO. 1292
103RD GENERAL ASSEMBLY
INTRODUCED BY SENATOR HUDSON.
4147S.01I KRISTINA MARTIN, Secretary
AN ACT
To repeal sections 190.103 and 190.105, RSMo, and to enact in lieu thereof two new sections
relating to emergency medical transportation of patients to abortion facilities.
Be it enacted by the General Assembly of the State of Missouri, as follows:
Section A. Sections 190.103 and 190.105, RSMo, are 1
repealed and two new sections enacted in lieu thereof, to be 2
known as sections 190.103 and 190.105, to read as follows:3
190.103. 1. One physician with expertise in emergency 1
medical services from each of the EMS regions shall be 2
elected by that region's EMS medical directors to serve as a 3
regional EMS medical director. The regional EMS medical 4
directors shall constitute the state EMS medical director's 5
advisory committee and shall advise the department and their 6
region's ambulance services on matters relating to medical 7
control and medical direction in accordance with sections 8
190.001 to 190.245 and rules adopted by the department 9
pursuant to sections 190.001 to 190.245. The regional EMS 10
medical director shall serve a term of four years. The 11
southwest, northwest, and Kansas City regional EMS medical 12
directors shall be elected to an initial two-year term. The 13
central, east central, and southeast regional EMS medical 14
directors shall be elected to an initial four-year term. 15
All subsequent terms following the initial terms shall be 16
four years. The state EMS medical director shall be the 17
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chair of the state EMS medical director's advisory 18
committee, and shall be elected by the members of the 19
regional EMS medical director's advisory committee, shall 20
serve a term of four years, and shall seek to coordinate EMS 21
services between the EMS regions, promote educational 22
efforts for agency medical directors, represent Missouri EMS 23
nationally in the role of the state EMS medical director, 24
and seek to incorporate the EMS system into the health care 25
system serving Missouri. 26
2. A medical director is required for all ambulance 27
services and emergency medical response agencies that 28
provide: advanced life support services; basic life support 29
services utilizing medications or providing assistance with 30
patients' medications; or basic life support services 31
performing invasive procedures including invasive airway 32
procedures. The medical director shall provide medical 33
direction to these services and agencies in these instances. 34
3. The medical director, in cooperation with the 35
ambulance service or emergency medical response agency 36
administrator, shall have the responsibility and the 37
authority to ensure that the personnel working under their 38
supervision are able to provide care meeting established 39
standards of care with consideration for state and national 40
standards as well as local area needs and resources. The 41
medical director, in cooperation with the ambulance service 42
or emergency medical response agency administrator, shall 43
establish and develop triage, treatment and transport 44
protocols, which may include authorization for standing 45
orders. Emergency medical technicians shall only perform 46
those medical procedures as directed by treatment protocols 47
approved by the local medical director or when authorized 48
through direct communication with online medical control. 49
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4. All ambulance services and emergency medical 50
response agencies that are required to have a medical 51
director shall establish an agreement between the service or 52
agency and their medical director. The agreement will 53
include the roles, responsibilities and authority of the 54
medical director beyond what is granted in accordance with 55
sections 190.001 to 190.245 and rules adopted by the 56
department pursuant to sections 190.001 to 190.245. The 57
agreement shall also include grievance procedures regarding 58
the emergency medical response agency or ambulance service, 59
personnel and the medical director. 60
5. Regional EMS medical directors and the state EMS 61
medical director elected as provided under subsection 1 of 62
this section shall be considered public officials for 63
purposes of sovereign immunity, official immunity, and the 64
Missouri public duty doctrine defenses. 65
6. The state EMS medical director's advisory committee 66
shall be considered a peer review committee under section 67
537.035. 68
7. Regional EMS medical directors may act to provide 69
online telecommunication medical direction to AEMTs, EMTs, 70
paramedics, and community paramedics and provide offline 71
medical direction per standardized treatment, triage, and 72
transport protocols when EMS personnel, including AEMTs, 73
EMTs, paramedics, and community paramedics, are providing 74
care to special needs patients or at the request of a local 75
EMS agency or medical director. 76
8. When developing treatment protocols for special 77
needs patients, regional EMS medical directors may 78
promulgate such protocols on a regional basis across 79
multiple political subdivisions' jurisdictional boundaries, 80
and such protocols may be used by multiple agencies 81
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including, but not limited to, ambulance services, emergency 82
response agencies, and public health departments. Treatment 83
protocols shall include steps to ensure the receiving 84
hospital is informed of the pending arrival of the special 85
needs patient, the condition of the patient, and the 86
treatment instituted. 87
9. Multiple EMS agencies including, but not limited 88
to, ambulance services, emergency response agencies, and 89
public health departments shall take necessary steps to 90
follow the regional EMS protocols established as provided 91
under subsection 8 of this section in cases of mass casualty 92
or state-declared disaster incidents. 93
10. When regional EMS medical directors develop and 94
implement treatment protocols for patients or provide online 95
medical direction for patients, such activity shall not be 96
construed as having usurped local medical direction 97
authority in any manner. 98
11. The state EMS medical directors advisory committee 99
shall review and make recommendations regarding all proposed 100
community and regional time-critical diagnosis plans. 101
12. Notwithstanding any other provision of law to the 102
contrary, when regional EMS medical directors are providing 103
either online telecommunication medical direction to AEMTs, 104
EMTs, paramedics, and community paramedics, or offline 105
medical direction per standardized EMS treatment, triage, 106
and transport protocols for patients, those medical 107
directions or treatment protocols may include the 108
administration of the patient's own prescription medications. 109
13. Notwithstanding any provision of law to the 110
contrary, no transportation protocol or physician order 111
shall direct an ambulance service to transport a patient to 112
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an abortion facility, as such term is defined in section 113
188.015. 114
190.105. 1. No person, either as owner, agent or 1
otherwise, shall furnish, operate, conduct, maintain, 2
advertise, or otherwise be engaged in or profess to be 3
engaged in the business or service of the transportation of 4
patients by ambulance in the air, upon the streets, alleys, 5
or any public way or place of the state of Missouri unless 6
such person holds a currently valid license from the 7
department for an ambulance service issued pursuant to the 8
provisions of sections 190.001 to 190.245. 9
2. No ground ambulance shall be operated for ambulance 10
purposes, and no individual shall drive, attend or permit it 11
to be operated for such purposes in the state of Missouri 12
unless the ground ambulance is under the immediate 13
supervision and direction of a person who is holding a 14
currently valid Missouri license as an emergency medical 15
technician. Nothing in this section shall be construed to 16
mean that a duly registered nurse, a duly licensed 17
physician, or a duly licensed physician assistant be 18
required to hold an emergency medical technician's license. 19
When a physician assistant is in attendance with a patient 20
on an ambulance, the physician assistant shall be exempt 21
from any mileage limitations in any collaborative practice 22
arrangement prescribed under law. Each ambulance service is 23
responsible for assuring that any person driving its 24
ambulance is competent in emergency vehicle operations and 25
has a safe driving record. Each ground ambulance shall be 26
staffed with at least two licensed individuals when 27
transporting a patient, except as provided in section 28
190.094. In emergency situations which require additional 29
medical personnel to assist the patient during 30
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transportation, an emergency medical responder, firefighter, 31
or law enforcement personnel with a valid driver's license 32
and prior experience with driving emergency vehicles may 33
drive the ground ambulance provided the ground ambulance 34
service stipulates to this practice in operational policies. 35
3. No license shall be required for an ambulance 36
service, or for the attendant of an ambulance, which: 37
(1) Is rendering assistance in the case of an 38
emergency, major catastrophe or any other unforeseen event 39
or series of events which jeopardizes the ability of the 40
local ambulance service to promptly respond to emergencies; 41
or 42
(2) Is operated from a location or headquarters 43
outside of Missouri in order to transport patients who are 44
picked up beyond the limits of Missouri to locations within 45
or outside of Missouri, but no such outside ambulance shall 46
be used to pick up patients within Missouri for 47
transportation to locations within Missouri, except as 48
provided in subdivision (1) of this subsection. 49
4. The issuance of a license pursuant to the 50
provisions of sections 190.001 to 190.245 shall not be 51
construed so as to authorize any person to provide ambulance 52
services or to operate any ambulances without a franchise in 53
any city not within a county or in a political subdivision 54
in any county with a population of over nine hundred 55
thousand inhabitants, or a franchise, contract or mutual-aid 56
agreement in any other political subdivision which has 57
enacted an ordinance making it unlawful to do so. 58
5. Sections 190.001 to 190.245 shall not preclude the 59
adoption of any law, ordinance or regulation not in conflict 60
with such sections by any city not within a county, or at 61
least as strict as such sections by any county, municipality 62
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or political subdivision except that no such regulations or 63
ordinances shall be adopted by a political subdivision in a 64
county with a population of over nine hundred thousand 65
inhabitants except by the county's governing body. 66
6. In a county with a population of over nine hundred 67
thousand inhabitants, the governing body of the county shall 68
set the standards for all ambulance services which shall 69
comply with subsection 5 of this section. All such 70
ambulance services must be licensed by the department. The 71
governing body of such county shall not prohibit a licensed 72
ambulance service from operating in the county, as long as 73
the ambulance service meets county standards. 74
7. An ambulance service or vehicle when operated for 75
the purpose of transporting persons who are sick, injured, 76
or otherwise incapacitated shall not be treated as a common 77
or contract carrier under the jurisdiction of the Missouri 78
division of motor carrier and railroad safety. 79
8. Sections 190.001 to 190.245 shall not apply to, nor 80
be construed to include, any motor vehicle used by an 81
employer for the transportation of such employer's employees 82
whose illness or injury occurs on private property, and not 83
on a public highway or property, nor to any person operating 84
such a motor vehicle. 85
9. A political subdivision that is authorized to 86
operate a licensed ambulance service may establish, operate, 87
maintain and manage its ambulance service, and select and 88
contract with a licensed ambulance service. Any political 89
subdivision may contract with a licensed ambulance service. 90
10. Except as provided in subsections 5 and 6, nothing 91
in section 67.300, or subsection 2 of section 190.109, shall 92
be construed to authorize any municipality or county which 93
is located within an ambulance district or a fire protection 94
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district that is authorized to provide ambulance service to 95
promulgate laws, ordinances or regulations related to the 96
provision of ambulance services. This provision shall not 97
apply to any municipality or county which operates an 98
ambulance service established prior to August 28, 1998. 99
11. Nothing in section 67.300 or subsection 2 of 100
section 190.109 shall be construed to authorize any 101
municipality or county which is located within an ambulance 102
district or a fire protection district that is authorized to 103
provide ambulance service to operate an ambulance service 104
without a franchise in an ambulance district or a fire 105
protection district that is authorized to provide ambulance 106
service which has enacted an ordinance making it unlawful to 107
do so. This provision shall not apply to any municipality 108
or county which operates an ambulance service established 109
prior to August 28, 1998. 110
12. No provider of ambulance service within the state 111
of Missouri which is licensed by the department to provide 112
such service shall discriminate regarding treatment or 113
transportation of emergency patients on the basis of race, 114
sex, age, color, religion, sexual preference, national 115
origin, ancestry, handicap, medical condition or ability to 116
pay. 117
13. No provision of this section, other than 118
subsections 5, 6, 10 and 11 of this section, is intended to 119
limit or supersede the powers given to ambulance districts 120
pursuant to this chapter or to fire protection districts 121
pursuant to chapter 321, or to counties, cities, towns and 122
villages pursuant to chapter 67. 123
14. Upon the sale or transfer of any ground ambulance 124
service ownership, the owner of such service shall notify 125
the department of the change in ownership within thirty days 126
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of such sale or transfer. After receipt of such notice, the 127
department shall conduct an inspection of the ambulance 128
service to verify compliance with the licensure standards of 129
sections 190.001 to 190.245. 130
15. Notwithstanding any provision of law to the 131
contrary, no provider of ambulance service within the state 132
of Missouri that is licensed by the department to provide 133
such service shall transport a patient to an abortion 134
facility, as such term is defined in section 188.015. 135
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