Proposition 11

Requires Private-Sector Paramedics to Remain On-Call During Work Breaks

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This measure would change an existing law that entitles hourly employees to breaks without being on-call so that it would not apply to private-sector ambulance employees. Proposition 11 is an initiative statute.

Fiscal Impact: Likely fiscal benefit to local governments (in the form of lower costs and higher revenues), potentially in the tens of millions of dollars each year.

Semi-official results:

Yes: 2,553,672 (62.0%)

No: 1,561,954 (38.0%)

Details

Pro/Con
Pro: 

Proponents of Proposition 11 argue that California faces disasters too often and this ballot measure ensures EMTs and paramedics are paid to be reachable during breaks to save lives, gives them better disaster training that meets FEMA standards and mandatory mental health coverage.

A YES vote on this measure means: Private ambulance companies could continue their current practice of having emergency medical technicians (EMTs) and paramedics stay on-duty during their meal and rest breaks in order to respond to 911 calls. Private ambulance companies would attempt to reschedule meal and rest breaks that are interrupted by a 911 call.

YesOn11.org

Con: 

No argument against Proposition 11 was submitted to the California Secretary of State.

A NO vote on this measure means: Private ambulance companies would be subject to labor laws for this industry. Based on a recent court decision, these laws likely would require ambulance companies to provide EMTs and paramedics with off-duty meal and rest breaks that cannot be interrupted by a 911 call.

In Depth

Background

Private companies own and operate most ambulances in California, and provide about 75 percent of all emergency ambulance rides. In the other 25 percent of cases, the local fire department has its own ambulances and drives patients to the hospital. More than two-thirds of ambulance trips are for patients with government insurance (such as Medicare or Medi-Cal), about 20 percent are for patients with commercial health insurance, and the remainder have no insurance. On average, commercial insurers pay $1,800 per ambulance ride—more than double the $750 cost of an ambulance trip in California. Medicare pays about $450 per trip, while Medi-Cal pays about $100 per trip.

Counties typically choose the ambulance company through a competitive bidding process, and the ambulance company pays the county for the right to provide ambulance trips in that area. The ambulance company generates revenue by collecting payments from patients' insurers. There are 17,000 emergency medical technicians (EMTs) and paramedics in California and about 3,600 ambulances.

Meal and Rest Breaks Taken by EMTs and Paramedics. In practice, EMTs and paramedics are “on call” for their entire work shift in case they receive an emergency call. This means that their breaks are sometimes interrupted by 911 calls. They can also be interrupted by a request to reposition to a new posting location. As a result, EMTs and paramedics are often unable to plan their meal and rest breaks. At the same time, most ambulance shifts include down time between emergency calls. (Urban areas tend to have less down time than rural areas do.) As a result, crews often have enough down time in their shift to take uninterrupted meal and rest breaks even though they are technically on call.

In 2016, the California Supreme Court ruled that on-call breaks violate state labor law, in a ruling called the Augustus decision. Instead, employers must provide breaks that are off-duty and not interruptible, even if an emergency occurs. To follow state law under this decision, ambulance crews would have to go off-duty during their meal and rest breaks. This would increase costs to ambulances companies—potentially by more than $100 million each year statewide. To address higher costs and still remain profitable, companies would need to raise revenue and/or reduce costs. It is likely that much of these higher costs would be borne by counties.

Proposition 11 Proposal

This measure makes changes to state laws that affect private-sector EMTs and paramedics. The measure would not apply to EMTs and paramedics who work for public agencies, such as fire departments.

Requires On-Call Meal and Rest Breaks for EMTs and Paramedics. The measure requires EMTs and paramedics to stay on call during their whole shift. In effect, the measure continues the industry practice of requiring EMTs and paramedics to remain on call during breaks. At the same time, however, the measure requires that meal breaks (1) not be during the first or last hour of a shift, and (2) be spaced at least two hours apart. The measure requires ambulance companies to operate enough ambulances to meet these meal break schedules.

Seeks to Limit Costs for Past Practice of On-Call Meal and Rest Breaks. The Augustus decision suggests that the practice of requiring EMTs and paramedics to stay on call during breaks is against the law. Private ambulance companies may now owe penalties for these past violations. Several groups of EMTs and paramedics have sued ambulance companies alleging these violations. These lawsuits are still active. In addition to requiring on-call meal and rest breaks going forward, this measure states that the past industry practice of on-call meal and rest breaks was allowable. This could eliminate costs that ambulance companies may face related to these lawsuits.

Requires Employer-Paid Training and Mental Health Services. The measure requires ambulance companies to offer EMTs and paramedics (1) annual natural disaster, active shooter, and violence prevention training; (2) mental health and wellness education; (3) mental health counseling sessions; and (4) access to long-term mental health services.

Source: LAO Analysis of Proposition 11

Polling

Visit Ballotpedia for summary data from recent polls and links to the complete published polls.

Berkeley IGS Polls

Voter Resources

Official California Documents

Official Voter Guide

Prop 11 - California Official Voter Guide

Campaign Finance Information

Voter's Edge Campaign Contributions: Total money raised, size of contributions, and top contributors

Power Search: Access and download data from the Secretary of State's CAL-ACCESS System

Nonpartisan Analysis

Ballotpedia

Requires Private-Sector Emergency Ambulance Employees to Remain on Call During Work Breaks. Changes Other Conditions of Employment. Initiative Statute. Legislative Analyst's Office.

Ballot Measure Guide - Prop 11. Berkeley IGS.

Multimedia
Non-Partisan
"Video Voter Series - Proposition 11" from Rose Institute of State and Local Government at Claremont McKenna College
"Video Voter Series - Proposition 11" from Rose Institute of State and Local Government at Claremont McKenna College
"Proposition 11 Explained in Under 1 Minute" from CALMatters1
"Proposition 11 Explained in Under 1 Minute" from CALMatters1
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