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Santaniello v. New Jersey Dep't of Health and Senior Services

October 22, 2010


On appeal from the Department of Health and Senior Services.

The opinion of the court was delivered by: Parrillo, J.A.D.



Argued September 28, 2010

Before Judges Parrillo, Yannotti, and Espinosa.

Appellant Steven Santaniello is an Emergency Medical Technician (EMT)-Paramedic, currently on inactive status, who challenges the validity of regulations of the Department of Health and Senior Services (Department) governing the recertification of EMT-Paramedics pursuant to the Emergency Medical Services Act (EMS Act), N.J.S.A. 26:2K--7 to -64. Specifically, appellant argues that the Department's recertification regulations: (1) exceed the scope of the EMS Act by adding requirements beyond those for initial certification; (2) impermissibly delegate the Department's oversight of EMTParamedics by requiring an applicant to obtain the endorsement of a mobile intensive care unit (MICU) hospital and to demonstrate to its medical director the applicant's proficiency in skills approved for pre-hospital care; and (3) violate his right to due process because the regulations do not provide a pre-denial hearing and are overly vague.

By way of background, pursuant to the Health Care Facilities Planning Act (HCFPA), N.J.S.A. 26:2H-1 to -26, the Department is tasked with "central responsibility for the development and administration of the State's policy with respect to health planning, hospital and related health care services . . . ." N.J.S.A. 26:2H--1. Health care services include pre-hospital care*fn1 rendered by paramedical, advanced life support (ALS)*fn2 , and ambulance services. . . ." N.J.S.A. 26:2H-2b. Under the EMS Act, the Department regulates emergency medical services provided by EMT-Paramedics and the hospitals that operate MICUs.*fn3 N.J.S.A. 26:2K-8. As part of its delegated responsibility, the Department certifies EMT-Paramedics.

N.J.S.A. 26:2K-8a.

To this end, the Commissioner of the Department must approve education programs for training EMT-Paramedics and establish written standards for their certification. N.J.S.A. 26:2K-8b. As such, pursuant to its statutory authority, the Department has promulgated regulations governing EMT-Paramedic and MICU certification as well as for ALS techniques approved for EMT-Paramedics. N.J.A.C. 8:41A-1.1 to -5.4. In order to obtain initial EMT-Paramedic certification, a candidate must be at least eighteen years old, possess a high school diploma, EMT-Basic, CPR, and other certifications, complete an EMT-Paramedic training program, and pass the National Registry EMT-Paramedic Certification Examination. N.J.A.C. 8:41A--4.1(b). Initial certifications are valid for a period of not less than twenty-four months, but no longer than thirty months. N.J.A.C. 8:41A-- 4.1(f).*fn4

Because EMT-Paramedics are "trained in [ALS] and . . . render [ALS] services as part of a [MICU,]" N.J.S.A. 26:2K-7h, the EMS Act requires that they operate under the direct supervision of a licensed physician or physician-directed registered professional nurse who is affiliated with a MICU at a hospital accredited by the Department. N.J.S.A. 26:2K--10. Furthermore, all EMT-Paramedics are required to have direct voice communications with the supervising physician or nurse when providing ALS. Ibid. In this regard, only hospitals operating MICUs can perform ALS procedures. N.J.S.A. 26:2K--12a.

Prior to the expiration of the certification, an EMTParamedic must recertify with the Department. See N.J.A.C. 8:41A-4.3.*fn5

Recertification entails meeting requirements in addition to those for initial certification enumerated in N.J.A.C. 8:41A-4.1(b). The candidate must complete forty-eight hours of advanced level continuing education, demonstrate to the MICU hospital's medical director proficiency in all skills approved by the Department under N.J.A.C. 8:41A--5.1 for pre-hospital care, and receive the endorsement of a MICU hospital. N.J.A.C. 8:41A--4.3(a).

"Proficiency may be demonstrated based on actual observation, field performance, or other methods as deemed necessary by the medical director." N.J.A.C. 8:41A-- 4.3(a)(3)(i). The medical director must then "attest[] to the level of proficiency of each EMT-Paramedic seeking recertification." Ibid. The MICU hospital endorsement, N.J.A.C. 8:41A--4.3(a)(4), must include a verification by the MICU director or educator that the applicant has met all the requirements for recertification and that the applicant is physically capable of performing his or her duties as an EMTParamedic. N.J.A.C. 8:41A--4.3(a)(4)(i). A MICU hospital that chooses not to extend its endorsement for recertification must notify the Department with a letter stating the hospital's reasoning. N.J.A.C. 8:41A--4.3(a)(4)(ii).

EMT-Paramedics may avoid expiration of their certification in one of two ways. An individual who is unable "to meet the recertification requirements due to personal illness or injury may be eligible for an extension of his or her EMT-Paramedic certification for a period of one year." N.J.A.C. 8:41A-4.3(h). The other available option is to enter "inactive status" by placing a request with the Department at least thirty days before the expiration of one's certification. N.J.A.C. 8:41A-- 4.5(a). An EMT-Paramedic on inactive status may not actively engage in the provision of ALS care. ...

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