Receiving a letter from the Maryland Institute for Emergency Medical Services Systems (MIEMSS) stating you are under investigation can be unsettling. However, understanding the process is crucial. This blog breaks down the EMS disciplinary procedure, from the initial letter to a potential hearing, and explains why seeking legal counsel early can significantly protect your certification, career, and reputation.
The Initial Investigation: How it Begins
The disciplinary process starts when MIEMSS receives an incident report concerning an EMS provider. An incident report is a formal written allegation that an EMS provider has violated Maryland law or EMS regulations. These reports can originate from various sources, including:
- Notifications about alleged violations by license, certification, or renewal applicants
- Law enforcement reports
- Reports from hospitals or other medical facilities
- Reports from other states, countries, military branches, or local/state government unit
- Consumer complaints
- News articles, media reports, or videos
- Malpractice claims
- Information submitted in Ambulance Information System run sheets
- Any other information, from any source, that warrants investigation (COMAR 30.02.05.02(b))
Once MIEMSS receives a report, an investigator reviews it and shares their findings with the Incident Review Committee. This committee assesses the case and decides to either:
- Close the matter
- Refer it for further investigation
- Proceed with filing a formal complaint (COMAR 30.02.05.03(E))
Receiving “The Letter”: Notification of a Complaint
If the Incident Review Committee decides to file a complaint against your EMS certification, the case is then sent to the Provider Review Panel. You will receive a formal letter informing you of the complaint and providing you with the opportunity to submit a written response to the allegations. Importantly, this letter will also advise you of your right to be represented by an attorney. You are not obligated to submit a written statement, whether you have legal representation or not (COMAR 30.02.05.03(F)).
Reviewing the Complaint: What Happens Next
The Provider Review Panel will review the complaint and any written response you submit. Following this review, the Panel will recommend an action to the EMS Board. The EMS Board can then take one of the following actions (COMAR 30.02.05.04):
- Dismiss the complaint: The Board finds no sufficient basis for disciplinary action.
- Ask the provider to enter a disposition agreement. This is an agreement where you agree to comply with specific conditions in exchange for the Board closing the investigation. Past disposition agreements have included requirements such as:
- Additional training or continuing education
- Random drug and alcohol testing
- Completion of an anger management program
- Psychological evaluation
- Mental health counseling
- Temporary suspension of your certification
- A probationary period where your certification remains active under additional oversight (See here)
- Issue a noncompliance notice: This is a formal written notification from the Maryland EMS Board stating they believe you have violated a regulation, law, or professional standard, and that disciplinary action may be taken. The notice will specify the potential disciplinary actions being considered, such as a reprimand, probation, suspension, revocation, denial or nonrenewal of your certificate, or a cease and desist order (COMAR 30.02.05.05).
Responding to a Noncompliance Notice: Your Right to a Hearing
If you receive a noncompliance notice, you have 30 days to request a hearing to challenge the Board’s decision (COMAR 30.02.05.08).
The Administrative Hearing: Presenting Your Case
If you request a hearing, the matter becomes a contested case (Md. Code Ann., State Gov’t § 10-202). This hearing provides you with a formal opportunity to present your side of the story, typically before an Administrative Law Judge (ALJ). These hearings function similarly to a mini-trial. Both you (or your attorney) and MIEMSS can:
- Call witnesses to testify
- Offer evidence to support your case
- Cross-examine the opposing party’s witnesses
- Present legal arguments (Md. Code Ann., State Gov’t § 10-213)
After the hearing, the ALJ will issue findings of fact, conclusions of law, and a proposed order to the EMS Board. However, the EMS Board is not obligated to follow the ALJ’s recommendations. Within 60 days, the Board will issue its final decision and mail a copy to you (Md. Code Ann., State Gov’t § 10-220).
Judicial Review: Appealing the Board’s Decision
If you disagree with the EMS Board’s Final Order, you have the right to seek judicial review in the Circuit Court. It’s important to understand that this is not a new trial. The court will only review the existing administrative record from the previous stages. The court can only reverse or modify the Board’s decision if it finds a clear legal error, a violation of your procedural rights, or that the decision is not supported by substantial evidence (Md. Code Ann., State Gov’t § 10-222). If the Circuit Court upholds the Board’s decision, you may have the option to appeal further to the Appellate Court of Maryland (Md. Code Ann., State Gov’t § 10-222).
Why Early Legal Counsel Is Crucial: Contact Kurt E. Nachtman and Silverman Thompson
Many EMS providers mistakenly wait too long to seek legal help. However, involving an attorney early in the disciplinary process can significantly impact the outcome of your case. An experienced attorney can:
- Assist you in drafting a comprehensive and effective response to the initial complaint
- Negotiate more favorable terms in a potential disposition agreement
- Provide a strong legal defense at your administrative hearing
- Critically, present competent evidence, including expert witnesses, on your behalf to counter the expert testimony presented by the Board
Navigating the complexities of this process and understanding your rights can be challenging. Engaging an attorney who specializes in administrative law and EMS regulations can be the crucial difference in protecting your certification and your career.
Kurt E. Nachtman is an experienced litigation attorney whose practice areas include criminal, civil, administrative, and medical malpractice law. If you are facing investigation from MIEMSS or have any questions surrounding EMS disciplinary procedures, do not hesitate to contact him at kurt@silvermanthompson.com or toll-free at 800.385.2243.