Supporters say the bill would update New Jersey's emergency medical services, providing more qualified personnel, uniform care, and reliable response times.
Many doctors, nurses, and medical directors liken the present system to the Wild West, where a group of volunteers can buy an ambulance and start a service without a license or criminal background checks, as required in Pennsylvania and most other states.
But opponents of the so-called EMS Redesign Bill, which awaits action by Gov. Christie by the end of the legislative session Monday, say it would increase bureaucracy and red tape.
Volunteer EMS providers and emergency medical technicians, including hundreds represented by the New Jersey State First Aid Council, acknowledge that changes are needed in the state law covering what they do.
But they say this legislation would severely affect the state, municipalities, and volunteer providers, loading them with millions of dollars in unfunded mandates that could lead to service cuts or the end of some squads.
"Emergency medical services are among the most fundamental functions we can provide as a government," said Assemblyman Herb Conaway (D., Burlington), sponsor of the EMS bill. "We need to overhaul our system."
The measure has elicited emotional debate and narrowly won passage last month. It is being studied by the Office of the Governor's Chief Counsel, which will offer recommendations to Christie.
He "could sign it, absolutely veto it, or conditionally veto it and send it back" with recommended changes, said Kevin Roberts, a spokesman for the governor. If a conditional veto is issued, the legislature could turn it around immediately, he said. Or the bill could be held over for the next legislative session.
Efforts to revamp the EMS system began to build after a 2007 report, requested by the legislature, that found it in a "state of crisis." The system was financially strapped, had declining volunteer membership, and lacked comprehensive legislation.
"There are only five states out of 50 that don't require licensure of EMS organizations," said Scott Kasper, corporate director of emergency services at Virtua-Mount Laurel and president of the New Jersey Association of Paramedic Programs. The bill "is nothing controversial or new, nothing outrageous."
The legislation applies to "everybody in the system," Kasper said. "This is not 'paid' vs. 'volunteers.' This should be about the patient. How do we provide the best service to the citizens of New Jersey?"
The measure would update and codify New Jersey's EMS standards, said Andy Lovell, chief of emergency medical services for Gloucester County.
"When you pick up the phone and dial 911, you expect a timely response," Lovell said. "You expect if I come to your home on what could be the worst day of your life, that I am trained to minimum standards and that I've been screened with background checks."
But questions about the bill's impact remain.
"Having the 'best quality of EMS' no matter where you live or work is a goal set by the New Jersey Department of Health and Senior Services," wrote William Dressel Jr., executive director of the New Jersey League of Municipalities, in a recent letter to Christie.
"The challenge is how to make that goal work within the budget structure we face. . . . Municipal revenues are down, donations are down, and expenses are increasing."
Volunteer rescue squads that don't charge for their services are wary of potential costs associated with the bill. The First Aid Council, which has 325 member squads, asked lawmakers to add language that would waive licensing fees for volunteer organizations and responders. The volunteers typically must raise their own funds and receive aid from their municipalities.
In the bill, only emergency medical technicians are specifically exempted. The failure to mention their organizations has led volunteers to conclude that the state will begin to charge the squads. Under current state regulations, only commercial ambulance squads are charged.
"I don't trust anything that is not specifically spelled out in legislation," said Howie Meyer, legislative director for the First Aid Council and an EMT instructor at a squad in Berkeley Heights, Union County.
Not only would the bill increase bureaucracy at the state level, it could cost volunteer squads a minimum $1,500 initial licensing fee, plus a $100 fee for each ambulance, said Edward Burdzy, executive director of the First Aid Council.
If fees were imposed on the volunteer organizations, they would pay $500 for licensing every two years after that and $100 for each ambulance.
There are not enough personnel to inspect ambulances, "so additional staff would be needed" at the state level, added Burdzy, former mayor of Holland Township in Hunterdon County and a life member of the Milford-Holland Rescue Squad.
Though agreeable to background checks and ambulance inspections, the volunteers oppose licensing of squads through the Department of Health, as required by the bill. Proponents point out that commercial ambulance services already are licensed by the state, a system they say should be standardized.
"We strongly recommend leaving the current system in place" providing for group certification rather than licensing, said Burdzy. "There is no difference in the care provided to patients, and this will eliminate a cost increase."
If licensing becomes a requirement, they would prefer it be done by a board in the state Division of Consumer Affairs that oversees other medical professions.
Another provision would require an ambulance to have an emergency medical technician on board "while it is in service." Volunteers interpret that to mean that the unit could not leave the station without that person, and would rather that a technician be allowed to rendezvous with the ambulance at the site of the patient.
"It's more important to get the [technician] to the patient than [to] the ambulance," said Meyer. "We believe the EMT can arrive separately to save time and be in the ambulance when the patient is on the way to the hospital."
Volunteers also have criticized the bill's requirement that ambulances have a GPS unit, saying it would cost hundreds of thousands of dollars and could lead to more calls outside of their jurisdictions.
Though the EMS community isn't unified on the bill, it knows change is necessary and inevitable.
"This legislation would institute various measures that will revolutionize services, making them more efficient and effective, while streamlining the system to save taxpayer dollars," said Assemblyman Angel Fuentes (D., Camden).