State emergency medical chief resigns

A state regulator who pushed for stronger oversight of California paramedics and backed an unsuccessful proposal to consolidate licensing of tens of thousands of emergency medical technicians has announced his resignation.

Dr. Cesar Aristeiguieta, director of the state Emergency Medical Services Authority, said in an interview that he would step down Jan. 1, citing a desire to return to the private sector for personal financial reasons.

The departure comes at a crucial juncture for a backwater state agency that has been trying to exert more influence over the state’s sprawling and fragmented medical rescue network.

The first physician to head the agency in nearly a decade, Aristeiguieta is departing after only two years on the job. His decision caught many observers off guard and triggered larger questions about how the agency’s top job should be structured.

Aristeiguieta, who is paid $200,000 a year, said he had an opportunity to join a Southern California medical firm and increase his income, which would help to cover his daughter’s college expenses. Recent conflicts over regulation of the state’s 70,000 EMTs did not play a role in his decision, he said.

State officials, firefighter groups, fire chiefs, ambulance companies and local medical care administrators are engaged in a debate over how to improve oversight of EMTs, who are regulated by dozens of local agencies.

Some of the agencies have failed to conduct criminal background checks on applicants. And with no central registry of EMTs, rescuers who have been fired or disciplined have been able to move across county lines to find new jobs. Aristeiguieta backed a proposal to license and discipline EMTs on a statewide basis. But negotiations have dragged on, as interest groups, lawmakers and Gov. Arnold Schwarzenegger have struggled to come to an agreement.

A Times investigation this year found haphazard oversight of both paramedics and lesser-trained EMTs. The numbers and types of disciplinary actions against EMTs were strikingly inconsistent from region to region. And allegations of potentially serious lapses in care by both types of medics were not always reported to regulators.

In response, Aristeiguieta said new legislation was needed to address shortfalls in reporting requirements.

Some emergency officials said Aristeiguieta’s departure underscores difficulties in retaining qualified physicians in the top job. Doctors have tended to stay in the job only a few years, said Lou Meyer, the ambulance industry representative on the state Commission on Emergency Medical Services, which advises Aristeiguieta’s agency.

“Someone needs to make a decision whether the authority should be run by a physician or run by a strong administrator who is supported by a medical advisory board,” he said.

“You’re overseeing medical care in the streets for 30 million people,” said Dr. Marc Eckstein, medical director for the Los Angeles Fire Department. “Why shouldn’t we have a qualified physician in that position?”

State law requires that a physician head the agency. But for years, a nonphysician manager, designated as an interim leader, was in charge partly because low pay failed to attract qualified applicants. The pay was increased during Aristeiguieta’s tenure.

Eckstein said ensuring adequate funding and giving the director greater job security and independence could be key to keeping doctors in the post.

“The job is so political. . . . Sometimes you have to ruffle feathers as a physician to do what’s right,” he said. “You only begin to make an impact in two years, especially in a system as complex as the state of California.”

That complexity was highlighted this year. After months of negotiations, various groups with a stake in regulation agreed on compromise reform legislation that would have required state and federal criminal background checks for EMTs. The bill also would have set up a state registry for EMTs, including records of disciplinary actions. Enforcement of discipline, however, was to be left primarily to fire departments and ambulance companies, with oversight by regional medical authorities.

Critics said the bill undercut regulators’ ability to protect the public from errant medics, and Schwarzenegger vetoed the bill.

Aristeiguieta was criticized by some for not participating in negotiations and allegedly urging the governor to veto the bill. He declined to respond to the criticism but said he was proud of what he had accomplished overall.

An Emergency Medical Services Authority administrator will serve as acting director while Aristeiguieta’s replacement is found, the governor’s office said.

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rich.connell@latimes.com