Kansas Attorney General Opinion 2014-020

December 18, 2014
ATTORNEY GENERAL OPINION NO. 2014- 20
Joseph House, Executive Director
Kansas Board of Emergency Medical Services
900 SW Jackson Street, Room 1031
Topeka, KS 66612
Re: 	Public 	Health—Emergency 	Medical 	Services—Paramedics; 	Authorized
Activities
Public Health—Healing Arts—Licensees Who Direct, Supervise, Order,
Refer, Accept Responsibility for, Enter into Practice Protocols with or
Delegate 	Acts 	Which 	Constitute 	Practice 	of 	Healing 	Arts 	to 	Others;
Requirements and Limitations
Synopsis: 	Under K.S.A. 2014 Supp. 65-6119, paramedics are not strictly limited to
working at the scene of a response or in an ambulance during patient
transport. 	During emergencies, subsection (d)(3) of the statute allows
paramedics 	to 	perform 	activities 	specifically 	authorized 	by 	medical
protocols, even in hospital settings. Subsection (d)(2), which authorizes a
paramedic to perform medical tasks while in voice contact with a physician
or certain other health care professionals authorized by a physician, is not
limited to emergency situations. 	To the extent Attorney General Opinion
No. 90-134 reached a different conclusion, that opinion is withdrawn.
A 	physician 	may 	delegate 	medical 	tasks 	to 	an 	emergency 	medical
services (EMS) attendant beyond those tasks specifically authorized in the
EMS Act as long as the attendant is competent to perform the tasks, the
delegation does not violate any other statute or regulation, and the other
criteria for delegation specified in K.S.A. 2014 Supp. 65-28,127 are met.
Cited herein: K.S.A. 2014 Supp 65-28,127; 65-6119.
* 	* 	*

Joseph House
Page 2
Dear Mr. House:
As Executive Director for the Kansas Board of Emergency Medical Services, you ask for
our opinion on two questions regarding the capabilities and limitations of certified
emergency medical services (EMS) attendants.1
The scope of paramedic practice under K.S.A. 2014 Supp. 65-6119
First, you ask whether K.S.A. 2014 Supp. 65-6119 authorizes a paramedic to provide
medical services within the paramedic scope of practice in a medical care facility,
general hospital, special hospital, ambulatory surgical center, recuperation center, or
critical access hospital.
K.S.A. 2014 Supp. 65-6119(d) provides:
(d) 	Upon 	transition 	notwithstanding 	any 	other 	provision 	of 	law, 	a
paramedic may:
(1) Perform all the authorized activities identified in K.S.A. 65-6120, 65-
6121, 65-6144, and amendments thereto;2
(2) when voice contact or a telemetered electrocardiogram is monitored by
a physician, physician assistant where authorized by a physician or an
advanced practice registered nurse where authorized by a physician or
licensed professional nurse where authorized by a physician and direct
communication 	is 	maintained, 	and 	upon 	order 	of 	such 	person, 	may
administer such medications or procedures as may be deemed necessary
by a person identified in subsection (d)(2);
(3) perform, during an emergency, those activities specified in subsection
(d)(2) before contacting a person identified in subsection (d)(2) when
specifically authorized to perform such activities by medical protocols; and
(4) perform, during nonemergency transportation, those activities specified
in this section when specifically authorized to perform such activities by
medical protocols.
1 These attendants include first responders, emergency medical responders, emergency medical
technicians, emergency medical technicians-intermediate, emergency medical technicians-defibrillator,
emergency medical technicians-intermediate/defibrillator, advanced emergency medical technicians,
mobile intensive care technicians, and paramedics. See K.S.A. 2014 Supp. 65-6112(f).
2 These statutes define the scope of practice for emergency medical technicians-intermediate and
advanced emergency medical technicians; emergency medical technicians; and first responders and
emergency medical responders respectively. Thus, paramedics have the broadest scope of practice for
the professions licensed under the EMS Act.

Joseph House
Page 3
You indicate that certified paramedics are currently working in a variety of clinical
settings 	as 	staff, 	relying 	on 	voice 	contact 	with 	a 	physician 	or 	other 	health 	care
professionals authorized by a physician under subsection (d)(2), or pursuant to medical
protocols during emergencies as authorized by subsection (d)(3). 	You wish to know
whether this is allowed or whether paramedics are limited to working at response
scenes and in ambulances during patient transport.
When interpreting statutes, courts begin with the text. 	If the statutory language is plain
and unambiguous, courts give effect to the statute as written. 3 	“Only when the
language of a statute is unclear or ambiguous” is it appropriate to “move to the next
analytical step, applying canons of construction or relying on legislative history to
construe the statute.”4
We are unable to find anything in the text of the EMS Act to suggest that the activities
specified in subsections (d)(2) and (d)(3) of K.S.A. 2014 Supp. 65-6119 may be
performed only at response scenes or in ambulances. 	To be sure, subsection (d)(3)
authorizes reliance on medical protocols only “during an emergency.” But emergencies
can occur in hospitals and other medical facilities as well as outside of them. 	We
conclude that during emergencies subsection (d)(3) of K.S.A. 2014 Supp. 65-6119
authorizes paramedics to perform activities specifically authorized by medical protocols,
even in hospital settings.
Subsection (d)(2) of K.S.A. 2014 Supp. 65-6119 authorizes a paramedic to perform
tasks deemed necessary by a physician or certain other health care professionals
authorized by a physician when the paramedic maintains voice contact and direct
communication 	with 	the 	physician 	or 	health 	care 	professional. 	Attorney 	General
Opinion No. 90-134 considered a prior version of this provision and concluded that it
was limited to emergency situations. 	Although the plain language of the statute
contained no such limitation, the opinion relied on the phrase “emergency medical
services” in the title of the bill to conclude that the Legislature intended paramedics to
act based on voice contact with a physician only during emergencies, not in settings
where medical tasks are foreseeable as part of a patient’s plan of care.
The conclusion of Attorney General Opinion No. 90-134 was debatable at the time.
Nothing in the text of what is now subsection (d)(2) would limit that provision to
emergency situations, and the fact that the phrase “during an emergency” is found only
in subsection (d)(3) strongly implies that subsection (d)(2) is not so limited. 	After all, if
the 	entire 	statute 	were 	limited 	to 	emergency 	situations, 	the 	phrase 	“during 	an
emergency” in (d)(3) would be superfluous, and statutes should generally be interpreted
to avoid redundancy. 5 	While Attorney General Opinion No. 90-134 correctly noted that
the title of a bill can be used as evidence of legislative intent when construing
ambiguous statutory terms, the opinion failed to identify any statutory ambiguity that
3 See, e.g., Unruh v. Purina Mills, LLC, 289 Kan. 1185, 1193-94 (2009).
4 Id.
5 See, e.g., State v. Sedellos, 279 Kan. 777, 783-84 (2005) (“[C]ourts should avoid interpreting a statute
in such a way that part of it becomes meaningless, useless, or surplusage.”).

Joseph House
Page 4
would provide a textual basis for its conclusion. 	And the Kansas Supreme Court has
repeatedly held that “[a] statute should not be read to add something that is not found in
the plain words used by the legislature.” 6
In any event, subsequent statutory changes to K.S.A. 65-6119 have further undermined
the conclusion of Attorney General Opinion No. 90-134. 	In 1991, the Legislature
amended the statute to authorize paramedics to perform certain medical tasks “during
nonemergency transportation.”7 	It is now no longer possible to conclude that the
paramedic scope of practice is limited to emergency situations, and so we believe the
statute should be given its plain meaning. 	Subsection (d)(3) of K.S.A. 2014 Supp. 65-
6119 	is 	limited 	to 	emergency 	situations, 	and 	subsection 	(d)(4) 	is 	limited 	to
nonemergency 	transportation. 	But 	subsection 	(d)(2) 	contains 	neither 	of 	these
limitations, and we decline to read them into the statute. To the extent Attorney General
Opinion No. 90-134 concluded that what is now K.S.A. 2014 Supp. 65-6119(d)(2) is
limited to emergency situations, that opinion is withdrawn.
Delegation by a physician pursuant to K.S.A. 2014 Supp. 65-28,127
Your second question is whether K.S.A. 2014 Supp. 65-28,127 authorizes a physician
to delegate medical tasks to certified EMS attendants beyond those tasks specifically
authorized by the relevant EMS statutes and regulations.
Prior Attorney General opinions reached differing conclusions on the scope of K.S.A.
65-28,127, which prior to 2009 stated:
(a) Every responsible licensee 8 who directs, supervises, orders, refers,
accepts responsibility for, enters into practice protocols with, or who
delegates acts which constitute the practice of the healing arts to other
persons shall:
. . . .
(3) direct, supervise, order, refer, enter into a practice protocol with, or
delegate 	to 	such 	persons 	only 	those 	acts 	and 	functions 	which 	the
responsible licensee knows or has reason to believe such person is
competent and authorized by law to perform. 9
The confusion centered on the phrase “authorized by law to perform” and whether this
meant physicians could only delegate acts that licensed health care professionals were
6 State v. Bruce, 295 Kan. 1036, 1048 (2012) (quotations and citations omitted).
7 L. 1991, ch. 203, § 2.
8 For purposes of K.S.A. 2014 Supp. 65-28,127, “‘responsible licensee’ means a person licensed by the
state board of healing arts to practice medicine and surgery or chiropractic [i.e., a physician or a
chiropractor] who has accepted responsibility for the actions of persons who perform acts pursuant to
practice protocols with, or at the order of, or referral, direction, supervision or delegation from such
responsible licensee.”
9 Emphasis and footnote added.

Joseph House
Page 5
already authorized to perform under the licensing act for their profession. 	As Attorney
General Opinion No. 2000-26 explained:
A narrow reading of the phrase ‘authorized by law to perform’ would
preclude any delegation of any task that falls under the professional
responsibility of a physician, except to another licensed professional when
the task is within the professional responsibility of that other professional.
A 	narrow 	reading 	would, 	therefore, 	preclude 	most 	delegation 	to
unlicen[s]ed individuals, and many acts which are currently deleg[a]ted to
licensed or registered individuals. 	Most probably, that phrase refers back
to the phrase ‘enter into a practice protocol with,’ to prohibit a physician
from entering into a practice protocol with an advanced registered nurse
practitioner that would exceed that practitioner’s normal scope of practice.
If the Legislature meant to prohibit delegation of all tasks except when
delegated to licensed or registered individuals in whose scopes of practice
such duties are a part, it could have said it much more simply.
The opinion found “nothing in the legis[l]ative history to demonstrate an intent to so
drastically limit delegation of tasks.”
Attorney 	General 	Opinion 	No. 	2008-6 	reached 	a 	different 	conclusion, 	however,
explaining that:
[T]here does not appear to be any reason to limit the phrase ‘authorized
by law to perform’ only to practice protocols. The phrase ‘authorized by
law to perform’ refers back to ‘direct, supervise, order, refer, accept
responsibility for, enter into a practice protocol with, or delegate,’ thus
limiting 	a 	physician 	from 	directing, 	supervising, 	ordering, 	referring,
accepting 	responsibility 	for, entering into a practice protocol with, or
delegating activities that would exceed an attendant’s authorized scope of
practice, i.e., the activities an attendant is authorized by law to perform.
In light of these conflicting conclusions, Attorney General Opinion No. 2009-4 withdrew
both Attorney General Opinion No. 2000-26 and Attorney General Opinion No. 2008-6
and concluded that the question would be “best resolved by the legislature after
consultation with health care providers.”
The Legislature responded to Attorney General Opinion No. 2009-4 by amending K.S.A.
65-28,127 to replace the phrase “such person is competent and authorized by law to
perform” with “can be competently performed by such person and is not in violation of
any other statute or regulation.” 10 	The legislative history indicates that this amendment
was introduced at the request of the Executive Director of the Kansas Medical Society,
who wished to ensure that physicians could delegate to registered nurse anesthetists
(RNAs) the ability to order pre- and post-operative medications and diagnostic tests,
10 See L. 2009, ch. 133, § 2.

Joseph House
Page 6
even though the Nurse Practice Act does not authorize RNAs to perform those tasks. 11
The amendment clarified that under certain conditions a physician may delegate acts to
a person who is not licensed to perform them as long as the performance of those acts
is not specifically prohibited by some other statute or regulation.
Given the 2009 amendment to K.S.A. 65-28,127, we conclude that a physician may
delegate medical tasks to an EMS attendant beyond those tasks specified in the EMS
Act provided the attendant is competent to perform the tasks, the delegation does not
violate any other statute or regulation, and the other statutory criteria for delegation are
met.
Sincerely,
Derek Schmidt
Attorney General
Dwight Carswell
Assistant Attorney General
DS:AA:DC:sb
11 Minutes, Senate Public Health and Welfare Committee, March 16, 2009.