Committee hears bill to extend peer-review protections to EMTs and paramedics; concerns raised about discovery

Representative Cook introduced House Bill 1980 as a patient-safety measure that would clarify that emergency medical services (EMS) professionals licensed under Missouri law are treated the same as other health-care professionals for peer-review and quality-improvement protections. "It's all about patient safety," Representative Cook said, urging the committee to allow candid internal review without fear that peer-review discussions later would be used in court.

Supporters, including Dr. Jeff Kochenour, trauma medical director at the University of Missouri, argued EMTs and paramedics routinely participate in quality-improvement work but lack explicit statutory protection. "This includes EMTs and paramedics... We just don't include EMTs and paramedics in that coverage," Dr. Kochenour said, adding that the measure would encourage frank conversations that improve care. Matt Bowen, president of the Missouri Ambulance Association, said the bill is not intended "to protect criminals" but to allow pre-hospital clinicians to take part in the same QA conversations as other clinicians.

Opponents raised concerns about the potential for abuse of peer-review privilege. Craig Waltworth, an attorney and member of the executive committee of the Missouri Association of Trial Attorneys, said courts sometimes allow overbroad privilege claims and cited examples where witness names and documents were withheld under assertions of peer-review privilege. "We have items under peer review and we get blanket, blanket peer review privilege called," Waltworth said, arguing expansion of the privilege risks hiding discoverable evidence in civil litigation.

Committee members asked a series of clarifying questions. Representative Nelson asked whether dispatchers would be included; Representative Cook said the bill applies to paramedics and EMTs, not dispatchers. Members also probed whether peer-review protection would shield contemporaneous factual records (such as ambulance video or medical charts). Witnesses and the sponsor agreed that factual elements — medical records, video, and testimony about what happened — remain discoverable; the statutory protection, as described in testimony, would apply to later peer-review opinions and internal work product.

Witnesses from EMS and hospital systems urged passage on policy grounds. Mark Alexander, director of EMS at Cox Health, said EMS participation in peer review is important for time-critical systems such as stroke and trauma care. Several organizations, including the Missouri Ambulance Association and physician specialty groups, testified in support.

The hearing concluded without a committee vote. Committee members and witnesses described a balance between improving system performance through protected internal review and preserving plaintiffs' access to factual evidence; the committee did not take final action on the bill during this session.