California Proposition 11, Ambulance Employees Paid On-Call Breaks, Training, and Mental Health Services Initiative (2018)
- General election: Nov. 6
- Voter registration deadline: Oct. 22
- Early voting: Oct. 8 - Nov. 5
- Absentee voting deadline: Postmark Nov. 6
- Online registration: Yes
- Same-day registration: Yes
- Voter ID: No
- Poll times: 7:00 a.m. to 8:00 p.m.
| California Proposition 11 | |
|---|---|
 | |
| Election date November 6, 2018 | |
| Topic Labor and unions | |
Status Approved | |
| Type State statute | Origin Citizens |
California Proposition 11, the Ambulance Employees Paid On-Call Breaks, Training, and Mental Health Services Initiative, was on the ballot in California as an initiated state statute on November 6, 2018.[1] The measure was approved.
A yes vote supported:
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A no vote opposed:
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Election results
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California Proposition 11 |
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|---|---|---|---|---|
| Result | Votes | Percentage | ||
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7,181,116 | 59.63% | ||
| No | 4,861,831 | 40.37% | ||
Overview
What did this ballot initiative change about ambulance operations?
Proposition 11 allowed ambulance providers to require workers to remain on-call (reachable by a portable communications device) during meal and rest breaks. The measure required ambulance providers to pay workers at their regular rate during breaks, not make workers take a meal break during the first or last hour of a shift, and space multiple meal breaks during a shift by at least two hours. If a worker is contacted during a meal or rest break, the initiative mandated that the interrupted break not be counted towards the breaks the worker is required to receive. The measure required ambulance providers to manage staffing levels sufficient to provide employees with the required breaks.[1]
The initiative required ambulance providers to provide ambulance employees, such as paramedics and EMTs, with training related to active shooters and multiple casualties, natural disasters, violence prevention, and mental health. The initiative also required ambulance providers to provide workers up to 10 paid mental health services per year and, for employers who provide health insurance, health insurance plans that offer long-term mental health services.[1]
Why was this ballot initiative proposed?
In December 2016, the California Supreme Court ruled in Augustus v. ABM Security Services that employer-required on-call rest breaks violated state labor law. According to the state Supreme Court, state labor law mandates that rest breaks must be considered off-duty and uninterruptible, including in the event of an emergency. Although Augustus specifically applied to private security guards, the California Legislative Analyst noted that on-call break practices among EMTs and paramedics are similar to that of private security guards. The analyst's office also noted that several lawsuits alleging break violations under Augustus had been brought against ambulance providers and remained unresolved. If Augustus was applied to ambulance employees, EMTs and paramedics would need to go off-duty during their meal and rest breaks. Ambulance providers, according to the analyst's office, would have needed to hire about 25 percent more ambulance crews to meet the requirements of Augustus.[2][3] The ballot initiative amended state labor law to allow EMTs and paramedics to be on-call during breaks and require employers to pay workers at their regular rates during breaks.[1]
Who was behind the campaigns surrounding the ballot initiative?
Californians for Emergency Preparedness and Safety led the campaign in support of Proposition 11. The committee had raised $29.89 million. American Medical Response, the country's largest medical transportation firm, provided 99.7 percent of the committee's total funds. There were no committees registered to oppose the ballot initiative.[4]
Text of measure
Ballot title
The official ballot title was as follows:[5]
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Requires Private-Sector Emergency Ambulance Employees to Remain on Call During Work Breaks. Changes Other Conditions of Employment. Initiative Statute.[6] |
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Ballot summary
The official ballot summary was as follows:[7]
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Fiscal impact
- Note: The fiscal impact statement for a California ballot initiative authorized for circulation is prepared by the state's legislative analyst and director of finance.
The fiscal impact statement was as follows:[5]
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Local government net savings likely in the tens of millions of dollars annually due to lower emergency ambulance contract costs.[6] |
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Full text
The full text of the measure was as follows:[1]
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Readability score
- See also: Ballot measure readability scores, 2018
| Using the Flesch-Kincaid Grade Level (FKGL and Flesch Reading Ease (FRE) formulas, Ballotpedia scored the readability of the ballot title and summary for this measure. Readability scores are designed to indicate the reading difficulty of text. The Flesch-Kincaid formulas account for the number of words, syllables, and sentences in a text; they do not account for the difficulty of the ideas in the text. The attorney general wrote the ballot language for this measure.
In 2018, for the 167 statewide measures on the ballot, the average ballot title or question was written at a level appropriate for those with between 19 and 20 years of U.S. formal education (graduate school-level of education), according to the FKGL formula. Read Ballotpedia's entire 2018 ballot language readability report here. |
Support
Californians for Emergency Preparedness and Safety led the campaign in support of the initiative.[8]
Supporters
- American Medical Response[4]
Arguments
Californians for Emergency Preparedness and Safety made the following argument on the committee's website:[8]
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Official arguments
Adam Dougherty, an emergency physician, Carol Meyer, former director of the Los Angeles County Emergency Medical Services Agency, and Jaison Chand, a paramedic, wrote the official argument found in the state voter information guide in support of Proposition 11:[7]
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Opposition
Opponents
Arguments
- State Assembly Member Freddie Rodriguez (D-52) stated, "As a career Emergency Medical Technician in the private ambulance industry, I am strongly opposed to Proposition 11, which is misleading and wrong. Approving this measure means harming first responders and allowing powerful corporation to escape paying millions in wages to hard working men and women. I stand with my fellow emergency medical service workers in urging all Californians to reject Proposition 11."[10]
Official arguments
There were no arguments submitted for the voter information guide in opposition to Proposition 11.[7]
Campaign finance
| Total campaign contributions: | |
| Support: | $29,887,769.96 |
| Opposition: | $0.00 |
There was one ballot measure committee registered in support of the measure—Californians for Emergency Preparedness and Safety. The committee had raised $29.89 million and spent $29.83 million. The largest contributor to the committee was the medical transportation firm American Medical Response, which provided 99.7 percent of the funds.[4]
There were no committees registered to oppose the ballot initiative.[4]
Support
The following table includes contribution and expenditure totals for the committee in support of the initiative:[4]
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Donors
The following was the top donor who contributed to the support committee:[4]
| Donor | Cash | In-kind | Total |
|---|---|---|---|
| American Medical Response | $29,600,000.00 | $187,769.96 | $29,787,769.96 |
| 911 Ambulance Provider's Medi-Cal Alliance | $25,000.00 | $0.00 | $25,000.00 |
Reporting dates
In California, ballot measure committees filed a total of five campaign finance reports in 2018. The filing dates for reports were as follows:[11]
| Campaign finance reporting dates for November 2018 ballot | ||
|---|---|---|
| Date | Report | Period |
| 1/31/2018 | Annual Report for 2017 | 1/01/2017 - 12/31/2017 |
| 4/30/2018 | Report #1 | 1/01/2018 - 3/31/2018 |
| 7/31/2018 | Report #2 | 4/01/2018 - 6/30/2018 |
| 9/27/2018 | Report #3 | 7/01/2018 - 9/22/2018 |
| 10/25/2018 | Report #4 | 9/23/2018 - 10/20/2018 |
| 1/31/2019 | Annual Report for 2018 | 10/21/2018 - 12/31/2018 |
Methodology
To read Ballotpedia's methodology for covering ballot measure campaign finance information, click here.
Media editorials
Support
- Bakersfield Californian: "Proposition 11 would make it clear that emergency medical technicians and paramedics working for private ambulance companies must remain reachable during paid work breaks so that they can respond immediately when needed. The proposition results from an earlier court ruling that placed the status of on-call workers in question. This is a sensible response. Vote yes."[12]
- Los Angeles Times: "Proposition 11 on the Nov. 6 ballot would make clear that emergency medical technicians and paramedics working for private ambulance services must remain reachable during paid work breaks so that they can respond immediately when needed. It’s a sensible proposal that would maintain the status quo among emergency responders, and voters should support it."[13]
- The Mercury News: "For the past 50 years, privately owned and operated ambulance firms in California have had their crews remain on call during their work breaks, making themselves available to answer emergency calls and then taking their breaks as time permits later in their shifts. It’s a reasonable practice in a life-or-death business. Especially in rural areas, where backup crews are not readily available or practical. But a 2016 state Supreme Court ruling on a private security provider case threw the legality of on-call breaks among paramedics and EMTs into question."[14]
- Monterey Herald: "Labor unions are opposed to this measure, which they argue is a special carve out for one industry. But Prop. 11 also protects workers, by requiring that meal breaks not be during the first or last hour of a shift and that breaks be spaced at least two hours apart. If workers are needed to respond to a call during a break, that break would not be counted as a required break. Voters should approve Proposition 11."[15]
- The Orange County Register: "Adequate rest is undeniably important for all emergency workers, and Prop. 11 requires ambulance operators to maintain staffing “at levels sufficient” to allow employees to take rest breaks during their typical 12-hour shifts. A court-imposed requirement for emergency medical workers to turn off electronic communication devices during those breaks could needlessly put lives at risk. It is simply good sense to state that labor law entitling hourly employees to take meal and rest breaks without being on-call does not apply to private-sector emergency ambulance employees. Prop. 11 it deserves a Yes vote."[16]
- The Sacramento Bee: "EMTs and paramedics typically work 12-hour shifts, and being on call makes it difficult to plan meal and rest breaks. But they can squeeze them in during down time; it’s also what they signed up for when they took the job. ... We generally support workers and their rights on the job. On these ballot measures, however, patients have to come first."[17]
- The San Diego Union-Tribune: "Meanwhile, it appears many emergency medical technicians and paramedics are fine with the current practice. No one bothered to submit a formal statement of opposition to election officials for use in the official state voter guide."[18]
- The San Luis Obispo Tribune: "Statewide, it could cost ambulance companies as much as $100 million per year in additional staffing and equipment costs if they had to provide ambulance crews with off-duty breaks. According to the Legislative Analyst, counties that contract for ambulance services would probably bear most of those costs."[19]
Opposition
- Marin Independent Journal: "There’s a lot about this measure that makes sense, but asking voters to mandate that ambulance workers get paid for on-call time when, due to emergencies, they often wind up working on their breaks is not the kind of issue that should be resolved by voters, who are being flooded with campaign slogans. This is a matter for diligent review by state lawmakers."[20]
- San Francisco Chronicle: "However, that bill stalled in the state Senate over two key issues: One was whether the interruptions could include less serious calls; the other was whether the legislation should effectively void pending labor-related lawsuits against American Medical Response, which also happens to be the funder of Prop. 11. Those workers should not be denied their day in court. This issue should be resolved in the Legislature, with all parties at the table to negotiate and compromise. Vote no on Prop. 11."[21]
Polls
- See also: Ballotpedia's approach to covering polls
| California Proposition 11 (2018) | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Poll | Support | Oppose | Undecided | Margin of error | Sample size | ||||||||||||||
| SurveyUSA 10/12/2018 - 10/14/2018 | 54.0% | 26.0.0% | 20.0% | +/-4.9 | 762 | ||||||||||||||
| Note: The polls above may not reflect all polls that have been conducted in this race. Those displayed are a random sampling chosen by Ballotpedia staff. If you would like to nominate another poll for inclusion in the table, send an email to editor@ballotpedia.org. | |||||||||||||||||||
Background
What did California Labor Code state about work breaks?
The California Labor Code (CLC) is a collection of statutes that govern employer-employee relations in California, including wages, hours, breaks, and working conditions. As of 2018, the CLC states that employers, with exceptions for certain industries, cannot require employees to work during meal or rest breaks.[22] This provision mandating meal or rest breaks for employees, with exceptions, was passed in 2000. The legislation was passed 22-14 in the state Senate and 42-31 in the state Assembly. Gov. Gray Davis (D) signed the legislation into law.[23]
What happened in Augustus v. ABM Security Services?
On December 22, 2016, the California Supreme Court ruled in the case Augustus v. ABM Security Services that workers on rest breaks cannot be required to be on-call. The court determined that California Labor Code (CLC) prohibited employers from controlling how employees spend their break time.[3]
Jennifer Augustus, the lead plaintiff in the case, sued ABM Security Services, alleging that ABM required security guards to keep their pagers and radio phones on during breaks and to respond to calls when needs arose. The state Supreme Court sided with Augustus that ABM violated state Labor Code.[3]
What is American Medical Response?
American Medical Response (AMR) was the firm funding the campaign in support of the ballot initiative. AMR, a medical transportation company, is the largest provider of ambulance services in California.[24]
Between 2010 and 2018, American Medical Response had contributed to local Democratic and Republican parties in California, candidates for the California State Legislature of both major parties, local officials of both major parties, and, according to FEC, one congressional candidate in 2012—Aaron Schock of Illinois.[4][25]
Path to the ballot
Process in California
In California, the number of signatures required for an initiated state statute is equal to 5 percent of the votes cast in the preceding gubernatorial election. Petitions are allowed to circulate for 180 days from the date the attorney general prepares the petition language. Signatures need to be certified at least 131 days before the general election. As the verification process can take multiple months, the secretary of state provides suggested deadlines for ballot initiatives.
The requirements to get initiated state statutes certified for the 2018 ballot:
- Signatures: 365,880 valid signatures were required.
- Deadline: The deadline for signature verification was June 28, 2018. However, the secretary of state suggested deadlines for turning in signatures of March 7, 2018, for initiatives needing a full check of signatures and April 24, 2018, for initiatives needing a random sample of signatures verified.
Signatures are first filed with local election officials, who determine the total number of signatures submitted. If the total number is equal to at least 100 percent of the required signatures, then local election officials perform a random check of signatures submitted in their counties. If the random sample estimates that more than 110 percent of the required number of signatures are valid, the initiative is eligible for the ballot. If the random sample estimates that between 95 and 110 percent of the required number of signatures are valid, a full check of signatures is done to determine the total number of valid signatures. If less than 95 percent are estimated to be valid, the initiative does not make the ballot.
Initiative #17-0043
On October 25, 2017, Sean Henschel submitted a letter requesting a title and summary for the initiative. The attorney general's office issued ballot language on December 29, 2017, allowing proponents to begin collecting signatures.
Proponents of the initiative had until June 27, 2018, to collect 365,880 valid signatures. However, 657,744 signatures were filed earlier in late April 2018. At least 55.63 percent of the submitted signatures needed to be valid for the initiative to make the ballot. Counties had until June 19, 2018, to conduct a random sample of signatures.[26]
On June 18, 2018, Secretary of State Alex Padilla said his office received more than the 365,880 required signatures, qualifying the measure for the ballot. The random sample that counties conducted indicated that 515,539 signatures were valid. Therefore, around 78.4 percent of signatures were valid.[27]
Compared to the 15 ballot initiatives certified for the ballot in California in 2016, a 55.6 percent validation requirement was about six percentage points below the average for an initiative to make the ballot. The 15 ballot initiatives from 2016 had an average validation requirement of 61.9 percent, with a range between 58.1 and 67.4 percent.
Cost of signature collection:
Sponsors of the measure hired National Petition Management, Inc. to collect signatures for the petition to qualify this measure for the ballot. A total of $2,892,967.03 was spent to collect the 365,880 valid signatures required to put this measure before voters, resulting in a total cost per required signature (CPRS) of $7.91.
How to cast a vote
- See also: Voting in California
Poll times
All polls in California are open from 7:00 a.m. to 8:00 p.m. Pacific Time. An individual who is in line at the time polls close must be allowed to vote.[28]
Registration requirements
- Check your voter registration status here.
To vote in California, an individual must be a U.S. citizen and California resident. A voter must be at least 18 years of age on Election Day. Pre-registration is available at 16 years of age. Pre-registered voters are automatically registered to vote when they turn 18.[29]
Automatic registration
California automatically registers eligible individuals to vote when they complete a driver's license, identification (ID) card, or change of address transaction through the Department of Motor Vehicles. Learn more by visiting this website.
Online registration
- See also: Online voter registration
California has implemented an online voter registration system. Residents can register to vote by visiting this website.
Same-day registration
California allows same-day voter registration.
Californians must be registered to vote at least 15 days before Election Day. If the registration deadline has passed for an upcoming election, voters may visit a location designated by their county elections official during the 14 days prior to, and including Election Day to conditionally register to vote and vote a provisional ballot, which are counted once county election officials have completed the voter registration verification process. The state refers to this process as Same Day Voter Registration.[30][31]
Residency requirements
To register to vote in California, you must be a resident of the state. State law does not specify a length of time for which you must have been a resident to be eligible.
Verification of citizenship
California's constitution requires that voters be U.S. citizens. When registering to vote, proof of citizenship is not required. Individuals who become U.S. citizens less than 15 days before an election must bring proof of citizenship to their county elections office to register to vote in that election. An individual applying to register to vote must attest that they are a U.S. citizen under penalty of perjury.[30]
As of November 2024, two jurisdictions in California had authorized noncitizen residents to vote for local board of education positions through local ballot measures. Only one of those jurisdictions, San Francisco, had implemented that law. Noncitizens voting for board of education positions must register to vote using a separate application from the state voter registration application.[32]
All 49 states with voter registration systems require applicants to declare that they are U.S. citizens in order to register to vote in state and federal elections, under penalty of perjury or other punishment.[33] Seven states — Alabama, Arizona, Georgia, Kansas, Louisiana, New Hampshire, and Wyoming — have laws requiring verification of citizenship at the time of voter registration, whether in effect or not. One state, Ohio, requires proof of citizenship only when registering to vote at a Bureau of Motor Vehicles facility. In three states — California, Maryland, and Vermont — at least one local jurisdiction allows noncitizens to vote in some local elections. Noncitizens registering to vote in those elections must complete a voter registration application provided by the local jurisdiction and are not eligible to register as state or federal voters.
Verifying your registration
The secretary of state's My Voter Status website allows residents to check their voter registration status online.
Voter ID requirements
California does not require voters to present identification before casting a ballot in most cases.
On September 29, 2024, Gov. Gavin Newsom (D) signed SB 1174 into law prohibiting any jurisdiction in the state from adopting a local law that requires voters to present ID before voting.[34]
The federal Help America Vote Act requires that individuals in all 50 states who register to vote by mail and who have not voted previously in a federal election in their state must provide either their driver's license or a paycheck, bank statement, current utility bill, or government document showing their name and address. Individuals voting by mail must include a copy of one of those documents with their absentee/mail-in ballot.[35]
These requirements do not apply if an individual submitted a copy of their identification, their driver's license number or the last four digits of their Social Security number when registering to vote.
The following list of accepted ID to comply with HAVA requirements was current as of October 2025. Click here for the California Secretary of State page to ensure you have the most current information.
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State profile
| Demographic data for California | ||
|---|---|---|
| California | U.S. | |
| Total population: | 38,993,940 | 316,515,021 |
| Land area (sq mi): | 155,779 | 3,531,905 |
| Race and ethnicity** | ||
| White: | 61.8% | 73.6% |
| Black/African American: | 5.9% | 12.6% |
| Asian: | 13.7% | 5.1% |
| Native American: | 0.7% | 0.8% |
| Pacific Islander: | 0.4% | 0.2% |
| Two or more: | 4.5% | 3% |
| Hispanic/Latino: | 38.4% | 17.1% |
| Education | ||
| High school graduation rate: | 81.8% | 86.7% |
| College graduation rate: | 31.4% | 29.8% |
| Income | ||
| Median household income: | $61,818 | $53,889 |
| Persons below poverty level: | 18.2% | 11.3% |
| Source: U.S. Census Bureau, "American Community Survey" (5-year estimates 2010-2015) Click here for more information on the 2020 census and here for more on its impact on the redistricting process in California. **Note: Percentages for race and ethnicity may add up to more than 100 percent because respondents may report more than one race and the Hispanic/Latino ethnicity may be selected in conjunction with any race. Read more about race and ethnicity in the census here. | ||
Presidential voting pattern
- See also: Presidential voting trends in California
California voted for the Democratic candidate in all seven presidential elections between 2000 and 2024.
More California coverage on Ballotpedia
- Elections in California
- United States congressional delegations from California
- Public policy in California
- Endorsers in California
- California fact checks
- More...
See also
External links
Information
Support
- Californians for Emergency Preparedness and Safety
- Californians for Emergency Preparedness and Safety on Facebook
- Californians for Emergency Preparedness and Safety on Twitter
Footnotes
- ↑ 1.0 1.1 1.2 1.3 1.4 California Attorney General, "Initiative #17-0043," accessed October 31, 2017
- ↑ California Legislative Analyst, "A.G. File No. 2017-043," December 14, 2017
- ↑ 3.0 3.1 3.2 California Supreme Court, "Augustus v. ABM Security Services, December 22, 2016
- ↑ 4.0 4.1 4.2 4.3 4.4 4.5 4.6 Cal-Access, "Campaign Finance," accessed April 4, 2018
- ↑ 5.0 5.1 California Secretary of State, "Initiatives and Referenda Cleared for Circulation," accessed March 6, 2017
- ↑ 6.0 6.1 6.2 6.3 6.4 6.5 6.6 Note: This text is quoted verbatim from the original source. Any inconsistencies are attributable to the original source.
- ↑ 7.0 7.1 7.2 California Secretary of State, "Official Voter Information Guide November 2018," accessed August 21, 2018
- ↑ 8.0 8.1 Californians for Emergency Preparedness and Safety, "Homepage," accessed April 4, 2018
- ↑ LA School Report, "Analysis: California Teachers Association to spend up to $10 million supporting two statewide ballot initiatives — and opposing three others," June 26, 2018
- ↑ Freddie Rodriguez, "News, accessed October 12, 2018
- ↑ California Fair Political Practices Commission, "When to File Campaign Statements: State & Local Filing Schedules," accessed December 6, 2017
- ↑ Bakersfield Californian, "Our View: We recommend: Fix our roads, deliver clean, abundant water," September 30, 2018
- ↑ Los Angeles Times, "A vote for Proposition 11 is a sensible vote for public safety," September 21, 2018
- ↑ The Mercury News, "Editorial: Prop. 11 will solve ambulance workers’ on-call issue," August 10, 2018
- ↑ Monterey Herald, "Editorial: California voters should approve props 11 and 12," September 8, 2018
- ↑ The Orange County Register, "Yes on Proposition 11 for more sensible 911 services," October 5, 2018
- ↑ The Sacramento Bee, "On Propositions 8 and 11, vote to protect patient safety," September 12, 2018
- ↑ The San Diego Union-Tribune, "Prop. 11: Vote yes to maintain public safety with private first responders," September 21, 2018
- ↑ The San Luis Obispo Tribune, "From gas tax to rent control, here are The Tribune’s recommendations on 11 statewide props," October 26, 2018
- ↑ Marin Independent Journal, "Editorial: IJ’s recommendations on state propositions," October 17, 2018
- ↑ San Francisco Chronicle, "Chronicle recommends: No on California Prop. 11 — a measure that does not belong on the state ballot," September 9, 2018
- ↑ California State Legislature, "California Labor Code 226.7," accessed June 15, 2018
- ↑ California State Legislature, "AB-2509," accessed June 15, 2018
- ↑ American Medical Response, "Homepage," accessed June 15, 2018
- ↑ Federal Elections Commission, "Campaign Finance Data," accessed June 15, 2018
- ↑ California Secretary of State, "Ballot Measures," accessed August 29, 2017
- ↑ California Secretary of State, "Final Random Sample," accessed June 18, 2018
- ↑ California Secretary of State, "Section 3: Polling Place Hours," accessed August 12, 2024
- ↑ California Secretary of State, "Voter Registration," accessed August 13, 2024
- ↑ 30.0 30.1 California Secretary of State, "Registering to Vote," accessed August 13, 2024
- ↑ California Secretary of State, "Same Day Voter Registration (Conditional Voter Registration)," accessed August 13, 2024
- ↑ SF.gov, "Non-citizen voting rights in local Board of Education elections," accessed November 14, 2024
- ↑ Under federal law, the national mail voter registration application (a version of which is in use in all states with voter registration systems) requires applicants to indicate that they are U.S. citizens in order to complete an application to vote in state or federal elections, but does not require voters to provide documentary proof of citizenship. According to the U.S. Department of Justice, the application "may require only the minimum amount of information necessary to prevent duplicate voter registrations and permit State officials both to determine the eligibility of the applicant to vote and to administer the voting process."
- ↑ Democracy Docket, "California Governor Signs Law to Ban Local Voter ID Requirements," September 30, 2024
- ↑ Congress, "H.R.3295 - Help America Vote Act of 2002," accessed September 30, 2025
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