How upcoming FCC regulation affects healthcare providers

Nikola Tesla developed the idea for the radio in 1893. It wasn’t until 1901, that Guglielmo Marconi sent the first radio signal, thus creating the radio. The 20th century witnessed the explosive use of radio and, as an emerging industry; its use in health care was no exception. Today, wireless radio communications technology in hospitals is the standard. According to the Federal Communications Commission (FCC), two-way radio use in hospitals, as well as other industries, are about to be impacted by regulations effective Jan. 1, 2013. My suspicion is that many hospitals are not focusing on this important regulatory deadline and will be facing substantial monetary penalties for non-compliance.

On Jan. 1, 2013, the FCC will require anyone using two-way radios with 25 kilohertz (kHz) efficiency technology to now instead use 12.5 kHz narrowband units in order to communicate. This will affect public safety communication systems, emergency communications, and more specifically hospital communication systems.

The purpose of mandatory “narrowbanding” is to promote more efficient use of the very-high frequency (VHF) and ultra-high frequency (UHF) land mobile bands. Over the years, these bands, in particular the 150-512 MHz band, have been crowded, and there is not enough room on the spectrum to expand or make new communication systems. In order to make more room, licensees must purchase equipment that operates on narrower bandwidths. This allows for new channels to be created and less overlap between them. Through narrowbanding, licensees can achieve greater interference protection, as well as enhanced opportunities for interoperability and system upgrades to advanced technologies (which wear out over time).

Users who do not make the switch by Jan. 1, 2013, face the loss of their communication capabilities. The FCC already moved forward in implementing its plan. On Jan. 1, 2011, the FCC stopped granting applications for new voice operations or applications that use 25 kHz channels, so that only narrowband authorizations will be granted. The FCC also now prohibits the manufacture or importation of new equipment that operates on 25 kHz channels. This will reduce the availability of new equipment for legacy radio systems and will affect how hospitals and others maintain and upgrade older systems. The failure to implement the new FCC narrowband standards will not only violate FCC rules but also cause harmful interference to adjacent narrowband channels, because 25 kHz channels will be competing with overlapping 12.5 kHz channels.

The financial consequences for non-compliance are steep. Penalties for non-compliance may include license revocation, and/or monetary forfeitures of up to $16,000 for each such violation or each day of a continuing violation, and up to $112,500 for any single act or failure to act.

According to Fish & Richardson P.C., an international law firm specializing in intellectual property and technology, the FCC’s process of dealing with violations has “become more formal and the costs of non-compliance have skyrocketed,” which puts further strains on organizations that have been putting off compliance.

A little history
The conversation around narrowbanding (which some techies initially called “refarming”) began over 20 years ago. The FCC released a Notice of Inquiry (NOI) on July 2, 1991 in order to promote efficiency in the frequency bands under 512 MHz. To address the NOI, PR Docket No. 92-235 proposed a number of measures to achieve this. Among the measures was the suggestion of reducing channel spacing to 6.25 kHz.

The Telecommunications Act of 1996, which amended the Communications Act of 1934, added Section 337 to U.S. law, which determined allocation and assignment of new public safety services licenses and commercial licenses, which gave the FCC the authority to carry out the mandate requiring spectrum efficient technology.

On Feb. 12, 2003, the FCC, in its Second Report and Order, adopted an order promoting spectrum efficient technologies on certain Part 90 frequencies, which imposed the deadlines for migration to 12.5 kHz technology for private land mobile radio services (PLMRS) systems operating in the 150-174 MHz and 421-512 MHz bands. The deadlines were Jan. 1, 2013 for non-public safety systems and Jan. 1, 2018 for public safety systems, however in December 2004, the date for public safety systems and others was revised to January 2013, the current deadline. Since then, certain counties, municipalities, companies, and organizations across the U.S. have requested waivers to extend the deadline for compliance.

What hospital associations and public safety communication organizations are saying
Surprisingly, neither the American Society for Healthcare Engineering of the American Hospital Association (AHA), nor the Federation of American Hospitals, or other hospital groups, appears to have formally commented on the upcoming FCC regulation on the narrowband mandate. However, based on a statement made by the AHA before the FCC’s Joint Advisory Committee on Communications Capabilities of Emergency Medical and Public Health Care Facilities, the AHA is open to new methods of effective interoperability.
On a daily basis, hospitals deal with multiple communication and data systems that are incompatible and/or too complex, and thus may look favorably on the goal of interoperability that can be achieved through the narrowband mandate. However, the AHA cautions that “financial support almost certainly will be needed to enable first responders and hospitals to replace existing communications systems with interoperable, advanced technology, especially in rural and remote areas of the nation.”

Who is supporting the mandate
The Association of Public-Safety Communications Officials (APCO) is fully supportive of the conversion to 12.5 kHz efficiency, encouraging all public safety licensees to make the conversion before the deadline, and urges Congress to “authorize the use of existing federal grant programs such as the State Homeland Security Program (SHSP), the Urban Area Security Initiative Grant Program (UASI), the Metropolitan Medical Response System (MMRS), Emergency Management Performance Grants (EMPG), the Regional Catastrophic Preparedness Grant Program (RCPGP), the Community Oriented Policing Services (COPS) Technology, Department of Justice’s State, Local, and Tribal Terrorism Prevention Training and Technical Assistance National Initiative Program, or the Justice Assistance Grant (JAG) Program to expedite the migration of wideband equipment to narrowband equipment.” APCO also responded to the accusation that the upcoming FCC regulation is an unfunded mandate: “The dates are extended enough to ensure most agencies have fully amortized the value of their current equipment by the time the mandates kick in.” However, budgetary problems may hamper efforts to fully comply, as was claimed in a case with the City of South Lake Tahoe.

The National Public Safety Telecommunications Council (NPSTC) is similarly supportive of the measure to replace 25 kHz efficiency technology and begin operating on channel bandwidths of 12.5 kHz or less, and is actively assisting in the transition by providing information and advising state and local agencies.
Every government agency that has a stake in emergency response is pushing for the implementation of this policy, especially the Department of Homeland Security, with its long list of literature related to the transition and guides to implementation.

In regards to how hospitals are specifically affected by the narrowband mandate, a letter written by Lee Burns, the Acting Director of the Bureau of Emergency Medical Services (EMS) to Hospital Chief Executive Officers in New York warns that because “radio equipment configured for wideband operation is incapable of communicating with equipment configured for narrowband operation on the same frequencies, it is imperative that the conversion of EMS-to-hospital radio systems to comply with this mandate be coordinated between the two, within each regional EMS system.” Burns also points out that “since the base station radio equipment used by hospitals typically has a much longer service life than the mobile and portable equipment used in the field, it is likely that many hospital radios pre-date the anticipation of this conversion, and therefore lack the capability of being re-configured to comply with it.” The cost may be greater for hospitals that have older radios due to the necessity for a complete replacement of radio equipment that is out of date.

Right now, there appears to be no agency or organization that believes that the FCC will push back its initiative, seeing as most organizations have had about 10 years to plan for and implement the changes. Yet many hospitals seem unaware of the pending deadline. This FCC regulation will inevitably be implemented, and for those that are not granted waivers by 2013 will either have to comply or face the operational consequences and substantial financial penalties.

Who is opposing the mandate
Opposition to these regulations does exist. It comes primarily from counties and municipalities struggling to come up with funds in order to implement the policy change. Seen in the rejected request for a waiver, the City of South Lake Tahoe “states that in 2010 its vendor informed it that narrowbanding its infrastructure would cost $800,000 and upgrading the infrastructure from analog to digital to compensate for coverage loss, could increase the cost to $1.5 million” and that “due to the economic downturn it is currently operating with an annual budget deficit of $4.7 million that precludes it from funding the narrowband transition.” The FCC did not find that Lake Tahoe presented sufficient evidence to conclude that a waiver was necessary. In addition to not finding its circumstances unique or unusual, the FCC stated that “Lake Tahoe provides no description of its prior efforts (if any) to obtain the necessary funding, or the results of such efforts. Finally, Lake Tahoe also provides no explanation for the proposed delay until July 2014 – a year and a half after the narrowbanding deadline – before it plans to undertake a budgetary analysis to determine its funding needs.”

Extensions and grants for conversion
By contrast, the FCC has, for example, granted the State of Oregon a 10-month extension, the University of Iowa Hospitals and Clinics a 12-month extension, and the County of Hawaii’s 21-month extension.
In an effort to assist states and counties with the cost of implementation, multiple grants are available for narrowbanding projects. The Public Safety Interoperable Communications grant program awarded $968,385,000 to fund interoperable communications projects in the 56 States and Territories.

Additionally, many FEMA Preparedness grants, including the SAFECOM program for Emergency Communication grants, which announced more than $1.3 billion in grant money for FY 2012, present states and counties with opportunities for additional federal funding. Of course, this does not mean that every state, county, and municipality in need of funding receives any. It appears that in most cases those that do receive federal funds only receive a certain percentage of the necessary funds to complete implementation.
In 1934, Nikola Tesla said “Radio power will revolutionize the world!” He was right. He also once said “Money does not represent such a value as men have placed upon it.” Hospitals and other organizations facing the enormous financial penalties for non-compliance with the FCC narrowbanding first-of-the-year deadline, are about to find out if Tesla was right on this observation as well.

Note: The author wishes to specifically thank Matthew Morris, 2012 Graduate, Columbian College of Arts and Sciences, George Washington University, for his research contributions to this article.
Robert Betz, Ph.D., is President of Robert Betz Associates, Inc. (RBA), a well-established federal health policy consulting firm located in the Washington, D.C. area. Additionally, Dr. Betz is an adjunct professor teaching at The George Washington University where he specializes in political science and health policy. For more information about RBA, visit

About the Author

Robert Betz Ph.D.
Robert Betz, Ph.D., is president of Robert Betz Associates, Inc. (RBA), a well-established federal health policy consulting firm located in the Washington, D.C. area. Additionally, Dr. Betz is an adjunct professor teaching at The George Washington University where he specializes in political science and health policy. For more information about RBA, visit