PROVIDENCE, R.I. (AP) — A doctor says patients have died in Rhode Island after they were improperly intubated when transported by emergency medical services.

The Public's Radio reports that Dr. Nick Asselin told a state panel earlier this year about 11 cases of patients arriving by ambulance with “esophageal intubations,” a misplaced breathing tube that sends air into the patient’s stomach.

The station reports a 12th fatality occurred after, and that Rhode Island is the only state in New England, and one of few nationally, that allows non-paramedics to perform intubations.

Advanced-level EMS providers, called EMT-Cardiacs, receive less training than paramedics but are licensed by the state to perform intubations.

Asselin looked at cases from the past three years. A health department official recommended that the state conform to national standards and allow only paramedics to place the tubes.

A coalition of Rhode Island’s EMS practitioners, municipal fire chiefs and the mayor of Johnston opposed the plan, arguing that EMT-Cardiacs save lives by placing the tube and that doctors are trying to encroach on their autonomy and drive up costs.

The state has not restricted the practice to paramedics, but has recommended that all providers consider less invasive measures before inserting a breathing tube.