SAN ANTONIO—The Texas Department of State Health Services wants to suspend three emergency workers and reprimand another who responded to a car accident in which one victim appeared dead but was actually alive.

The agency mailed notices to Mike Gardner, William Bullock, Jeremy Huntsman and Michael Collins last week. The San Antonio Fire Department had already disciplined them for their roles in assessing Erica N. Smith, whose vital signs were not checked after a head-on collision on Dec. 16.

Smith, 23, remained in the wreckage with a tarp over her body for more than an hour before it was discovered she was still breathing. She died the next day.

The agency said Gardner didn’t check Smith’s vital signs even after he “witnessed the patient move” and that Collins did not make “direct voice contact” with an on-call doctor—which is standard procedure for San Antonio paramedics who are on the scene for more than 20 minutes, San Antonio Express-News reported.

The Texas Department of State Health Services said Huntsman and Bullock did not make physical contact “with that patient to check or measure” her vital signs.

The agency proposed suspending the paramedic certifications of Gardner, Bullock and Huntsman for one year and reprimanding Collins. The men have about a week to request a conference or hearing on the proposed punishment.

After the incident, Gardner was transferred to the San Antonio Fire Department’s firefighting division and permanently restricted from working as a paramedic in San Antonio. Huntsman, Bullock and Collins were de-authorized as San Antonio paramedics indefinitely and transferred to the firefighting division.

“They’ve already been punished,” said Chris Steele, president of the San Antonio Professional Firefighters Association. “The guys are already not on the ambulance, so it’s kind of redundant.”

Assistant Fire Chief Mario Guerra said it’s up to the state agency to make decisions about paramedics’ certification or license.

“That’s the state’s call,” Guerra said.

None of the men could be reached Friday. A message was left for Steele seeking comment from the men.