Senate Committee of Reference Report
Committee on Judiciary
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April 14, 2025
After consideration on the merits, the Committee recommends the following:
SB25-130 be amended as follows, and as so amended, be referred to the Committee on Appropriations with favorable recommendation:
Page 1, Line 1Amend printed bill, strike everything below the enacting clause and
Page 1, Line 2substitute:
Page 1, Line 3"SECTION 1. In Colorado Revised Statutes, add 25-3-132 as
Page 1, Line 4follows:
Page 1, Line 525-3-132. Emergency medical condition - emergency medical
Page 1, Line 6services - transfer - discharge - nonliability - enforcement -
Page 1, Line 7definitions. (1) Requirements. A facility shall provide emergency
Page 1, Line 8medical services to a person who presents to the emergency
Page 1, Line 9department when the person requests or a request is made on the
Page 1, Line 10person's behalf for emergency medical services. In the absence
Page 1, Line 11of a request, a facility shall provide emergency medical services
Page 1, Line 12to a person if a prudent layperson would believe, based on the
Page 1, Line 13person's appearance or behavior, that the person is in need of
Page 1, Line 14emergency medical services.
Page 1, Line 15(2) Central log required. For each person who presents to
Page 1, Line 16a facility and requests emergency medical services or a request
Page 1, Line 17is made on the person's behalf for emergency medical services,
Page 1, Line 18the facility shall input into a central log whether the person
Page 1, Line 19refused treatment, was denied treatment, whether no treatment
Page 1, Line 20was required, or whether the person was transferred, admitted
Page 1, Line 21and treated, stabilized and transferred, or discharged.
Page 1, Line 22(3) Nondiscrimination. A facility is a place of public
Page 1, Line 23accommodation subject to part 6 of article 34 of title 24 and
Page 1, Line 24shall not deny emergency medical services or discriminate in
Page 1, Line 25providing emergency medical services to a patient for a
Page 1, Line 26discriminatory or unlawful reason as described in part 6 of
Page 1, Line 27article 34 of title 24.
Page 2, Line 1(4) Provider protections. (a) A facility shall not penalize
Page 2, Line 2or take any adverse action against a health-care provider for
Page 2, Line 3refusing to transfer a patient with an emergency medical
Page 2, Line 4condition that has not been stabilized.
Page 2, Line 5(b) This subsection (4) does not alter or limit the rights
Page 2, Line 6and protections afforded to a person pursuant to section
Page 2, Line 724-34-402 (1).
Page 2, Line 8(5) Financial inquiry. A facility shall not delay providing
Page 2, Line 9emergency medical services to a person in order to inquire about
Page 2, Line 10the person's ability to pay for emergency medical services.
Page 2, Line 11(6) Appropriate transfer. If a patient has received an
Page 2, Line 12appropriate medical screening examination as described in
Page 2, Line 13subsection (10)(c)(I)(A) of this section and the examining
Page 2, Line 14health-care provider determines that an emergency medical
Page 2, Line 15condition exists and the condition has not been stabilized, the
Page 2, Line 16facility shall not transfer the patient unless all of the
Page 2, Line 17following conditions are met:
Page 2, Line 18(a) The patient is provided medical treatment within the
Page 2, Line 19facility's capacity that minimizes the risks to the patient's
Page 2, Line 20health;
Page 2, Line 21(b) The receiving facility has the space and qualified
Page 2, Line 22personnel available for treating the patient and has agreed to
Page 2, Line 23accept transfer of the patient and to provide appropriate
Page 2, Line 24medical treatment;
Page 2, Line 25(c) The transfer is effected through qualified personnel
Page 2, Line 26and transportation equipment, including the use of necessary
Page 2, Line 27and medically appropriate life support measures during the
Page 2, Line 28transfer;
Page 2, Line 29(d) The transferring facility sends all medical records,
Page 2, Line 30or copies of the medical records, related to the patient's
Page 2, Line 31emergency medical condition that the patient presented to the
Page 2, Line 32facility for, that are available at the time of the transfer,
Page 2, Line 33including medical records, or copies of the medical records,
Page 2, Line 34related to observations of signs and symptoms; preliminary
Page 2, Line 35diagnosis; treatment provided to the patient; test results; the
Page 2, Line 36informed written request or certification provided pursuant to
Page 2, Line 37subsection (6)(f) of this section, or a copy of the request or
Page 2, Line 38certification; and, if relevant, the name and address of any
Page 2, Line 39on-call physician who refused or failed to appear at the facility
Page 2, Line 40within a reasonable amount of time to provide the patient with
Page 2, Line 41necessary stabilizing treatment;
Page 2, Line 42(e) The transfer conforms with applicable facility
Page 2, Line 43standards established by the state board of health, created in
Page 3, Line 1section 25-1-103, in accordance with the department's authority
Page 3, Line 2established pursuant to section 25-1.5-103. The facility
Page 3, Line 3standards must reflect the federal rules and regulations
Page 3, Line 4described in 42 CFR 489.24 and adopted pursuant to the federal
Page 3, Line 5"Emergency Medical Treatment and Active Labor Act", 42 U.S.C.
Page 3, Line 6sec. 1395dd; and
Page 3, Line 7(f) (I) After being informed of the facility's obligations
Page 3, Line 8pursuant to this section and the risk of transfer, the patient or
Page 3, Line 9the patient's representative requests the transfer in writing;
Page 3, Line 10(II) A physician has signed a certification that includes a
Page 3, Line 11summary of the risks and benefits of transferring the patient
Page 3, Line 12and a statement that, based upon the information available at
Page 3, Line 13the time of the transfer, the medical benefits reasonably
Page 3, Line 14expected from the provision of appropriate medical treatment at
Page 3, Line 15another facility outweigh the increased risks to the patient
Page 3, Line 16from being transferred; or
Page 3, Line 17(III) If a physician is not physically present in the facility
Page 3, Line 18at the time a patient is transferred, the examining health-care
Page 3, Line 19provider has signed a certification that includes the
Page 3, Line 20information described in subsection (6)(f)(II) of this section and
Page 3, Line 21the physician, after consulting with the examining health-care
Page 3, Line 22provider, agrees with the certification and subsequently
Page 3, Line 23countersigns the certification.
Page 3, Line 24(7) Appropriate discharge. (a) If a patient has received an
Page 3, Line 25appropriate medical screening examination as described in
Page 3, Line 26subsection (10)(c)(I)(A) of this section and the examining
Page 3, Line 27health-care provider determines that an emergency medical
Page 3, Line 28condition exists, the facility shall not discharge the patient
Page 3, Line 29unless all of the following conditions are met:
Page 3, Line 30(I) The patient's emergency medical condition has been
Page 3, Line 31stabilized; and
Page 3, Line 32(II) The discharge conforms with applicable facility
Page 3, Line 33standards established by the state board of health, created in
Page 3, Line 34section 25-1-103, in accordance with the department's authority
Page 3, Line 35established pursuant to section 25-1.5-103. The facility
Page 3, Line 36standards must reflect the federal rules and regulations
Page 3, Line 37described in 42 CFR 489.24 and adopted pursuant to the federal
Page 3, Line 38"Emergency Medical Treatment and Active Labor Act", 42 U.S.C.
Page 3, Line 39sec. 1395dd.
Page 3, Line 40(b) If a patient has not been stabilized, discharging the
Page 3, Line 41patient is only permitted if:
Page 3, Line 42(I) After being informed of the facility's obligations
Page 3, Line 43pursuant to this section and the risk of discharge, the patient or
Page 4, Line 1the patient's representative requests a discharge in writing; or
Page 4, Line 2(II) The facility offers the patient further medical
Page 4, Line 3examination and treatment and informs the patient or the
Page 4, Line 4patient's representative of the risks and benefits of the
Page 4, Line 5examination and treatment but the patient or the patient's
Page 4, Line 6representative does not consent to the medical examination and
Page 4, Line 7treatment. The patient's medical record must contain a
Page 4, Line 8description of the examination and, if applicable, the treatment,
Page 4, Line 9and a statement that the patient or the patient's representative
Page 4, Line 10refused. The facility shall take all reasonable steps to secure
Page 4, Line 11the patient's written informed refusal, which must indicate the
Page 4, Line 12patient has been informed of the risks and benefits of the
Page 4, Line 13examination and treatment, if applicable.
Page 4, Line 14(8) Nonliability. A facility or health-care provider does
Page 4, Line 15not violate this section if:
Page 4, Line 16(a) The patient is provided an appropriate medical
Page 4, Line 17screening examination as described in subsection (10)(c)(I)(A) of
Page 4, Line 18this section by a health-care provider and the examining
Page 4, Line 19health-care provider determines that no emergency medical
Page 4, Line 20condition exists and records the determination in the patient's
Page 4, Line 21medical record;
Page 4, Line 22(b) The patient is provided an appropriate medical
Page 4, Line 23screening examination as described in subsection (10)(c)(I)(A) of
Page 4, Line 24this section by a health-care provider and the examining
Page 4, Line 25health-care provider determines that an emergency medical
Page 4, Line 26condition exists and the patient is appropriately transferred or
Page 4, Line 27discharged pursuant to subsection (6) or (7) of this section; or
Page 4, Line 28(c) The patient is provided an appropriate medical
Page 4, Line 29screening examination as described in subsection (10)(c)(I)(A) of
Page 4, Line 30this section by a health-care provider and the examining
Page 4, Line 31health-care provider determines that an emergency medical
Page 4, Line 32condition exists and the patient is admitted in good faith to the
Page 4, Line 33facility as an inpatient for further stabilizing treatment.
Page 4, Line 34(9) Investigation and penalty. (a) The department may
Page 4, Line 35investigate a facility that negligently violates this section
Page 4, Line 36pursuant to section 25-1.5-103 (1)(a).
Page 4, Line 37(b) (I) A physician who negligently violates this section
Page 4, Line 38engages in unprofessional conduct and is subject to discipline
Page 4, Line 39pursuant to section 12-240-121.
Page 4, Line 40(II) This subsection (9)(b) applies to a physician who:
Page 4, Line 41(A) Signs a certification pursuant to subsection (6)(f)(II)
Page 4, Line 42of this section that states the medical benefits reasonably
Page 4, Line 43expected from appropriate medical treatment at another
Page 5, Line 1facility outweigh the increased risks to the patient from being
Page 5, Line 2transferred if the physician knew or should have known the
Page 5, Line 3benefits did not outweigh the risks;
Page 5, Line 4(B) Misrepresents a patient's condition or other
Page 5, Line 5information, including a facility's obligations pursuant to this
Page 5, Line 6section; or
Page 5, Line 7(C) Is the on-call physician and fails or refuses to present
Page 5, Line 8to the facility within a reasonable period of time pursuant to
Page 5, Line 9subsection (10)(c)(I)(B) of this section after being contacted.
Page 5, Line 10(c) If a civil monetary penalty is imposed pursuant to
Page 5, Line 11section 25-1.5-103 or 12-240-121, the maximum civil monetary
Page 5, Line 12penalty amount must be reduced by any civil monetary penalty
Page 5, Line 13imposed pursuant to the federal "Emergency Medical Treatment
Page 5, Line 14and Active Labor Act", 42 U.S.C. 1395dd (d) for the same
Page 5, Line 15violation.
Page 5, Line 16(10) Definitions. As used in this section, unless the context
Page 5, Line 17otherwise requires:
Page 5, Line 18(a) "Abortion" has the same meaning as set forth in section
Page 5, Line 1925-6-402.
Page 5, Line 20(b) (I) "Emergency medical condition" means:
Page 5, Line 21(A) A medical condition manifesting itself by acute signs
Page 5, Line 22and symptoms of sufficient severity, including severe pain, such
Page 5, Line 23that the absence of immediate medical attention could
Page 5, Line 24reasonably be expected to result in placing the health of the
Page 5, Line 25person in serious jeopardy, serious impairment of bodily
Page 5, Line 26functions, or serious dysfunction of any bodily organ or part;
Page 5, Line 27or
Page 5, Line 28(B) With respect to a pregnant person who is having
Page 5, Line 29contractions, there is inadequate time to effectuate a safe
Page 5, Line 30transfer to another facility before delivery, or that
Page 5, Line 31transferring the patient may pose a threat to the health or
Page 5, Line 32safety of the patient.
Page 5, Line 33(II) "Emergency medical condition" includes, but is not
Page 5, Line 34limited to, labor, ectopic pregnancy, a complication resulting
Page 5, Line 35from pregnancy loss, and emergent hypertensive disorders when
Page 5, Line 36the absence of immediate medical attention could reasonably be
Page 5, Line 37expected to result in placing the health of the patient in serious
Page 5, Line 38jeopardy, serious impairment to bodily functions, or serious
Page 5, Line 39dysfunction of any bodily organ or part.
Page 5, Line 40(c) (I) "Emergency medical services" means:
Page 5, Line 41(A) An appropriate medical screening examination within
Page 5, Line 42the capability of the facility, including ancillary services
Page 5, Line 43routinely available to the facility, to determine if an
Page 6, Line 1emergency medical condition exists; and
Page 6, Line 2(B) When the examining health-care provider determines
Page 6, Line 3that an emergency medical condition exists, the medical
Page 6, Line 4treatment necessary to stabilize the emergency medical
Page 6, Line 5condition that is within the capability of the facility. If the
Page 6, Line 6patient's emergency medical condition requires the services of
Page 6, Line 7an on-call physician, the examining health-care provider shall
Page 6, Line 8attempt to contact the on-call physician.
Page 6, Line 9(II) "Emergency medical services" includes providing an
Page 6, Line 10abortion or sterilization procedures when a patient has an
Page 6, Line 11emergency medical condition and an abortion or sterilization
Page 6, Line 12procedures are necessary to stabilize the patient and are within
Page 6, Line 13the capability and capacity of the facility.
Page 6, Line 14(d) "Facility" means a hospital licensed pursuant to
Page 6, Line 15section 25-3-101; a freestanding emergency department, as
Page 6, Line 16defined in section 25-1.5-114 (5)(b); or a community clinic, as
Page 6, Line 17defined in section 25-3-101 (2)(a)(I)(B).
Page 6, Line 18(e) "Labor" means the process of childbirth beginning with
Page 6, Line 19the latent or early phase of labor and continuing through the
Page 6, Line 20delivery of the placenta. A person experiencing contractions is
Page 6, Line 21in labor unless a physician, certified nurse midwife, or other
Page 6, Line 22qualified medical personnel, acting within the person's scope of
Page 6, Line 23practice as defined in the facility's medical staff bylaws and
Page 6, Line 24state law, certifies after a reasonable time of observation that
Page 6, Line 25the person is in false labor.
Page 6, Line 26(f) "Stabilize" means to provide medical treatment that
Page 6, Line 27may be necessary to ensure, within reasonable medical
Page 6, Line 28probability, that no material deterioration of the patient's
Page 6, Line 29condition, serious impairment of bodily functions or dysfunction
Page 6, Line 30of any bodily organ or part, or a threat to the patient's life is
Page 6, Line 31likely to result from or occur during the transfer or discharge
Page 6, Line 32of the patient.
Page 6, Line 33SECTION 2. In Colorado Revised Statutes, 12-240-121, add
Page 6, Line 34(1)(jj) as follows:
Page 6, Line 3512-240-121. Unprofessional conduct - definitions.
Page 6, Line 36(1) "Unprofessional conduct" as used in this article 240 means:
Page 6, Line 37(jj) Negligently violating section 25-3-132.
Page 6, Line 38SECTION 3. In Colorado Revised Statutes, 24-31-101, amend
Page 6, Line 39(1)(i)(XXII) and (1)(i)(XXIII); and add (1)(i)(XXIV) as follows:
Page 6, Line 4024-31-101. Powers and duties of attorney general. (1) The
Page 6, Line 41attorney general:
Page 6, Line 42(i) May independently initiate and bring civil and criminal actions
Page 6, Line 43to enforce state laws, including actions brought pursuant to:
Page 7, Line 1(XXII) Part 14 of article 12 of title 38; and
Page 7, Line 2(XXIII) Section 24-34-806; and
Page 7, Line 3(XXIV) Section 25-3-132.
Page 7, Line 4SECTION 4. Severability. If any provision of this act or the
Page 7, Line 5application of this act to any person or circumstance is held invalid, the
Page 7, Line 6invalidity does not affect other provisions or applications of the act that
Page 7, Line 7can be given effect without the invalid provision or application, and to
Page 7, Line 8this end the provisions of this act are declared to be severable.
Page 7, Line 9SECTION 5. Safety clause. The general assembly finds,
Page 7, Line 10determines, and declares that this act is necessary for the immediate
Page 7, Line 11preservation of the public peace, health, or safety or for appropriations for
Page 7, Line 12the support and maintenance of the departments of the state and state
Page 7, Line 13institutions.".