Senate Bill 25-130 Reengrossed

A Bill for an Act

• Page 1, Line 101Concerning providing emergency medical services, and, in

• Page 1, Line 102connection therewith, making an appropriation.

Bill Summary

(Note: This summary applies to this bill as introduced and does not reflect any amendments that may be subsequently adopted. If this bill passes third reading in the house of introduction, a bill summary that applies to the reengrossed version of this bill will be available at http://leg.colorado.gov.)

The bill requires an emergency department, including a labor and delivery department, to provide emergency medical services to a patient who presents to the emergency department.

For each person who presents to an emergency department for treatment, the bill requires the emergency department to input into a central log whether the person refused treatment or was denied treatment, or whether the person was admitted and treated, stabilized and transferred, or discharged.

The bill prohibits an emergency department from denying or discriminating in providing emergency medical services to a patient because of certain characteristics.

The bill requires an emergency department to implement a protocol to ensure a health-care provider is available at all times who is willing and able to provide emergency medical services; except that a health-care provider is not required to provide emergency medical services if the emergency medical services conflict with the health-care provider's sincerely held religious beliefs. The bill prohibits an emergency department from taking any adverse action against a health-care provider who provides or refuses to provide emergency medical services.

The bill prohibits an emergency department from inquiring about a patient's ability to pay for emergency medical services until after the services have been rendered.

The bill prohibits an emergency department from transferring or discharging a patient with an emergency medical condition unless certain conditions are met.

An emergency department does not violate the bill requirements if certain conditions are met.

The bill authorizes the attorney general to bring a civil action to seek injunctive relief or a civil penalty not to exceed $50,000 against an emergency department or examining health-care provider who negligently violates the requirements of the bill. The bill creates a private right of action for a person who suffers personal injury by an emergency department.

• Page 2, Line 1Be it enacted by the General Assembly of the State of Colorado:

• Page 2, Line 2SECTION 1.  In Colorado Revised Statutes, add 25-3-132 as follows:

• Page 2, Line 325-3-132.  Emergency medical condition - emergency medical

• Page 2, Line 4services - transfer - discharge - nonliability - enforcement -

• Page 2, Line 5definitions. (1)  Requirements.A facility shall provide emergency

• Page 2, Line 6medical services to a person who presents to the emergency

• Page 2, Line 7department when the person requests or a request is made on the

• Page 2, Line 8person's behalf for emergency medical services. In the absence

• Page 2, Line 9of a request, a facility shall provide emergency medical services

• Page 3, Line 1to a person if a prudent layperson would believe, based on the

• Page 3, Line 2person's appearance or behavior, that the person is in need of emergency medical services.

• Page 3, Line 3(2)  Central log required.For each person who presents to

• Page 3, Line 4a facility and requests emergency medical services or a request

• Page 3, Line 5is made on the person's behalf for emergency medical services,

• Page 3, Line 6the facility shall input into a central log whether the person

• Page 3, Line 7refused treatment, was denied treatment, whether no treatment

• Page 3, Line 8was required, or whether the person was transferred, admitted and treated, stabilized and transferred, or discharged.

• Page 3, Line 9(3)  Nondiscrimination.A facility is a place of public

• Page 3, Line 10accommodation subject to part 6 of article 34 of title 24 and

• Page 3, Line 11shall not deny emergency medical services or discriminate in

• Page 3, Line 12providing emergency medical services to a patient for a

• Page 3, Line 13discriminatory or unlawful reason as described in part 6 of article 34 of title 24.

• Page 3, Line 14(4)  Provider protections. (a)  A facility shall not penalize

• Page 3, Line 15or take any adverse action against a health-care provider for

• Page 3, Line 16refusing to transfer a patient with an emergency medical condition that has not been stabilized.

• Page 3, Line 17(b)  This subsection (4) does not alter or limit the rights

• Page 3, Line 18and protections afforded to a person pursuant to section 24-34-402 (1).

• Page 3, Line 19(5)  Financial inquiry.A facility shall not delay providing

• Page 3, Line 20emergency medical services to a person in order to inquire about the person's ability to pay for emergency medical services.

• Page 3, Line 21(6)  Appropriate transfer.If a patient has received an

• Page 4, Line 1appropriate medical screening examination as described in

• Page 4, Line 2subsection (10)(c)(I)(A) of this section and the examining

• Page 4, Line 3health-care provider determines that an emergency medical

• Page 4, Line 4condition exists and the condition has not been stabilized, the

• Page 4, Line 5facility shall not transfer the patient unless all of the following conditions are met:

• Page 4, Line 6(a)  The patient is provided medical treatment within the

• Page 4, Line 7facility's capacity that minimizes the risks to the patient's health;

• Page 4, Line 8(b)  The receiving facility has the space and qualified

• Page 4, Line 9personnel available for treating the patient and has agreed to

• Page 4, Line 10accept transfer of the patient and to provide appropriate medical treatment;

• Page 4, Line 11(c)  The transfer is effected through qualified personnel

• Page 4, Line 12and transportation equipment, including the use of necessary

• Page 4, Line 13and medically appropriate life support measures during the transfer;

• Page 4, Line 14(d)  The transferring facility sends all medical records,

• Page 4, Line 15or copies of the medical records, related to the patient's

• Page 4, Line 16emergency medical condition that the patient presented to the

• Page 4, Line 17facility for, that are available at the time of the transfer,

• Page 4, Line 18including medical records, or copies of the medical records,

• Page 4, Line 19related to observations of signs and symptoms; preliminary

• Page 4, Line 20diagnosis; treatment provided to the patient; test results; the

• Page 4, Line 21informed written request or certification provided pursuant to

• Page 4, Line 22subsection (6)(f) of this section, or a copy of the request or

• Page 4, Line 23certification; and, if relevant, the name and address of any

• Page 5, Line 1on-call physician who refused or failed to appear at the facility

• Page 5, Line 2within a reasonable amount of time to provide the patient with necessary stabilizing treatment;

• Page 5, Line 3(e)  The transfer conforms with applicable facility

• Page 5, Line 4standards established by the state board of health, created in

• Page 5, Line 5section 25-1-103, in accordance with the department's authority

• Page 5, Line 6established pursuant to section 25-1.5-103. The facility

• Page 5, Line 7standards must reflect the federal rules and regulations

• Page 5, Line 8described in 42 CFR 489.24 and adopted pursuant to the federal

• Page 5, Line 9"Emergency Medical Treatment and Active Labor Act", 42 U.S.C. sec. 1395dd.

• Page 5, Line 10(f) (I)  After being informed of the facility's obligations

• Page 5, Line 11pursuant to this section and the risk of transfer, the patient or the patient's representative requests the transfer in writing;

• Page 5, Line 12(II)  A physician has signed a certification that includes a

• Page 5, Line 13summary of the risks and benefits of transferring the patient

• Page 5, Line 14and a statement that, based upon the information available at

• Page 5, Line 15the time of the transfer, the medical benefits reasonably

• Page 5, Line 16expected from the provision of appropriate medical treatment at

• Page 5, Line 17another facility outweigh the increased risks to the patient from being transferred; or

• Page 5, Line 18(III)  If a physician is not physically present in the facility

• Page 5, Line 19at the time a patient is transferred, the examining health-care

• Page 5, Line 20provider has signed a certification that includes the

• Page 5, Line 21information described in subsection (6)(f)(II) of this section and

• Page 5, Line 22the physician, after consulting with the examining health-care

• Page 5, Line 23provider, agrees with the certification and subsequently countersigns the certification.

• Page 6, Line 1(7)  Appropriate discharge. (a)  If a patient has received an

• Page 6, Line 2appropriate medical screening examination as described in

• Page 6, Line 3subsection (10)(c)(I)(A) of this section and the examining

• Page 6, Line 4health-care provider determines that an emergency medical

• Page 6, Line 5condition exists, the facility shall not discharge the patient unless all of the following conditions are met:

• Page 6, Line 6(I)  The patient's emergency medical condition has been stabilized; and

• Page 6, Line 7(II) The discharge conforms with applicable facility

• Page 6, Line 8standards established by the state board of health, created in

• Page 6, Line 9section 25-1-103, in accordance with the department's authority

• Page 6, Line 10established pursuant to section 25-1.5-103. The facility

• Page 6, Line 11standards must reflect the federal rules and regulations

• Page 6, Line 12described in 42 CFR 489.24 and adopted pursuant to the federal

• Page 6, Line 13"Emergency Medical Treatment and Active Labor Act", 42 U.S.C. sec. 1395dd.

• Page 6, Line 14(b)  If a patient has not been stabilized, discharging the patient is only permitted if:

• Page 6, Line 15(I)  After being informed of the facility's obligations

• Page 6, Line 16pursuant to this section and the risk of discharge, the patient or the patient's representative requests a discharge in writing; or

• Page 6, Line 17(II)  The facility offers the patient further medical

• Page 6, Line 18examination and treatment and informs the patient or the

• Page 6, Line 19patient's representative of the risks and benefits of the

• Page 6, Line 20examination and treatment but the patient or the patient's

• Page 6, Line 21representative does not consent to the medical examination and

• Page 7, Line 1treatment. The patient's medical record must contain a

• Page 7, Line 2description of the examination and, if applicable, the treatment,

• Page 7, Line 3and a statement that the patient or the patient's representative

• Page 7, Line 4refused. The facility shall take all reasonable steps to secure

• Page 7, Line 5the patient's written informed refusal, which must indicate the

• Page 7, Line 6patient has been informed of the risks and benefits of the examination and treatment, if applicable.

• Page 7, Line 7(8)  Nonliability.A facility or health-care provider does not violate this section if:

• Page 7, Line 8(a)  The patient is provided an appropriate medical

• Page 7, Line 9screening examination as described in subsection (10)(c)(I)(A) of

• Page 7, Line 10this section by a health-care provider and the examining

• Page 7, Line 11health-care provider determines that no emergency medical

• Page 7, Line 12condition exists and records the determination in the patient's medical record;

• Page 7, Line 13(b)  The patient is provided an appropriate medical

• Page 7, Line 14screening examination as described in subsection (10)(c)(I)(A) of

• Page 7, Line 15this section by a health-care provider and the examining

• Page 7, Line 16health-care provider determines that an emergency medical

• Page 7, Line 17condition exists and the patient is appropriately transferred or discharged pursuant to subsection (6) or (7) of this section; or

• Page 7, Line 18(c)  The patient is provided an appropriate medical

• Page 7, Line 19screening examination as described in subsection (10)(c)(I)(A) of

• Page 7, Line 20this section by a health-care provider and the examining

• Page 7, Line 21health-care provider determines that an emergency medical

• Page 7, Line 22condition exists and the patient is admitted in good faith to the

• Page 7, Line 23facility as an inpatient for further stabilizing treatment.

• Page 8, Line 1(9)  Investigation and penalty. (a)  The department may

• Page 8, Line 2investigate a facility that negligently violates this section pursuant to section 25-1.5-103 (1)(a).

• Page 8, Line 3(b) (I)  A physician who negligently violates this section

• Page 8, Line 4engages in unprofessional conduct and is subject to discipline pursuant to section 12-240-121.

• Page 8, Line 5(II)  This subsection (9)(b) applies to a physician who:

• Page 8, Line 6(A)  Signs a certification pursuant to subsection (6)(f)(II)

• Page 8, Line 7of this section that states the medical benefits reasonably

• Page 8, Line 8expected from appropriate medical treatment at another

• Page 8, Line 9facility outweigh the increased risks to the patient from being

• Page 8, Line 10transferred if the physician knew or should have known the benefits did not outweigh the risks;

• Page 8, Line 11(B)  Misrepresents a patient's condition or other

• Page 8, Line 12information, including a facility's obligations pursuant to this section; or

• Page 8, Line 13(C)  Is the on-call physician and fails or refuses to present

• Page 8, Line 14to the facility within a reasonable period of time pursuant to subsection (10)(c)(I)(B) of this section after being contacted.

• Page 8, Line 15(c)  If a civil monetary penalty is imposed pursuant to

• Page 8, Line 16section 25-1.5-103 or 12-240-121, the maximum civil monetary

• Page 8, Line 17penalty amount must be reduced by any civil monetary penalty

• Page 8, Line 18imposed pursuant to the federal "Emergency Medical Treatment

• Page 8, Line 19and Active Labor Act", 42 U.S.C. 1395dd (d) for the same violation.

• Page 8, Line 20(10)  Definitions.As used in this section, unless the context

• Page 8, Line 21otherwise requires:

• Page 9, Line 1(a)  "Abortion" has the same meaning as set forth in section 25-6-402.

• Page 9, Line 2(b) (I)  "Emergency medical condition" means:

• Page 9, Line 3(A)  A medical condition manifesting itself by acute signs

• Page 9, Line 4and symptoms of sufficient severity, including severe pain, such

• Page 9, Line 5that the absence of immediate medical attention could

• Page 9, Line 6reasonably be expected to result in placing the health of the

• Page 9, Line 7person in serious jeopardy, serious impairment of bodily

• Page 9, Line 8functions, or serious dysfunction of any bodily organ or part; or

• Page 9, Line 9(B)  With respect to a pregnant person who is having

• Page 9, Line 10contractions, there is inadequate time to effectuate a safe

• Page 9, Line 11transfer to another facility before delivery, or that

• Page 9, Line 12transferring the patient may pose a threat to the health or safety of the patient.

• Page 9, Line 13(II)  "Emergency medical condition" includes, but is not

• Page 9, Line 14limited to, labor, ectopic pregnancy, a complication resulting

• Page 9, Line 15from pregnancy loss, and emergent hypertensive disorders when

• Page 9, Line 16the absence of immediate medical attention could reasonably be

• Page 9, Line 17expected to result in placing the health of the patient in serious

• Page 9, Line 18jeopardy, serious impairment to bodily functions, or serious dysfunction of any bodily organ or part.

• Page 9, Line 19(c) (I)  "Emergency medical services" means:

• Page 9, Line 20(A)  An appropriate medical screening examination within

• Page 9, Line 21the capability of the facility, including ancillary services

• Page 9, Line 22routinely available to the facility, to determine if an

• Page 9, Line 23emergency medical condition exists; and

• Page 10, Line 1(B)  When the examining health-care provider determines

• Page 10, Line 2that an emergency medical condition exists, the medical

• Page 10, Line 3treatment necessary to stabilize the emergency medical

• Page 10, Line 4condition that is within the capability of the facility. If the

• Page 10, Line 5patient's emergency medical condition requires the services of

• Page 10, Line 6an on-call physician, the examining health-care provider shall attempt to contact the on-call physician.

• Page 10, Line 7(II)  "Emergency medical services" includes providing an

• Page 10, Line 8abortion or sterilization procedures when a patient has an

• Page 10, Line 9emergency medical condition and an abortion or sterilization

• Page 10, Line 10procedures are necessary to stabilize the patient and are within the capability and capacity of the facility.

• Page 10, Line 11(d)  "Facility" means a hospital licensed pursuant to

• Page 10, Line 12section 25-3-101; a freestanding emergency department, as

• Page 10, Line 13defined in section 25-1.5-114 (5)(b); or a community clinic, as defined in section 25-3-101 (2)(a)(I)(B).

• Page 10, Line 14(e)  "Labor" means the process of childbirth beginning with

• Page 10, Line 15the latent or early phase of labor and continuing through the

• Page 10, Line 16delivery of the placenta. A person experiencing contractions is

• Page 10, Line 17in labor unless a physician, certified nurse midwife, or other

• Page 10, Line 18qualified medical personnel, acting within the person's scope of

• Page 10, Line 19practice as defined in the facility's medical staff bylaws and

• Page 10, Line 20state law, certifies after a reasonable time of observation that the person is in false labor.

• Page 10, Line 21(f)  "Stabilize" means to provide medical treatment that

• Page 10, Line 22may be necessary to ensure, within reasonable medical

• Page 10, Line 23probability, that no material deterioration of the patient's

• Page 11, Line 1condition, serious impairment of bodily functions or dysfunction

• Page 11, Line 2of any bodily organ or part, or a threat to the patient's life is

• Page 11, Line 3likely to result from or occur during the transfer or discharge of the patient.

• Page 11, Line 4SECTION 2.  In Colorado Revised Statutes, 12-240-121, add (1)(jj) as follows:

• Page 11, Line 512-240-121.  Unprofessional conduct - definitions. (1)  "Unprofessional conduct" as used in this article 240 means:

• Page 11, Line 6(jj)  Negligently violating section 25-3-132.

• Page 11, Line 7SECTION 3.  Appropriation. (1)  For the 2025-26 state fiscal

• Page 11, Line 8year, $82,768 is appropriated to the department of public health and

• Page 11, Line 9environment for use by the health facilities and emergency medical

• Page 11, Line 10services division. This appropriation is from the health facilities general

• Page 11, Line 11licensure cash fund created in section 25-3-103.1 (1), C.R.S. To implement this act, the division may use this appropriation as follows:

• Page 11, Line 12(a)  $19,796 for administration and operations, which amount is

• Page 11, Line 13based on an assumption that the division will require an additional 0.2 FTE; and

• Page 11, Line 14(b)  $62,972 for the health facility survey, which amount is based on an assumption that the division will require an additional 0.5 FTE.

• Page 11, Line 15SECTION 4.  Severability. If any provision of this act or the

• Page 11, Line 16application of this act to any person or circumstance is held invalid, the

• Page 11, Line 17invalidity does not affect other provisions or applications of the act that

• Page 11, Line 18can be given effect without the invalid provision or application, and to this end the provisions of this act are declared to be severable.

• Page 11, Line 19SECTION 5.  Safety clause. The general assembly finds,

• Page 11, Line 20determines, and declares that this act is necessary for the immediate

• Page 12, Line 1preservation of the public peace, health, or safety or for appropriations for

• Page 12, Line 2the support and maintenance of the departments of the state and state institutions.