A Bill for an Act
Page 1, Line 101Concerning providing emergency medical services.
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.
This Unofficial Version Includes Committee
Amendments Not Yet Adopted on Second Reading
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 2, Line 10to a person if a prudent layperson would believe, based on the
Page 3, Line 1person's appearance or behavior, that the person is in need of emergency medical services.
Page 3, Line 2(2) Central log required.For each person who presents to
Page 3, Line 3a facility and requests emergency medical services or a request
Page 3, Line 4is made on the person's behalf for emergency medical services,
Page 3, Line 5the facility shall input into a central log whether the person
Page 3, Line 6refused treatment, was denied treatment, whether no treatment
Page 3, Line 7was required, or whether the person was transferred, admitted and treated, stabilized and transferred, or discharged.
Page 3, Line 8(3) Nondiscrimination.A facility is a place of public
Page 3, Line 9accommodation subject to part 6 of article 34 of title 24 and
Page 3, Line 10shall not deny emergency medical services or discriminate in
Page 3, Line 11providing emergency medical services to a patient for a
Page 3, Line 12discriminatory or unlawful reason as described in part 6 of article 34 of title 24.
Page 3, Line 13(4) Provider protections. (a) A facility shall not penalize
Page 3, Line 14or take any adverse action against a health-care provider for
Page 3, Line 15refusing to transfer a patient with an emergency medical condition that has not been stabilized.
Page 3, Line 16(b) This subsection (4) does not alter or limit the rights
Page 3, Line 17and protections afforded to a person pursuant to section 24-34-402 (1).
Page 3, Line 18(5) Financial inquiry.A facility shall not delay providing
Page 3, Line 19emergency medical services to a person in order to inquire about the person's ability to pay for emergency medical services.
Page 3, Line 20(6) Appropriate transfer.If a patient has received an
Page 3, Line 21appropriate medical screening examination as described in
Page 4, Line 1subsection (10)(c)(I)(A) of this section and the examining
Page 4, Line 2health-care provider determines that an emergency medical
Page 4, Line 3condition exists and the condition has not been stabilized, the
Page 4, Line 4facility shall not transfer the patient unless all of the following conditions are met:
Page 4, Line 5(a) The patient is provided medical treatment within the
Page 4, Line 6facility's capacity that minimizes the risks to the patient's health;
Page 4, Line 7(b) The receiving facility has the space and qualified
Page 4, Line 8personnel available for treating the patient and has agreed to
Page 4, Line 9accept transfer of the patient and to provide appropriate medical treatment;
Page 4, Line 10(c) The transfer is effected through qualified personnel
Page 4, Line 11and transportation equipment, including the use of necessary
Page 4, Line 12and medically appropriate life support measures during the transfer;
Page 4, Line 13(d) The transferring facility sends all medical records,
Page 4, Line 14or copies of the medical records, related to the patient's
Page 4, Line 15emergency medical condition that the patient presented to the
Page 4, Line 16facility for, that are available at the time of the transfer,
Page 4, Line 17including medical records, or copies of the medical records,
Page 4, Line 18related to observations of signs and symptoms; preliminary
Page 4, Line 19diagnosis; treatment provided to the patient; test results; the
Page 4, Line 20informed written request or certification provided pursuant to
Page 4, Line 21subsection (6)(f) of this section, or a copy of the request or
Page 4, Line 22certification; and, if relevant, the name and address of any
Page 4, Line 23on-call physician who refused or failed to appear at the facility
Page 5, Line 1within a reasonable amount of time to provide the patient with necessary stabilizing treatment;
Page 5, Line 2(e) The transfer conforms with applicable facility
Page 5, Line 3standards established by the state board of health, created in
Page 5, Line 4section 25-1-103, in accordance with the department's authority
Page 5, Line 5established pursuant to section 25-1.5-103. The facility
Page 5, Line 6standards must reflect the federal rules and regulations
Page 5, Line 7described in 42 CFR 489.24 and adopted pursuant to the federal
Page 5, Line 8"Emergency Medical Treatment and Active Labor Act", 42 U.S.C. sec. 1395dd; and
Page 5, Line 9(f) (I) After being informed of the facility's obligations
Page 5, Line 10pursuant to this section and the risk of transfer, the patient or the patient's representative requests the transfer in writing;
Page 5, Line 11(II) A physician has signed a certification that includes a
Page 5, Line 12summary of the risks and benefits of transferring the patient
Page 5, Line 13and a statement that, based upon the information available at
Page 5, Line 14the time of the transfer, the medical benefits reasonably
Page 5, Line 15expected from the provision of appropriate medical treatment at
Page 5, Line 16another facility outweigh the increased risks to the patient from being transferred; or
Page 5, Line 17(III) If a physician is not physically present in the facility
Page 5, Line 18at the time a patient is transferred, the examining health-care
Page 5, Line 19provider has signed a certification that includes the
Page 5, Line 20information described in subsection (6)(f)(II) of this section and
Page 5, Line 21the physician, after consulting with the examining health-care
Page 5, Line 22provider, agrees with the certification and subsequently
Page 5, Line 23countersigns 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 6, Line 22treatment. The patient's medical record must contain a
Page 7, Line 1description of the examination and, if applicable, the treatment,
Page 7, Line 2and a statement that the patient or the patient's representative
Page 7, Line 3refused. The facility shall take all reasonable steps to secure
Page 7, Line 4the patient's written informed refusal, which must indicate the
Page 7, Line 5patient has been informed of the risks and benefits of the examination and treatment, if applicable.
Page 7, Line 6(8) Nonliability.A facility or health-care provider does not violate this section if:
Page 7, Line 7(a) The patient is provided an appropriate medical
Page 7, Line 8screening examination as described in subsection (10)(c)(I)(A) of
Page 7, Line 9this section by a health-care provider and the examining
Page 7, Line 10health-care provider determines that no emergency medical
Page 7, Line 11condition exists and records the determination in the patient's medical record;
Page 7, Line 12(b) The patient is provided an appropriate medical
Page 7, Line 13screening examination as described in subsection (10)(c)(I)(A) of
Page 7, Line 14this section by a health-care provider and the examining
Page 7, Line 15health-care provider determines that an emergency medical
Page 7, Line 16condition exists and the patient is appropriately transferred or discharged pursuant to subsection (6) or (7) of this section; or
Page 7, Line 17(c) The patient is provided an appropriate medical
Page 7, Line 18screening examination as described in subsection (10)(c)(I)(A) of
Page 7, Line 19this section by a health-care provider and the examining
Page 7, Line 20health-care provider determines that an emergency medical
Page 7, Line 21condition exists and the patient is admitted in good faith to the facility as an inpatient for further stabilizing treatment.
Page 7, Line 22(9) Investigation and penalty. (a) The department may
Page 8, Line 1investigate a facility that negligently violates this section pursuant to section 25-1.5-103 (1)(a).
Page 8, Line 2(b) (I) A physician who negligently violates this section
Page 8, Line 3engages in unprofessional conduct and is subject to discipline pursuant to section 12-240-121.
Page 8, Line 4(II) This subsection (9)(b) applies to a physician who:
Page 8, Line 5(A) Signs a certification pursuant to subsection (6)(f)(II)
Page 8, Line 6of this section that states the medical benefits reasonably
Page 8, Line 7expected from appropriate medical treatment at another
Page 8, Line 8facility outweigh the increased risks to the patient from being
Page 8, Line 9transferred if the physician knew or should have known the benefits did not outweigh the risks;
Page 8, Line 10(B) Misrepresents a patient's condition or other
Page 8, Line 11information, including a facility's obligations pursuant to this section; or
Page 8, Line 12(C) Is the on-call physician and fails or refuses to present
Page 8, Line 13to the facility within a reasonable period of time pursuant to subsection (10)(c)(I)(B) of this section after being contacted.
Page 8, Line 14(c) If a civil monetary penalty is imposed pursuant to
Page 8, Line 15section 25-1.5-103 or 12-240-121, the maximum civil monetary
Page 8, Line 16penalty amount must be reduced by any civil monetary penalty
Page 8, Line 17imposed pursuant to the federal "Emergency Medical Treatment
Page 8, Line 18and Active Labor Act", 42 U.S.C. 1395dd (d) for the same violation.
Page 8, Line 19(10) Definitions.As used in this section, unless the context otherwise requires:
Page 8, Line 20(a) "Abortion" has the same meaning as set forth in section 25-6-402.
Page 9, Line 1(b) (I) "Emergency medical condition" means:
Page 9, Line 2(A) A medical condition manifesting itself by acute signs
Page 9, Line 3and symptoms of sufficient severity, including severe pain, such
Page 9, Line 4that the absence of immediate medical attention could
Page 9, Line 5reasonably be expected to result in placing the health of the
Page 9, Line 6person in serious jeopardy, serious impairment of bodily
Page 9, Line 7functions, or serious dysfunction of any bodily organ or part; or
Page 9, Line 8(B) With respect to a pregnant person who is having
Page 9, Line 9contractions, there is inadequate time to effectuate a safe
Page 9, Line 10transfer to another facility before delivery, or that
Page 9, Line 11transferring the patient may pose a threat to the health or safety of the patient.
Page 9, Line 12(II) "Emergency medical condition" includes, but is not
Page 9, Line 13limited to, labor, ectopic pregnancy, a complication resulting
Page 9, Line 14from pregnancy loss, and emergent hypertensive disorders when
Page 9, Line 15the absence of immediate medical attention could reasonably be
Page 9, Line 16expected to result in placing the health of the patient in serious
Page 9, Line 17jeopardy, serious impairment to bodily functions, or serious dysfunction of any bodily organ or part.
Page 9, Line 18(c) (I) "Emergency medical services" means:
Page 9, Line 19(A) An appropriate medical screening examination within
Page 9, Line 20the capability of the facility, including ancillary services
Page 9, Line 21routinely available to the facility, to determine if an emergency medical condition exists; and
Page 9, Line 22(B) When the examining health-care provider determines
Page 10, Line 1that an emergency medical condition exists, the medical
Page 10, Line 2treatment necessary to stabilize the emergency medical
Page 10, Line 3condition that is within the capability of the facility. If the
Page 10, Line 4patient's emergency medical condition requires the services of
Page 10, Line 5an on-call physician, the examining health-care provider shall attempt to contact the on-call physician.
Page 10, Line 6(II) "Emergency medical services" includes providing an
Page 10, Line 7abortion or sterilization procedures when a patient has an
Page 10, Line 8emergency medical condition and an abortion or sterilization
Page 10, Line 9procedures are necessary to stabilize the patient and are within the capability and capacity of the facility.
Page 10, Line 10(d) "Facility" means a hospital licensed pursuant to
Page 10, Line 11section 25-3-101; a freestanding emergency department, as
Page 10, Line 12defined 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 13(e) "Labor" means the process of childbirth beginning with
Page 10, Line 14the latent or early phase of labor and continuing through the
Page 10, Line 15delivery of the placenta. A person experiencing contractions is
Page 10, Line 16in labor unless a physician, certified nurse midwife, or other
Page 10, Line 17qualified medical personnel, acting within the person's scope of
Page 10, Line 18practice as defined in the facility's medical staff bylaws and
Page 10, Line 19state law, certifies after a reasonable time of observation that the person is in false labor.
Page 10, Line 20(f) "Stabilize" means to provide medical treatment that
Page 10, Line 21may be necessary to ensure, within reasonable medical
Page 10, Line 22probability, that no material deterioration of the patient's
Page 10, Line 23condition, serious impairment of bodily functions or dysfunction
Page 11, Line 1of any bodily organ or part, or a threat to the patient's life is
Page 11, Line 2likely to result from or occur during the transfer or discharge of the patient.
Page 11, Line 3SECTION 2. In Colorado Revised Statutes, 12-240-121, add (1)(jj) as follows:
Page 11, Line 412-240-121. Unprofessional conduct - definitions. (1) "Unprofessional conduct" as used in this article 240 means:
Page 11, Line 5(jj) Negligently violating section 25-3-132.
Page 11, Line 6SECTION 3. In Colorado Revised Statutes, 24-31-101, amend (1)(i)(XXII) and (1)(i)(XXIII); and add (1)(i)(XXIV) as follows:
Page 11, Line 724-31-101. Powers and duties of attorney general. (1) The attorney general:
Page 11, Line 8(i) May independently initiate and bring civil and criminal actions to enforce state laws, including actions brought pursuant to:
Page 11, Line 9(XXII) Part 14 of article 12 of title 38;
and(XXIII) Section 24-34-806; and
Page 11, Line 10(XXIV) Section 25-3-132.
Page 11, Line 11SECTION 4. Severability. If any provision of this act or the
Page 11, Line 12application of this act to any person or circumstance is held invalid, the
Page 11, Line 13invalidity does not affect other provisions or applications of the act that
Page 11, Line 14can 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 15SECTION 5. Safety clause. The general assembly finds,
Page 11, Line 16determines, and declares that this act is necessary for the immediate
Page 11, Line 17preservation of the public peace, health, or safety or for appropriations for
Page 11, Line 18the support and maintenance of the departments of the state and state
Page 11, Line 19institutions.