Senate Bill 25-130 Introduced

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.

• 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)  Requirement.An emergency department shall

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

• Page 2, Line 7(2)  Central log required.For each person who presents to

• Page 2, Line 8an emergency department for treatment, the emergency

• Page 2, Line 9department shall input into a central log whether the person

• Page 3, Line 1refused treatment or was denied treatment, or whether the

• Page 3, Line 2person was admitted and treated, stabilized and transferred, or discharged.

• Page 3, Line 3(3)  Nondiscrimination.An emergency department shall not

• Page 3, Line 4deny or discriminate in providing emergency medical services to

• Page 3, Line 5a patient because of the patient's sex, including pregnancy and

• Page 3, Line 6pregnancy outcomes; ability to pay for medical care; insurance

• Page 3, Line 7status; or any characteristic described in section 24-34-601(2)(a).

• Page 3, Line 8(4)  Exception for sincerely held religious belief. (a)  An

• Page 3, Line 9emergency department shall implement a protocol to ensure a

• Page 3, Line 10health-care provider is available at all times who is willing and

• Page 3, Line 11able to provide emergency medical services in accordance with this section.

• Page 3, Line 12(b)  This section does not require a health-care provider

• Page 3, Line 13to provide emergency medical services if the emergency medical

• Page 3, Line 14services conflict with the health-care provider's sincerely held religious beliefs.

• Page 3, Line 15(c)  An emergency department shall not take any adverse

• Page 3, Line 16action against a health-care provider who provides emergency

• Page 3, Line 17medical services in accordance with this section, including, but

• Page 3, Line 18not limited, to actions related to discharge, promotion,

• Page 3, Line 19demotion, suspension, compensation, training opportunities, staff privileges, admitting privileges, or other disciplinary actions.

• Page 3, Line 20(d)  This subsection (4) does not alter or limit the rights

• Page 3, Line 21and protections afforded to a person pursuant to section

• Page 3, Line 2224-34-402 (1).

• Page 4, Line 1(5)  Financial inquiry.An emergency department shall not

• Page 4, Line 2inquire about a patient's ability to pay for emergency medical services until after the services have been rendered.

• Page 4, Line 3(6)  Appropriate transfer. (a)  An emergency department

• Page 4, Line 4shall not transfer a patient with an emergency medical

• Page 4, Line 5condition for a nonmedical reason unless all of the following conditions are met:

• Page 4, Line 6(I)  The patient is provided an appropriate medical

• Page 4, Line 7screening examination as described in subsection (10)(d)(I) of this

• Page 4, Line 8section by a health-care provider at the transferring emergency department;

• Page 4, Line 9(II)  The patient has been stabilized;

• Page 4, Line 10(III)  A health-care provider at the transferring

• Page 4, Line 11emergency department has notified and obtained consent from

• Page 4, Line 12a health-care provider at the receiving emergency department

• Page 4, Line 13that the patient meets the receiving emergency department's admission criteria;

• Page 4, Line 14(IV)  The transferring emergency department provides the

• Page 4, Line 15appropriate personnel and equipment that a reasonable and

• Page 4, Line 16prudent health-care provider in the same or similar locality exercising ordinary care would use to effectuate the transfer;

• Page 4, Line 17(V)  The patient's pertinent medical records and copies of

• Page 4, Line 18the appropriate diagnostic test results that are reasonably

• Page 4, Line 19available are transferred with the patient, including a transfer summary;

• Page 4, Line 20(VI)  The transfer conforms with rules established by the

• Page 4, Line 21department of public health and environment; and

• Page 5, Line 1(VII)  The transferring emergency department contacts,

• Page 5, Line 2or attempts to contact, and notifies the patient's preferred

• Page 5, Line 3contact person about the proposed transfer. If the patient is not

• Page 5, Line 4able to identify their preferred contact person, the

• Page 5, Line 5transferring emergency department shall make a reasonable

• Page 5, Line 6effort to ascertain the identity of the preferred contact person

• Page 5, Line 7or the next of kin and notify them about the proposed transfer.

• Page 5, Line 8The transferring emergency department shall document any

• Page 5, Line 9attempts to contact a preferred contact person or next of kin in the patient's medical record.

• Page 5, Line 10(b)  If a patient has not been stabilized, transferring the patient to another emergency department is only permitted if:

• Page 5, Line 11(I)  The patient is provided an appropriate medical

• Page 5, Line 12screening examination as described in subsection (10)(d)(I) of this section by a health-care provider;

• Page 5, Line 13(II)  The examining health-care provider determines the

• Page 5, Line 14medical benefits of transferring the patient outweigh the risks,

• Page 5, Line 15and the health-care provider communicates the reasoning to the

• Page 5, Line 16receiving health-care provider and documents the reasoning in the patient's medical record; and

• Page 5, Line 17(III)  The patient or the patient's representative requests

• Page 5, Line 18a transfer and gives informed consent to the transfer against

• Page 5, Line 19medical advice. The health-care provider shall document the

• Page 5, Line 20request, informed consent, and medical advice in the patient's medical record.

• Page 5, Line 21(7)  Appropriate discharge. (a)  An emergency department

• Page 5, Line 22shall not discharge a patient with an emergency medical condition unless all of the following conditions are met:

• Page 6, Line 1(I)  The patient is provided an appropriate medical

• Page 6, Line 2screening examination as described in subsection (10)(d)(I) of this section by a health-care provider at the emergency department;

• Page 6, Line 3(II)  The patient has been stabilized;

• Page 6, Line 4(III)  The patient's pertinent medical records and copies of

• Page 6, Line 5the appropriate diagnostic test results that are reasonably

• Page 6, Line 6available are provided to the patient upon discharge, including a discharge summary;

• Page 6, Line 7(IV)  The discharge conforms with rules established by the department of public health and environment; and

• Page 6, Line 8(V)  The emergency department contacts, or attempts to

• Page 6, Line 9contact, and notifies the patient's preferred contact person

• Page 6, Line 10about the proposed discharge. If the patient is not able to

• Page 6, Line 11identify their preferred contact person, the discharging

• Page 6, Line 12emergency department shall make a reasonable effort to

• Page 6, Line 13ascertain the identity of the preferred contact person or the

• Page 6, Line 14next of kin and notify them about the proposed discharge. The

• Page 6, Line 15emergency department shall document any attempts to contact

• Page 6, Line 16a preferred contact person or next of kin in the patient's medical record.

• Page 6, Line 17(b)  If a patient has not been stabilized, discharging the patient is only permitted if:

• Page 6, Line 18(I)  The patient is provided an appropriate medical

• Page 6, Line 19screening examination as described in subsection (10)(d)(I) of this section by a health-care provider; and

• Page 6, Line 20(II)  The patient or the patient's representative requests a

• Page 7, Line 1discharge and gives informed consent to the discharge against

• Page 7, Line 2medical advice. The health-care provider shall document the

• Page 7, Line 3request, informed consent, and medical advice in the patient's medical record.

• Page 7, Line 4(8)  Nonliability.An emergency department does not violate this section if:

• Page 7, Line 5(a)  The patient is provided an appropriate medical

• Page 7, Line 6screening examination as described in subsection (10)(d)(I) of this

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

• Page 7, Line 8health-care provider determines that no emergency medical

• Page 7, Line 9condition exists and records the determination in the patient's medical record;

• Page 7, Line 10(b)  The patient is provided an appropriate medical

• Page 7, Line 11screening examination as described in subsection (10)(d)(I) of this

• Page 7, Line 12section by a health-care provider and the examining

• Page 7, Line 13health-care provider determines that an emergency medical

• Page 7, Line 14condition exists and the patient is appropriately transferred or discharged pursuant to subsection (6) or (7) of this section; or

• Page 7, Line 15(c)  The patient is provided an appropriate medical

• Page 7, Line 16screening examination as described in subsection (10)(d)(I) of this

• Page 7, Line 17section by a health-care provider and the examining

• Page 7, Line 18health-care provider determines that an emergency medical

• Page 7, Line 19condition exists and the patient is admitted in good faith to the emergency department for further stabilizing treatment.

• Page 7, Line 20(9)  Enforcement. (a)  The attorney general may bring a

• Page 7, Line 21civil action on behalf of the state to seek injunctive relief or

• Page 7, Line 22the imposition of a civil monetary penalty against an emergency

• Page 8, Line 1department or a health-care provider for negligently violating

• Page 8, Line 2this section. The court, upon finding a violation of this section,

• Page 8, Line 3shall impose a civil penalty in an amount not to exceed fifty thousand dollars for each violation.

• Page 8, Line 4(b)  A patient who suffers personal injury pursuant to this

• Page 8, Line 5section has a private right of action against an emergency

• Page 8, Line 6department and may institute a civil action in district court for

• Page 8, Line 7any appropriate remedy within three years from the date of the alleged violation.

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

• Page 8, Line 9(a)  "Active labor" means a pregnant patient is

• Page 8, Line 10experiencing symptoms of labor, including, but not limited to,

• Page 8, Line 11contractions, pain, bleeding, cervical dilation, or shortened

• Page 8, Line 12cervical length, unless the examining obstetrician certifies

• Page 8, Line 13that, after a reasonable time of observation, the patient is in false labor.

• Page 8, Line 14(b)  "Emergency department" means an emergency

• Page 8, Line 15department of a hospital licensed pursuant to section 25-3-101;

• Page 8, Line 16a freestanding emergency department, as defined in section

• Page 8, Line 1725-1.5-114; a labor and delivery unit of a general hospital; a

• Page 8, Line 18maternity hospital; a hospital or health-care facility, or area

• Page 8, Line 19of a hospital or health-care facility, that holds itself out to

• Page 8, Line 20the public as providing emergency care; or a hospital or

• Page 8, Line 21health-care facility at which at least one-third of outpatient

• Page 8, Line 22visits during the prior calendar year were for emergency

• Page 8, Line 23medical care.

• Page 9, Line 1(c) (I)  "Emergency medical condition" means a medical

• Page 9, Line 2condition with symptoms of an illness or injury that may

• Page 9, Line 3progress in severity or result in complications with a high

• Page 9, Line 4probability for morbidity or mortality if treatment does not begin quickly.

• Page 9, Line 5(II)  "Emergency medical condition" includes, but is not

• Page 9, Line 6limited to, active labor; a threatened ectopic pregnancy or

• Page 9, Line 7miscarriage; a complication resulting from pregnancy or

• Page 9, Line 8pregnancy loss; risks to future fertility; a preterm premature

• Page 9, Line 9rupture of membranes; a placental abnormality; and emergent hypertensive disorders, such as preeclampsia.

• Page 9, Line 10(III)  "Emergency medical condition" includes a scenario in

• Page 9, Line 11which there is inadequate time to safely transfer the patient to

• Page 9, Line 12another emergency department or in which the transfer might pose a threat to the safety of the patient.

• Page 9, Line 13(d) (I)  "Emergency medical services" means:

• Page 9, Line 14(A)  A medical screening examination that is appropriate

• Page 9, Line 15to the patient's presenting signs and symptoms to determine if an emergency medical condition exists;

• Page 9, Line 16(B)  For a pregnant patient, a medical screening

• Page 9, Line 17examination conducted by an on-call obstetrician that is

• Page 9, Line 18appropriate to the patient's presenting signs and symptoms to determine if an emergency medical condition exists; and

• Page 9, Line 19(C)  When an emergency medical condition exists, the

• Page 9, Line 20medical treatment and care necessary to stabilize the patient as determined by the examining health-care provider.

• Page 9, Line 21(II)  "Emergency medical services" includes providing

• Page 10, Line 1abortion services when a patient has an emergency medical condition and an abortion is necessary to stabilize the patient.

• Page 10, Line 2(e)  "Stabilize" means to provide medical treatment that

• Page 10, Line 3may be necessary to ensure, within reasonable medical

• Page 10, Line 4probability, that no material deterioration of the patient's

• Page 10, Line 5condition is likely to result from or occur during the transfer or discharge of the patient.

• Page 10, Line 6SECTION 2.  In Colorado Revised Statutes, 24-31-101, amend (1)(i)(XXII) and (1)(i)(XXIII); and add (1)(i)(XXIV) as follows:

• Page 10, Line 724-31-101.  Powers and duties of attorney general. (1)  The attorney general:

• Page 10, Line 8(i)  May independently initiate and bring civil and criminal actions to enforce state laws, including actions brought pursuant to:

• Page 10, Line 9(XXII)  Part 14 of article 12 of title 38; and

• (XXIII)  Section 24-34-806; and

• Page 10, Line 10(XXIV)  Section 25-3-132.

• Page 10, Line 11SECTION 3.  Severability. If any provision of this act or the

• Page 10, Line 12application of this act to any person or circumstance is held invalid, the

• Page 10, Line 13invalidity does not affect other provisions or applications of the act that

• Page 10, 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 10, Line 15SECTION 4.  Safety clause. The general assembly finds,

• Page 10, Line 16determines, and declares that this act is necessary for the immediate

• Page 10, Line 17preservation of the public peace, health, or safety or for appropriations for

• Page 10, Line 18the support and maintenance of the departments of the state and state institutions.