Senate Bill 25-130 Revised

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 facility when

• Page 2, Line 7the person requests or a request is made on the person's behalf

• Page 2, Line 8for emergency medical services. In the absence of a request, a

• Page 2, Line 9facility shall provide emergency medical services to a person if

• Page 3, Line 1a prudent layperson would believe, based on the person's

• Page 3, Line 2appearance 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)(e)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 4(e) (I)  After being informed of the facility's obligations

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

• Page 5, Line 6(II)  A physician has signed a certification that includes a

• Page 5, Line 7summary of the risks and benefits of transferring the patient

• Page 5, Line 8and a statement that, based upon the information available at

• Page 5, Line 9the time of the transfer, the medical benefits reasonably

• Page 5, Line 10expected from the provision of appropriate medical treatment at

• Page 5, Line 11another facility outweigh the increased risks to the patient from being transferred; or

• Page 5, Line 12(III)  If a physician is not physically present in the facility

• Page 5, Line 13at the time a patient is transferred, the examining health-care

• Page 5, Line 14provider has signed a certification that includes the

• Page 5, Line 15information described in subsection(6)(e)(II)of this section and

• Page 5, Line 16the physician, after consulting with the examining health-care

• Page 5, Line 17provider, agrees with the certification and subsequently countersigns the certification.

• Page 5, Line 18(7)  Appropriate discharge. (a)  If a patient has received an

• Page 5, Line 19appropriate medical screening examination as described in

• Page 5, Line 20subsection (10)(c)(I)(A) of this section and the examining

• Page 5, Line 21health-care provider determines that an emergency medical

• Page 5, Line 22condition exists, the facility shall not discharge the patient

• Page 5, Line 23unless the patient's emergency medical condition has been stabilized.

• Page 6, Line 1(b)  If a patient has not been stabilized, discharging the patient is only permitted if:

• Page 6, Line 2(I)  After being informed of the facility's obligations

• Page 6, Line 3pursuant to this section and the risk of discharge, the patient or the patient's representative requests a discharge in writing; or

• Page 6, Line 4(II)  The facility offers the patient further medical

• Page 6, Line 5examination and treatment and informs the patient or the

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

• Page 6, Line 7examination and treatment but the patient or the patient's

• Page 6, Line 8representative does not consent to the medical examination and

• Page 6, Line 9treatment. The patient's medical record must contain a

• Page 6, Line 10description of the examination and, if applicable, the treatment,

• Page 6, Line 11and a statement that the patient or the patient's representative

• Page 6, Line 12refused. The facility shall take all reasonable steps to secure

• Page 6, Line 13the patient's written informed refusal, which must indicate the

• Page 6, Line 14patient has been informed of the risks and benefits of the examination and treatment, if applicable.

• Page 6, Line 15(8)  Nonliability.A facility or health-care provider does not violate this section if:

• Page 6, Line 16(a)  The patient is provided an appropriate medical

• Page 6, Line 17screening examination as described in subsection (10)(c)(I)(A) of

• Page 6, Line 18this section by a health-care provider and the examining

• Page 6, Line 19health-care provider determines that no emergency medical

• Page 6, Line 20condition exists and records the determination in the patient's medical record;

• Page 6, Line 21(b)  The patient is provided an appropriate medical

• Page 7, Line 1screening examination as described in subsection (10)(c)(I)(A) of

• Page 7, Line 2this section by a health-care provider and the examining

• Page 7, Line 3health-care provider determines that an emergency medical

• Page 7, Line 4condition exists and the patient is appropriately transferred or discharged pursuant to subsection (6) or (7) of this section; or

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

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

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

• Page 7, Line 8health-care provider determines that an emergency medical

• Page 7, Line 9condition exists and the patient is admitted in good faith to the facility as an inpatient for further stabilizing treatment.

• Page 7, Line 10(9)  Investigation and penalty. (a)  The department may

• Page 7, Line 11investigate a facility that negligently violates this section pursuant to section 25-1.5-103 (1)(a).

• Page 7, Line 12(b) (I)  A physician who negligently violates this section

• Page 7, Line 13engages in unprofessional conduct and is subject to discipline pursuant to section 12-240-121.

• Page 7, Line 14(II)  This subsection (9)(b) applies to a physician who:

• Page 7, Line 15(A)  Signs a certification pursuant to subsection (6)(f)(II)

• Page 7, Line 16of this section that states the medical benefits reasonably

• Page 7, Line 17expected from appropriate medical treatment at another

• Page 7, Line 18facility outweigh the increased risks to the patient from being

• Page 7, Line 19transferred if the physician knew or should have known the benefits did not outweigh the risks;

• Page 7, Line 20(B)  Misrepresents a patient's condition or other

• Page 7, Line 21information, including a facility's obligations pursuant to this

• Page 7, Line 22section; or

• Page 8, Line 1(C)  Is the on-call physician and fails or refuses to present

• Page 8, Line 2to the facility within a reasonable period of time pursuant to subsection (10)(c)(I)(B) of this section after being contacted.

• Page 8, Line 3(c)  If a civil monetary penalty is imposed pursuant to

• Page 8, Line 4section 25-1.5-103 or 12-240-121, the maximum civil monetary

• Page 8, Line 5penalty amount must be reduced by any civil monetary penalty

• Page 8, Line 6imposed pursuant to the federal "Emergency Medical Treatment

• Page 8, Line 7and Active Labor Act", 42 U.S.C. 1395dd (d) for the same violation.

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

• Page 8, Line 9(a)  "Abortion" has the same meaning as set forth in section 25-6-402.

• Page 8, Line 10(b) (I)  "Emergency medical condition" means:

• Page 8, Line 11(A)  A medical condition manifesting itself by acute signs

• Page 8, Line 12and symptoms of sufficient severity, including severe pain, such

• Page 8, Line 13that the absence of immediate medical attention could

• Page 8, Line 14reasonably be expected to result in placing the health of the

• Page 8, Line 15person in serious jeopardy, serious impairment of bodily

• Page 8, Line 16functions, or serious dysfunction of any bodily organ or part; or

• Page 8, Line 17(B)  With respect to a pregnant person who is having

• Page 8, Line 18contractions, there is inadequate time to effectuate a safe

• Page 8, Line 19transfer to another facility before delivery, or that

• Page 8, Line 20transferring the patient may pose a threat to the health or safety of the patient.

• Page 8, Line 21(II)  "Emergency medical condition" includes, but is not

• Page 9, Line 1limited to, labor, ectopic pregnancy, a complication resulting

• Page 9, Line 2from pregnancy or pregnancy loss, and emergent hypertensive

• Page 9, Line 3disorders when the absence of immediate medical attention

• Page 9, Line 4could reasonably be expected to result in placing the health of

• Page 9, Line 5the person in serious jeopardy, serious impairment to bodily functions, or serious dysfunction of any bodily organ or part.

• Page 9, Line 6(c) (I)  "Emergency medical services" means:

• Page 9, Line 7(A)  An appropriate medical screening examination within

• Page 9, Line 8the capability of the facility, including ancillary services

• Page 9, Line 9routinely available to the facility, to determine if an emergency medical condition exists; and

• Page 9, Line 10(B)  When the examining health-care provider determines

• Page 9, Line 11that an emergency medical condition exists, the medical

• Page 9, Line 12treatment necessary to stabilize the emergency medical

• Page 9, Line 13condition that is within the capability of the facility. If the

• Page 9, Line 14patient's emergency medical condition requires the services of

• Page 9, Line 15an on-call physician, the examining health-care provider shall attempt to contact the on-call physician, if applicable.

• Page 9, Line 16(II)  "Emergency medical services" includes providing an

• Page 9, Line 17abortion or sterilization procedures when a patient has an

• Page 9, Line 18emergency medical condition and an abortion or sterilization

• Page 9, Line 19procedures are necessary to stabilize the patient and are within the capability and capacity of the facility.

• Page 9, Line 20(d)  "Facility" means an emergency department of a

• Page 9, Line 21hospital licensed pursuant to section 25-3-101; a freestanding

• Page 9, Line 22emergency department, as defined in section 25-1.5-114; or any

• Page 9, Line 23other licensed health-care facility, or area of a hospital or

• Page 10, Line 1health-care facility, that holds itself out to the public as providing emergency care.

• Page 10, Line 2(e)  "Labor" means the process of childbirth beginning with

• Page 10, Line 3the latent or early phase of labor and continuing through the

• Page 10, Line 4delivery of the placenta. A person experiencing contractions is

• Page 10, Line 5in labor unless a physician, certified nurse midwife, or other

• Page 10, Line 6qualified medical personnel, acting within the person's scope of

• Page 10, Line 7practice as defined in the facility's medical staff bylaws and

• Page 10, Line 8state law, certifies after a reasonable time of observation that the person is in false labor.

• Page 10, Line 9(f)  "Stabilize" means to provide medical treatment that

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

• Page 10, Line 11probability, that no material deterioration of the patient's

• Page 10, Line 12condition, serious impairment of bodily functions or dysfunction

• Page 10, Line 13of any bodily organ or part, or a threat to the patient's life is

• Page 10, Line 14likely to result from or occur during the transfer or discharge of the patient.

• Page 10, Line 15SECTION 2.  In Colorado Revised Statutes, 12-240-121, add (1)(jj) as follows:

• Page 10, Line 1612-240-121.  Unprofessional conduct - definitions. (1)  "Unprofessional conduct" as used in this article 240 means:

• Page 10, Line 17(jj)  Negligently violating section 25-3-132.

• Page 10, Line 18SECTION 3.  Appropriation. (1)  For the 2025-26 state fiscal

• Page 10, Line 19year, $82,768 is appropriated to the department of public health and

• Page 10, Line 20environment for use by the health facilities and emergency medical

• Page 10, Line 21services division. This appropriation is from the health facilities general

• Page 10, Line 22licensure 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 1(a)  $19,796 for administration and operations, which amount is

• Page 11, Line 2based on an assumption that the division will require an additional 0.2 FTE; and

• Page 11, Line 3(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 4SECTION 4.  Severability. If any provision of this act or the

• Page 11, Line 5application of this act to any person or circumstance is held invalid, the

• Page 11, Line 6invalidity does not affect other provisions or applications of the act that

• Page 11, Line 7can 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 8SECTION 5.  Safety clause. The general assembly finds,

• Page 11, Line 9determines, and declares that this act is necessary for the immediate

• Page 11, Line 10preservation of the public peace, health, or safety or for appropriations for

• Page 11, Line 11the support and maintenance of the departments of the state and state institutions.