SB 1681

This bill prohibits a hospital emergency department, including a satellite emergency department, from denying to a woman who presents at such facility and purports or, if incapacitated, appears to be pregnant and experiencing active labor, other symptoms associated with active labor, or an emergency medical condition, an appropriate medical screening examination within the capability of the emergency department, including ancillary services routinely available to the emergency department, to determine wh et her or not an emergency medical condition or active labor exists. If a hospital emergency department determines that a pregnant woman described in the prior paragraph has an emergency medical condition or is in active labor, then this bill requires the hospital affiliated with the emergency department to provide either of the following:  Within the staff and facilities available at the hospital, for such further medical examination and such treatment as may be required to stabilize the medical condition.  For transfer of the pregnant woman to another medical facility in accordance with this bill. When providing further medical examination and treatment to stabilize the medical condition, this bill provides that a hospital is deemed to meet such requirement with respect to the pregnant woman if the hospital offers the pregnant woman such further m edical examination and treatment and informs the pregnant woman, or a legally authorized person acting on the woman's behalf, of the risks and benefits to the pregnant woman of such examination and treatment, but the pregnant woman, or the legally authori ze d person acting on the woman's behalf, refuses to consent to the examination and treatment. The hospital must take all reasonable steps to secure the pregnant woman's or authorized person's written informed consent to refuse such examination and treatmen t. When transferring a pregnant woman to another medical facility, this bill provides that a hospital is deemed to meet such requirement with respect to the pregnant woman if the hospital offers to transfer the pregnant woman to another medical facility and informs the pregnant woman, or a legally authorized person acting on the woman's behalf, of the risks and benefits to the pregnant woman of such transfer, but the pregnant woman, or the legally authorized person acting on the woman's behalf, refuses to c on sent to the transfer. The hospital must take all reasonable steps to secure the pregnant woman's or authorized person's written informed consent to refuse such transfer. If a pregnant woman at a hospital has an emergency medical condition or active labor that has not been stabilized, then this bill prohibits the hospital from transferring the pregnant woman unless all of the following criteria is met:  The pregnant woman, or a legally authorized person acting on the woman's behalf, after being informed of the hospital's obligations under this bill and of the risk of transfer, in writing requests transfer to another medical facility.  Either (i) a physician has signed a certification that, based upon the information available at the time of transfer, the medical benefits reasonably expected from the provision of appropriate medical treatment at another medical facility outweigh the increased risks to the pregnant woman and, in the case of labor, to the unborn child from effecting the transfer; or (ii) if a physician is not physically present in the emergency department at the time the pregnant woman is transferred, a qualified medical professional, as defined by the commissioner of health by rule, has signed such a certification after a physician, in consultation with the qualified medical professional, has made such determination, and subsequently countersigns the certification.  The transfer is an appropriate transfer to that facility as determined by federal law. "EMERGENCY MEDICAL CONDITION"" DEFINED As used in this bill, an ""emergency medical condition"" means (i) a medical condition manifesting itself by acute symptoms of sufficient severity, including severe pain, such that the absence of immediate medical attention could reasonably be expected to r esult in placing the health of the individual or, with respect to a pregnant woman, the health of the woman or the woman's unborn child, in serious jeopardy; serious impairment to bodily functions; or serious dysfunction of any bodily organ or part; and ( ii ) with respect to a pregnant woman who is having contractions, that there is inadequate time to effect a safe transfer to another hospital before delivery or that transfer may pose a threat to the health or safety of the woman or the woman's unborn child. SPECIALIZED HOSPITAL This bill prohibits a hospital that has specialized capabilities or facilities from refusing to accept an appropriate transfer pursuant to this bill of a pregnant woman who requires such specialized capabilities or facilities if the hospital has the capa city to treat the pregnant woman. As used in this provision, ""specialized capabilities or facilities"" includes burn units; trauma units; neonatal intensive care units; and with respect to rural areas, regional referral centers as identified by federal re gu lation by the federal secretary of health and human services. MEDICAL SCREENING This bill prohibits a hospital from delaying provision of an appropriate medical screening examination required under this bill or further medical examination and treatment required under this bill in order to inquire about the pregnant woman's method of payment or insurance status. IMMUNITY This bill prohibits a hospital from penalizing or taking adverse action against either of the following:  A qualified medical professional or a physician because the qualified medical professional or physician refuses to authorize the transfer of a pregnant woman with an emergency medical condition that has not been stabilized.  Any hospital employee because the employee reports a violation of this bill. INVESTIGATION This bill authorizes the executive director of the health facilities commission to investigate and enforce violations of this bill by licensed healthcare facilities. Additionally, the department of health, including a health-related licensing board atta ched to the department of health, is authorized to investigate and enforce violations of this bill by individual healthcare professionals licensed, regulated, certified, or otherwise permitted in this state to deliver health care in the course of a profes si on in this state. PENALTIES This bill authorizes a hospital or satellite emergency department that violates this bill to be subject to a civil penalty of no more than $50, 000 for each violation or, in the case of a hospital with less than 100 beds, no more than $25, 000 for each vio lation. This bill generally provides that a physician who is responsible for the examination, treatment, or transfer of a pregnant woman in a hospital, including a physician on-call for the care of such pregnant woman, and who violates this bill is subject to a civil penalty of no more than $50, 000 for each violation and licensure sanction by the board of medical examiners or the board of osteopathic examination, as applicable. However, if, after an initial examination, a physician determines that the pregnant wo man requires the services of a physician listed by the hospital on its list of on-call physicians, if required by federal law, notifies the on-call physician, the on-call physician fails or refuses to appear within a reasonable period of time, and the phy sician orders the transfer of the pregnant woman because the physician determines that without the services of the on-call physician, the benefits of transfer outweigh the risks of transfer, then the physician authorizing the transfer is not subject to th e civil penalty of $50, 000 or licensure sanction. However, this exemption does not apply to the hospital or to the on-call physician who failed or refused to appear. For purposes of applying the civil penalty of $50, 000 or licensure sanction for a violation of this bill as described above, a ""physician who is responsible for the examination, treatment, or transfer of a pregnant woman in a hospital"" includes a physici an who (i) signs a certification that the medical benefits reasonably to be expected from a transfer to another facility outweigh the risks associated with the transfer, if the physician knew or should have known that the benefits did not outweigh the ri sk s; or (ii) misrepresents a pregnant woman's condition or other information, including a hospital's obligations under this bill. APPLICABILITY This bill applies to conduct occurring on or after July 1, 2026. ON FEBRUARY 26, 2026, THE SENATE ADOPTED AMENDMENT #1 AND PASSED SENATE BILL 1681, AS AMENDED. AMENDMENT #1 provides that a physician, qualified medical professional, or hospital employee is not subject to a civil penalty, licensure sanction, or other adverse action under the bill if the physician, qualified medical professional, or hospital employee acts in good faith and exercises reasonable clinical judgment based on the information available at the time care is provided or a transfer decision is made. Further, a civil penalty or licensure sanction is prohibited from being imposed under the bill for conduct that is the subject of an enforcement action, settlement, corrective action plan, or final determination under the federal Emergency Medical Treatment and Labor Act (EMTALA). This amendment clarifies that ""capacity"" has the same meaning as defined in federal regulations for purposes of the provision in the bill that prohibits a hospital that has specialized capabilities or facilities from refus ing to accept an appropriate transfer of a pregnant woman who requires such specialized capabilities or facilities if the hospital has the capacity to treat the pregnant woman. This amendment clarifies that civil penalties imposed pursuant to the bill are limited to one civil penalty per patient encounter, regardless of the number of alleged violations arising from the same event. Further, a physician must knowingly and willfu lly violate the bill to be subject to civil penalties and licensure sanctions for such a violation."