HB6443: Health facilities: hospitals; emergency medical screening and stabilizing treatment; require…

HOUSE BILL NO. 6443 A bill to amend 1978 PA 368, entitled "Public health code," (MCL 333.1101 to 333.25211) by adding sections 17028, 17528, 21528, 21528a, 21528b, 21528c, and 21528d. the people of the state of michigan enact: Sec. 17028. A physician shall comply with sections 21528 to 21528d. Sec. 17528. A physician shall comply with sections 21528 to 21528d. Sec. 21528. (1) A hospital shall provide an emergency medical service to an individual who presents to the hospital under any of the following circumstances: (a) On the individual's request. (b) On the request of another individual on behalf of the individual. (c) If a prudent layperson would believe, based on the individual's approach or behavior, that the individual is in need of an emergency medical service. (2) A hospital shall create and maintain a central log for a request received under subsection (1). The central log must document all of the following for each individual who presents to the hospital and requests an emergency medical service or for whom an emergency medical service is requested on the individual's behalf: (a) Whether the individual refused treatment. (b) Whether the individual was denied treatment. (c) Whether treatment was required for the individual. (d) Whether the individual was transferred, admitted and treated, brought to stabilization and transferred, or discharged. (3) A hospital shall not delay providing an emergency medical service to an individual to inquire about the individual's ability to pay for the emergency medical service. (4) As used in this section and sections 21528a to 21528d: (a) "Emergency medical condition" includes, but is not limited to, any of the following: ( i ) A medical condition manifesting itself by acute signs and symptoms of sufficient severity, including, but not limited to, severe pain, such that the absence of immediate medical attention could reasonably be expected to result in placing the health of the individual in serious jeopardy, a serious impairment of a bodily function, or a serious dysfunction of a bodily organ or part. ( ii ) If the individual is pregnant and having contractions, there is inadequate time to effectuate a safe transfer to another hospital before delivery or transferring the individual to another hospital may pose a threat to the health or safety of the patient. ( iii ) Any of the following if the absence of immediate medical attention could reasonably be expected to result in placing the health of the individual in serious jeopardy, a serious impairment of bodily function, or a serious dysfunction of a bodily organ or part: (A) Labor. (B) An ectopic pregnancy. (C) A complication resulting from pregnancy or pregnancy loss. (D) An emergent hypertensive disorder. (b) "Emergency medical service" means both of the following: ( i ) A medical screening examination. ( ii ) If the result of a medical screening examination is that an emergency medical condition exists, the medical treatment necessary to bring the patient to stabilization that is within the capability and capacity of the hospital, including an abortion. (c) "Health professional" means an individual who is licensed, registered, or otherwise authorized to engage in a health profession under article 15. (d) "Labor" means the process of childbirth beginning with the latent or early phase of labor and continuing through the delivery of the placenta. An individual experiencing contractions is in labor unless a health professional acting within the scope of that health professional's scope of practice determines after a reasonable time of observation that the individual is in false labor. (e) "Medical screening examination" means an examination within the capability of the hospital, and any ancillary services routinely available to the hospital, that screens an individual to determine if the individual has an emergency medical condition. (f) "Stabilization" means the point at which no material deterioration of a condition is likely, within reasonable medical probability, to result from or occur during transfer of the patient. Sec. 21528a. If the results of a medical screening examination indicate that a patient's emergency medical condition requires the services of an on-call physician to provide the patient with treatment necessary to bring the patient to stabilization, the hospital shall attempt to contact the on-call physician and shall direct the physician to appear at the hospital within a reasonable amount of time to bring the patient to stabilization. Sec. 21528b. If a patient has received a medical screening examination and the health professional performing the medical screening examination determines that an emergency medical condition exists and the patient has not been brought to stabilization, the hospital shall not transfer the patient to another hospital unless all of the following conditions are met: (a) The patient is provided medical treatment within the hospital's capacity that minimizes any risk to the patient's health. (b) The receiving hospital has the space and qualified personnel available to treat the patient and has agreed to accept the transfer of the patient and to provide appropriate medical treatment. (c) The transfer occurs through qualified personnel and transportation equipment, including the use of necessary and medically appropriate support measures during the transfer. (d) The transferring hospital sends to the receiving hospital the medical records related to the patient's emergency medical condition that are available at the time of the transfer or copies of those records. The medical records must include all of the following: ( i ) Records related to observing signs and symptoms, preliminary diagnosis, the treatment provided, and test results. ( ii ) If applicable, the name and address of any on-call physician who refused or failed to appear at the hospital within a reasonable amount of time to bring the patient to stabilization. ( iii ) A copy of the certification described in subdivision (e). (e) After informing the patient of the hospital's obligations under this section and the risk of transfer, the patient or the patient's representative requests the transfer in writing and 1 of the following is met: ( i ) A physician signs a certification that includes a summary of the risks and benefits of transferring the patient and a statement that, based on the information available at the time of the transfer, the medical benefits reasonably expected from providing appropriate medical treatment at another hospital outweigh the increased risks to the patient from being transferred. ( ii ) If a physician is not physically present in the hospital at the time a patient is transferred, the health professional examining the patient signs a certification that includes the information described in subparagraph ( i ) and a physician, after consulting with the health professional examining the patient, agrees with the certification and subsequently countersigns the certification. Sec. 21528c. (1) Except as otherwise provided in this section, if a patient has received a medical screening examination and the health professional examining the patient determines that an emergency medical condition exists, the hospital shall not discharge the patient unless the patient has been brought to stabilization. (2) If a patient described in subsection (1) has not been brought to stabilization, the patient may be discharged only if both of the following apply: (a) After being informed of the hospital's obligations under this section and the risk of discharge, the patient or the patient's representative requests a discharge in writing. (b) The hospital offers the patient further medical examination and treatment and informs the patient or the patient's representative of the risks and benefits of the examination and treatment but the patient or the patient's representative does not consent to the medical examination and treatment. (3) If a patient or the patient's representative does not consent to medical examination or treatment under subsection (2), the patient's medical record must contain a description of the examination and, if applicable, the treatment and a statement that the patient or the patient's representative refused medical examination or treatment. The hospital shall take all reasonable steps to secure the patient's written informed refusal, which must indicate that the patient has been informed of the risks and benefits of the examination and treatment, if applicable. Sec. 21528d. A hospital shall ensure that a physician employed by or under contract to the hospital does not do any of the following: (a) Sign a certification under section 21528b that states the medical benefits reasonably expected from appropriate treatment at another hospital outweigh the increased risks to the patient from being transferred if the physician knows or should have known the benefits did not outweigh the risks. (b) Misrepresents a patient's condition or other information under section 21528b, including a hospital's obligation under that section. (c) If the physician is the on-call physician, fails or refuses to present to the hospital within a reasonable period of time after being contacted under section 21528a.