Official Summary Text
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 emplo
yee 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 bi
ll
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 refusing to accept an appropriate tra
nsfer 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.
ON MARCH 30, 2026, THE HOUSE SUBSTITUTED SENATE BILL 1681 FOR HOUSE BILL 1943, ADOPTED AMENDMENT #1, AND PASSED SENATE BILL 1681, AS AMENDED.
AMENDMENT #1 clarifies that the amendment does not authorize an abortion unless (i) the physician determined, based upon the facts known to the physician at the time, that the abortion was necessary to prevent the death of the pregnant woman or to preven
t serious risk of substantial and irreversible impairment of a major bodily function of the pregnant woman; and (ii) the physician performs or attempts to perform the abortion in the manner which, based upon the facts known to the physician at the time, p
ro
vides the best opportunity for the unborn child to survive, unless termination of the pregnancy in that manner would pose a greater risk of death to the pregnant woman or substantial an irreversible impairment of a major bodily function.
ON APRIL 2, 2026, THE SENATE NONCONCURRED IN HOUSE AMENDMENT #1.
ON APRIL 7, 2026, THE HOUSE REFUSED TO RECEDE IN ITS ADOPTION OF HOUSE
AMENDMENT #1.
ON APRIL 13, 2026, THE SENATE REFUSED TO RECEDE FROM ITS NONCONCURRENCE IN HOUSE AMENDMENT #1 AND APPOINTED A CONFERENCE COMMITTEE.
Current Bill Text
Read the full stored bill text
SENATE BILL 1681
By Lamar
HOUSE BILL 1943
By Love
HB1943
010494
- 1 -
AN ACT to amend Tennessee Code Annotated, Title 63
and Title 68, relative to medical facility procedures
for women experiencing certain medical
conditions.
BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF TENNESSEE:
SECTION 1. Tennessee Code Annotated, Title 68, Chapter 11, Part 2, is amended by
adding the following as a new section:
(a) As used in this section:
(1) "Emergency medical condition" means:
(A) 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 result in:
(i) 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;
(ii) Serious impairment to bodily functions; or
(iii) Serious dysfunction of any bodily organ or part; and
(B) With respect to a pregnant woman who is having contractions:
(i) That there is inadequate time to effect a safe transfer to
another hospital before delivery; or
(ii) That transfer may pose a threat to the health or safety
of the woman or the woman's unborn child;
(2) "Specialized capabilities or facilities" includes:
(A) Burn units;
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(B) Trauma units;
(C) Neonatal intensive care units; and
(D) With respect to rural areas, regional referral centers as
identified by federal regulation by the federal secretary of health and
human services;
(3) "Stabilize" has the same meaning as defined in the federal
Emergency Medical Treatment and Labor Act (EMTALA) (42 U.S.C. § 1395dd);
(4) "Stabilized" has the same meaning as defined in the federal
Emergency Medical Treatment and Labor Act (EMTALA) (42 U.S.C. § 1395dd);
and
(5) "Transfer" has the same meaning as defined in the federal
Emergency Medical Treatment and Labor Act (EMTALA) (42 U.S.C. § 1395dd).
(b) A hospital emergency department, including a satellite emergency
department, shall not deny 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 whether
or not an emergency medical condition or active labor exists.
(c)
(1) If a hospital emergency department determines that a pregnant
woman described in subsection (b) has an emergency medical condition or is in
active labor, then the hospital affiliated with the emergency department shall
provide:
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(A) 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; or
(B) For transfer of the pregnant woman to another medical facility
in accordance with subsection (d).
(2) A hospital is deemed to meet the requirement of subdivision (c)(1)(A)
with respect to a pregnant woman if the hospital offers the pregnant woman the
further medical examination and treatment described in subdivision (c)(1)(A) 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 authorized
person acting on the woman's behalf, refuses to consent to the examination and
treatment. The hospital shall take all reasonable steps to secure the pregnant
woman's or authorized person's written informed consent to refuse such
examination and treatment.
(3) A hospital is deemed to meet the requirement of subdivision (c)(1)(B)
with respect to a pregnant woman if the hospital offers to transfer the pregnant
woman to another medical facility in accordance with subdivision (c)(1)(B) 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 consent to the transfer. The hospital shall take all reasonable
steps to secure the pregnant woman's or authorized person's written informed
consent to refuse such transfer.
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(d) If a pregnant woman at a hospital has an emergency medical condition or
active labor that has not been stabilized, then the hospital shall not transfer the pregnant
woman unless:
(1) The pregnant woman, or a legally authorized person acting on the
woman's behalf, after being informed of the hospital's obligations under this
section and of the risk of transfer, in writing requests transfer to another medical
facility;
(2) Either:
(A) 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
(B) 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 a certification described in subdivision (d)(2)(A) after a
physician, in consultation with the qualified medical professional, has
made the determination described in subdivision (d)(2)(A), and
subsequently countersigns the certification; and
(3) The transfer is an appropriate transfer, as described in 42 U.S.C. §
1395dd, to that facility.
(e) A hospital that has specialized capabilities or facilities shall not refuse to
accept an appropriate transfer pursuant to subsection (d) of a pregnant woman who
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requires such specialized capabilities or facilities if the hospital has the capacity to treat
the pregnant woman.
(f) A hospital shall not delay provision of an appropriate medical screening
examination required under subsection (b) or further medical examination and treatment
required under subdivision (c)(1)(A) in order to inquire about the pregnant woman's
method of payment or insurance status.
(g) A hospital shall not penalize or take adverse action against:
(1) A qualified medical professional described in subdivision (d)(2)(B) 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; or
(2) Any hospital employee because the employee reports a violation of
this section.
(h)
(1) The executive director of the health facilities commission is
authorized to investigate and enforce violations of this section by healthcare
facilities licensed under this part.
(2) The department of health, including a health-related licensing board
attached to the department of health, is authorized to investigate and enforce
violations of this section by individual healthcare professionals licensed,
regulated, certified, or otherwise permitted pursuant to title 63 or this title to
deliver health care in the course of a profession in this state.
(3) A hospital or satellite emergency department that violates this section
may be subject to a civil penalty of not more than fifty thousand dollars ($50,000)
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for each violation or, in the case of a hospital with less than one hundred (100)
beds, not more than twenty-five thousand dollars ($25,000) for each violation.
(4)
(A) Subject to subdivision (h)(4)(B), 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 section is subject to:
(i) A civil penalty of not more than fifty thousand dollars
($50,000) for each violation; and
(ii) Licensure sanction by the board of medical examiners
or the board of osteopathic examination, as applicable.
(B) If, after an initial examination, a physician determines that the
pregnant woman requires the services of a physician listed by the hospital
on its list of on-call physicians, if required by 42 U.S.C. § 1395cc(a)(1)(I),
notifies the on-call physician, the on-call physician fails or refuses to
appear within a reasonable period of time, and the physician 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 a penalty under subdivision (h)(4)(A). However, the
exemption created by this subdivision (h)(4)(A) does not apply to the
hospital or to the on-call physician who failed or refused to appear.
(C) Subdivision (h)(4)(A) includes a physician who:
(i) Signs a certification under subdivision (d)(2)(B) that the
medical benefits reasonably to be expected from a transfer to
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another facility outweigh the risks associated with the transfer, if
the physician knew or should have known that the benefits did not
outweigh the risks; or
(ii) Misrepresents a pregnant woman's condition or other
information, including a hospital's obligations under this section.
SECTION 2. This act takes effect July 1, 2026, the public welfare requiring it, and
applies to conduct occurring on or after that date.