Federal Regulations.  The Examination and Treatment for Emergency Medical Conditions and Women is a federal law that requires hospital to provide for an appropriate medical screening examination within the capability of the hospital's emergency department. Those federal regulations include the following: medical screening requirement; necessary stabilizing treatment for emergency medical conditions and labor; restricting transfers until individual is stabilized; nondiscrimination; and no delay in examination or treatment.

Medical Screening Requirement. In the case of a hospital that has a hospital emergency department (ED), if any individual comes to the ED and a request is made on the individual's behalf for examination or treatment for a medical condition, the hospital must provide for an appropriate medical screening examination within the capability of the hospital's ED, including ancillary services routinely available to the ED, to determine whether or not an emergency medical condition exists.

Necessary Stabilizing Treatment for Emergency Medical Conditions and Labor. If any individual comes to a hospital and the hospital determines that the individual has an emergency medical condition, the hospital must provide either:

• 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
• transfer of the individual to another medical facility in accordance with the transfer requirements.

A hospital is deemed to meet the requirement for providing further medical examination and such treatment to stabilize the medical condition with respect to an individual if the hospital offers the individual the further medical examination and treatment and informs the individual, or a person acting on the individual's behalf, refuses to consent to the examination and treatment. The hospital must take all reasonable steps to secure the individual's, or person acting on the individual's behalf, written informed consent to refuse such examination and treatment.

A hospital is deemed to meet the requirement of  necessary stabilizing treatment for emergency medical conditions and labor with respect to an individual if the hospital offers to transfer the individual to another medical facility in accordance with the transfer requirements and informs the individual, or a person acting on the individual's behalf, of the risks and benefits to the individual of such transfer, but the individual, or a person acting on the individual's behalf, refuses to consent to the transfer. The hospital shall take all reasonable steps to secure the individual's, or person acting on the individual's behalf, written informed consent to refuse such transfer.

Restricting Transfers Until Individual Stabilized. If an individual at a hospital has an emergency medical condition which has not been stabilized, as defined below, the hospital may not transfer the individual unless the transfer is an appropriate transfer to that facility and one of the three following clauses are met:

• clause one—the individual, or a legally responsible person acting on the individual'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;
• clause two—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 individual and, in the case of labor, to the unborn child from effecting the transfer; or
• clause three—if a physician is not physically present in the ED at the time an individual is transferred, a qualified medical person has signed a certification described in clause two after a physician, in consultation with the person, has made the determination described in such clause, and subsequently countersigns the certification.

A certification described in clause two or three shall include a summary of the risks and benefits upon which the certification is based.

An appropriate transfer to a medical facility is a transfer:

• in which the transferring hospital provides the medical treatment within its capacity which minimizes the risks to the individual's health and, in the case of a woman in labor, the health of the unborn child;
• in which the receiving facility: has available space and qualified personnel for the treatment of the individual, and has agreed to accept transfer of the individual and to provide appropriate medical treatment;
• in which the transferring hospital sends to the receiving facility all medical records, or copies thereof, related to the emergency condition for which the individual has presented, available at the time of the transfer, including records related to the individual's emergency medical condition, observations of signs or symptoms, preliminary diagnosis, treatment provided, results of any tests and the informed written consent or certification, or copy thereof, and the name and address of any on-call physician who has refused or failed to appear within a reasonable time to provide necessary stabilizing treatment;
• in which the transfer is effected through qualified personnel and transportation equipment, as required including the use of necessary and medically appropriate life support measures during the transfer; and
• which meets such other requirements as the secretary of Health and Human Services (HHS) may find necessary in the interest of the health and safety of individuals transferred.

Nondiscrimination. A participating hospital that has specialized capabilities or facilities—such as burn units, shock-trauma units, neonatal intensive care units, or with respect to rural areas regional referral centers as identified by the HHS secretary in regulation—shall not refuse to accept an appropriate transfer of an individual who requires such specialized capabilities or facilities if the hospital has the capacity to treat the individual.

No Delay in Examination or Treatment. A participating hospital may not delay provision of an appropriate medical screening examination or further medical examination and treatment in order to inquire about the individual's method of payment or insurance status.

Emergency Medical Condition. Emergency medical condition means:

• 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: placing the health of the individual—or, with respect to a pregnant woman, the health of the woman or her unborn child—in serious jeopardy; serious impairment to bodily functions; or serious dysfunction of any bodily organ or part; or
• 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 unborn child.

When providing emergency services, hospitals must provide treatment to a pregnant person who comes to the hospital with an emergency condition that is consistent with the applicable standard of care for such condition or, if authorized by law, transfer the patient to another hospital capable of providing the treatment, with the patient's informed consent.

If the pregnancy's termination is the treatment consistent with the applicable standard of care, the hospital must provide such treatment following and as promptly as dictated by the standard of care or, if authorized by law, transfer the patient to another hospital capable of providing the treatment, with the patient's informed consent.

Neither the pregnancy's continuation nor any embryo or fetus' health must be a basis for withholding care from the pregnant person, and neither the pregnancy's continuation nor any embryo or fetus' health must be prioritized over the pregnant person's health or safety absent the pregnant person's informed consent

Hospitals must make transfers to other hospitals in such circumstances and as promptly as dictated by the standard of care and follow reasonable procedures in making transfers to other hospitals including confirmation of acceptance of the transfer by the receiving hospital.

Emergency Medical Conditions. Emergency medical condition means a condition of such severity that the absence of immediate medical attention could result in:

• placing an individual's health or, with respect to a pregnant person, the pregnant person's or their embryo or fetus' health in serious jeopardy; serious impairment to bodily functions; or serious dysfunction of a bodily organ or part.

Emergency medical condition also means with respect to a pregnant person who is having contractions that:

• there is inadequate time to affect a safe transfer to another hospital before delivery; or
• transfer may pose a threat to the pregnant person's or their embryo or fetus's health or safety.

Emergency medical condition also means any of the following conditions: ectopic pregnancy; emergent complications resulting from pregnancy or of pregnancy loss; previable preterm premature rupture of membranes; emergent placental abnormalities; or emergent hypertensive disorders, such as preeclampsia.

The committee recommended a different version of the bill than what was heard.  PRO: Current law allows pregnant patients to seek medical care without interference.  Hospitals in the state do currently comply with the federal Emergency Medical Treatment & Labor Act  and emergency care requirements. The federal safeguards are under threat nationwide and it is putting people's lives and rights at risk. This bill codifies long-standing federal standards into state law and is a common sense piece of legislation. It guarantees that everyone will have the best and appropriate care when in Washington State and that the health choice of the patient is made not by the hospital but by the patient in consultation with her provider. This legislation provides the state with clear and comprehensive standards guiding emergency medical care for pregnant patients. There are some suggested amendments.

CON: The bill is designed to force hospitals to perform abortions regardless of their religious or moral opposition to the procedure. Hospitals should not be required to perform abortion when a woman's life is not at stake. This bill promotes abortion in all cases and strips all other institutions and individuals of their own rights of choice and conscience.

PRO: Senator Deborah Krishnadasan, Prime Sponsor; Nicole Kern, Planned Parenthood Alliance Advocates; Zosia Stanley, Washington State Hospital Association; Sarah Goh; Molly Voris, Washington State Women's Commission; Dr. Stephanie Sola; Dr. Shannon Bailey, American College of Obstetricians and Gynecologists (ACOG); Lacy Fehrenbach, Washington State Department of Health; Nancy Sapiro, American College of Obstetricians and Gynecologists.