Summary#
HB 6443 would amend Michigan’s Public Health Code by adding duties for hospitals and physicians. Its stated goal is to require emergency medical screening and stabilizing treatment. It is introduced and is not law; passage is uncertain. The supplied material does not include the existing Code, so I could not verify how these duties compare with current law.
- Hospitals would have to provide emergency services when a person asks, someone asks on the person’s behalf, or a prudent layperson would believe from the person’s approach or behavior that the person needs emergency care. The bill defines that service as a medical screening and, if an emergency medical condition exists, treatment needed to stabilize the person within the hospital’s capability and capacity, including an abortion.
- The bill lists emergency conditions that include acute signs and symptoms that could put health in serious jeopardy or seriously impair bodily function or an organ; certain pregnancy-related situations involving contractions, labor, ectopic pregnancy, pregnancy or pregnancy-loss complications, and emergent hypertensive disorders.
- Hospitals would have to keep a central log of certain requests and record whether treatment was refused, denied or required, and whether the patient was transferred, admitted and treated, stabilized and transferred, or discharged.
- Hospitals could not delay emergency services to ask whether a person can pay. They would face limits on transferring or discharging a patient with an emergency medical condition who has not been stabilized, subject to specific written-request and other conditions.
- Hospitals would have to try to contact an on-call physician when needed for stabilization and direct that physician to come within a reasonable time. They would also have to ensure employed or contracted physicians do not engage in specified conduct, including misrepresenting a patient’s condition or failing to appear when called. The bill also says physicians must comply, but the supplied material does not show which physician groups the two added Code sections cover.
What it means for you#
- Patients: A hospital could not delay emergency services to ask about your ability to pay. The bill does not say that care would be free or cancel a bill.
- Patients who are not stabilized: A hospital generally could not transfer you unless it provides treatment within its capacity to reduce risk, a receiving hospital agrees and has space and qualified staff, and qualified personnel and suitable equipment handle the transfer. It also requires medical records to be sent. The patient or representative must request the transfer in writing after being informed of the risks and the hospital’s obligations, and a physician must certify that expected benefits outweigh transfer risks. If a physician is not at the hospital, the examining health professional may certify after consulting with a physician, who must later countersign.
- Patients who are not stabilized and may be discharged: Discharge is allowed only if, after being told about the risks and the hospital’s obligations, the patient or representative requests it in writing and refuses offered further examination or treatment after being informed of its risks and benefits. The hospital must document the refusal and take reasonable steps to obtain written informed refusal.
- Hospitals and physicians: The bill would require screening, stabilization within the hospital’s capability and capacity, recordkeeping, and the on-call steps described above. It does not set a process for applications, appeals, or individual reviews.
Money#
No cost information is in the available material.
- The bill requires hospitals to provide services, keep records, and take transfer and discharge steps, but gives no cost estimate or staffing estimate.
- It does not set fees, change payment rules, or state who pays for care.
What is unclear#
- The supplied material does not include the existing Public Health Code, so current duties and any overlap with existing rules could not be checked.
- The bill does not define “prudent layperson,” “reasonable time,” or “reasonable period of time.”
- It does not explain how hospital capability and capacity would be assessed, or how disagreements about stabilization or transfer certifications would be resolved.
- The bill text gives no start date, enforcement process, or penalties for failing to meet the new duties.
- It does not explain how the two added sections requiring physician compliance relate to different physician groups or to each other.
Case for#
- A possible argument for the bill is that it would set out clear duties to screen people who appear to need emergency care, rather than making care depend on whether they can pay.
- The transfer rules could help protect patients who need further treatment by requiring the receiving hospital to agree and have space and qualified staff, and by requiring medical records and suitable transport.
- The discharge rules could protect patients by requiring an informed written request and refusal before an unstabilized patient is discharged.
Case against#
- The bill sets substantial duties but does not specify penalties or how compliance would be enforced.
- Terms such as “reasonable time” and “prudent layperson” are not defined in the bill, which could leave uncertainty about when duties apply.
- Hospitals must act within their capability and capacity, but the bill does not explain how to resolve disputes about those limits or who decides whether a patient is stabilized.
- The bill gives no cost or staffing estimate, even though it requires hospitals to provide services and keep records.