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State f/Jennessee
PUBLIC CHAPTER NO. 1080
SENATE BILL NO. 1681
By Lamar, Akbari, Campbell, Pody
Substituted for: House Bill No. 1943
By Love, Clemmons
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;
(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
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(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:
(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
(8) 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)(8) 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.
(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. requires such
specialized capabilities or facilities if the hospital has the capacity to treat the pregnant
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woman. As used in this subsection (e), "capacity" has the same meaning as defined in 42
CFR 489.24.
(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)(8) 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) 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. Civil penalties imposed
pursuant to this section are limited to one (1) civil penalty per patient encounter,
regardless of the number of alleged violations arising from the same event.
(4)(A) Subject to subdivision. (h)(4)(8), 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
knowingly and willfully 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)(B) 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 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.
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(i) A physician, qualified medical professional, or hospital employee is not subject to a
civil penalty, licensure sanction, or other adverse action under this section if the physician,
qualified medical professional, or hospital employee acts in good faith and exercises
reasonable clinical judgment based upon the information available at the time care is
rendered or a transfer decision is made.
0) A civil penalty or licensure sanction shall not be imposed under this section 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) (42 U.S.C. § 1395dd), as amended, or federal regulations promulgated to
effectuate such act.
(k) This section does not authorize an abortion unless the conditions in § 39-15-
213(c) are met.
SECTION 2. This act takes effect July 1, 2026, the public welfare requiring it, and applies to
conduct occurring on or after that date.
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SENATE BILL NO. 1681
PASSED: April 22, 2026
n RANDY l\cNALLY
SPEAKER OF THElENATE
CAMERONSEXTON,SPEAKER
HOUSE OF REPRESENTATIVES
APPROVED this ?;J,v,t;;J day of ~ 2026
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BILL LEE, GOVERNOREvery fact on this page links to its source, starting with the official bill record.