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Bill to require patient choice for transfers from freestanding emergency facilities draws wide testimony
Summary
HB 16‑53 would require freestanding emergency facilities to offer and document a patient's choice of receiving hospital when transfer is medically necessary; hospital clinicians and EMS warned that integrated records and proximity matter for time‑sensitive cases while freestanding ER operators said federal law (EMTALA) and existing practice already protect patient choice.
Representative Laura Talerski introduced HB 16‑53 to require freestanding hospital emergency facilities (FHEFs) to offer patients or their legal representatives the opportunity to choose the receiving hospital when a transfer is necessary and to prohibit steering to an affiliated parent hospital. Talerski said the bill is intended to protect patient choice, continuity of care and to reduce unnecessary secondary transfers.
The hearing drew extensive testimony. Physicians and the two nonprofit hospital systems in the Nashua area said choice and continuity matter in time‑sensitive conditions — trauma, stroke and cardiac emergencies — because minutes between diagnosis and definitive therapy affect outcomes. Dr. Jane Wheeler (medical director, St. Joseph's emergency department) and trauma and cardiac clinicians urged that patients be empowered to choose the closest capable receiving hospital and that documentation of the transfer decision be retained in the medical record.
Hospital system representatives and freestanding ER operators (including HCA representatives) pushed back: they said EMTALA already requires stabilization and documentation of transfers, argued most patients already choose their arrival site, and cautioned that a state transfer mandate could duplicate or conflict with federal law and impose operational burdens. Witnesses discussed transfer logistics: admission and acceptance require an accepting physician and bed assignment before external ambulance transport can be scheduled; EMS availability and integrated electronic medical records affect how quickly a transfer can occur.
Committee members asked about the number of existing FHEFs (several in operation, more planned), admission and transfer rates (witness estimates: admissions and transfers from FHEFs are a small percentage of visits — 2–5% — while ER admission rates at main hospitals run higher), and how EMTALA documentation currently works. The committee closed the public hearing with no vote and asked staff to consider the EMTALA interaction and operational consequences.
