Maryland subcommittee reviews bill to codify EMTALA protections for pregnancy-related emergencies; motion withdrawn pending AG opinion

The Public Health and Minority Health Disparities Subcommittee of the Health and Government Operations Committee considered Senate Bill 447 on emergency pregnancy-related medical conditions, which would codify aspects of the federal Emergency Medical Treatment and Labor Act (EMTALA) for Maryland hospitals with emergency departments and require hospitals to stabilize patients "including the termination of a pregnancy when the termination is medically necessary to stabilize the patient," a staff briefing said.

Supporters and presenters said the bill seeks to provide clarity because federal enforcement of EMTALA's pregnancy provisions has been uneven. Erin, the staff briefing presenter, outlined the bill’s definitions and stabilizing standard and told the subcommittee the measure limits the state law to emergency pregnancy-related conditions and ties transfers for unstabilized patients to federal EMTALA transfer rules (42 U.S.C. 1395dd).

"The bill provides that it only applies to hospitals with emergency departments," Erin said, and the legislation requires hospitals "to provide further examination and the treatment required to stabilize the emergency pregnancy-related medical condition, including the termination of a pregnancy when the termination is medically necessary to stabilize the patient." The measure also would require hospitals to document informed refusal if a patient or representative rejects further care or transfer.

The bill includes statutory protections for treating providers and employees who report violations and a civil-penalty scheme: up to $50,000 per negligent violation at hospitals with 100 or more beds and up to $25,000 per violation at smaller hospitals. Senate amendments would require the Maryland Department of Health to stay final state enforcement while a related federal investigation is ongoing and to reduce or refund state fines by the amount of any federal fine imposed for the same incident within two years.

Legal and policy witnesses said that clarity and transparency motivated the explicit language. "It's on page 3, lines 15 through 16 and uses the terminology, the termination of the pregnancy," Robin Elliott of the Women's Law Center of Maryland said, adding that naming the procedure in state law improves public and facility understanding. "I think there's certainly different sort of pathways … but states have always had the purview of being able to enact facility regulations," she said.

Scott, staff in Senator Lamb's office, cited a reported case at St. Agnes in which, he said, a patient presenting with pre-PPROM ultimately experienced a fetal death after care was delayed by hospital policies. "Per the reporting ... the fetus did die," Scott said, urging that lack of clarity in some provider policies motivated the bill.

The Maryland Hospital Association signaled neutrality on the amended bill after negotiation. "We worked very closely with Senator Lam on amendments, that would bring the hospital association to neutral on this bill. And so we are, okay with the bill as it was amended," Natasha Mayhew said.

Members pressed questions about litigation risk and whether explicitly naming abortion-related care could expose the state or providers to constitutional challenges. Delegate Hill said he worried the wording could "trigger a Hobby Lobby"–style suit, and several members asked for an attorney general opinion before advancing the bill. Scott said the sponsor's office had not requested an AG opinion but offered to obtain one.

After discussion, Delegate Hill moved to advance the bill and a second was recorded, but members urged waiting for the AG's guidance. The mover withdrew the motion and the Chair said the subcommittee would hold the bill from the vote session until the attorney general’s letter is received. The planned briefing on Xylazine was postponed and the subcommittee adjourned without taking a vote on SB 447.

The next procedural step is for the sponsor's office to request and for the subcommittee to review an attorney general opinion; a new briefing date will be communicated by the committee.