Sen. Stuts’ substitute to track ER physician presence wins committee backing, but final measure fails

Sen. Stuts told the committee that his substitute to bill 84N1HF-1 would require hospitals to collect quarterly data showing whether a licensed physician is "physically present" and to report that information to the Alabama Department of Public Health (ADPH).

"The public fully expects that if you show up in the emergency room a doctor's going to be there to take care of you," Sen. Stuts said, arguing the measure is a transparency tool that would let policymakers see whether emergency departments are routinely staffed.

The substitute narrows enforcement language from the sponsor’s earlier draft and removes a proposed requirement that hospitals update a public website minute-by-minute when an ER doctor leaves. The substitute also clarified that telemedicine or physicians available only by telephone would not count as "physically present," and it defines "physically present" as a licensed physician on site and primarily responsible for the emergency room.

Supporters described the proposal as a limited, one-year data collection. "You can't manage what you don't measure," Sen. Stuts told colleagues, saying the data would be collected for a defined period so lawmakers could decide whether further action was needed.

Opponents and senators representing rural districts urged caution. Several members warned mandatory reporting could impose regulatory or reputational risk on under-resourced rural hospitals and raise costs if facilities had to rely more heavily on staffing agencies. "If somebody sees on the report that . . . the ER doctor isn't there, they're going to stop going to the hospital," said Sen. Stewart, who represents a rural district, adding that patient flows already shift toward larger cities when local capacity is perceived as limited.

Committee members also disputed the fiscal estimate attached to the measure. A fiscal note referenced in committee discussion totaled $231,100 — including a roughly $126,000 software cost and about $105,000 in annual costs — and several senators questioned whether the reporting could be done using data hospitals already submit to ADPH. The sponsor said hospitals already report admissions and other statistics and that the additional entry would be a small incremental task.

On enforcement, Sen. Gaban pressed whether a hospitalist or a physician temporarily away from the ER would count as "present." Sen. Stuts said the substitute treats a physician as present only if the physician is on site and primarily responsible for the emergency room; brief absences for clinical duties would not disqualify that status.

After debate, the committee held a roll call on the substitute and reported 10 ayes and 2 nays, adopting the substitute. A subsequent motion to advance the measure failed on a separate roll call, with five yays and eight nays. The committee adjourned without the bill moving forward from that session.

The transcript records senators offering to consider a sunset amendment on the floor; the sponsor said he would accept an amendment to limit the reporting period if colleagues preferred that approach. The hearing did not establish a mandate for additional funding to cover reporting costs, and senators urged that any operational or fiscal burdens on rural hospitals be considered in future deliberations.