,i  #aae? ,,congress  #a/ ,session  ,h4 
,r4 #dgf  ,,9 ,,! ,,h\se ,,(            
,,repres5tatives  ,janu>y #ab1 #bjag,mr4
 ,ne:\se 7= himself1 ,mr4 ,gohm]t1 ,mr4 
,h5s>l+1 ,mr4 ,jones1 ,mr4 ,m>%all1 ,mr4
 ,olson1 ,mrs4 ,radewag51 & ,mr4 ,"y (  
,i[a7 introduc$ ! foll[+ bill2 :i* 0    
ref]r$ to ! ,committee on ,vet]ans'     
,affairs  ,a ,,bill  ,to am5d title #ch1
 ,unit$ ,/ates ,code1 to cl>ify !       
em]g5cy hospital c>e furni%$ by !       
,secret>y ( ,vet]ans ,affairs to c]ta9  
vet]ans4  #a4 ,%ort title ,?is ,act may 
be cit$ z ! ,vet]ans ,em]g5cy ,treatm5t 
,act or ! ,,vet ,act4  #b4 ,cl>ification
 ( em]g5cy hospital c>e furni%$ by !    
,secret>y ( ,vet]ans ,affairs to c]ta9  
vet]ans  7a7 ,9 g5]al ,*apt] #ag ( title
 #ch1 ,unit$ ,/ates ,code1 is am5d$ by  
ins]t+ aft] section #agcj;,a ! foll[+   
new section3  #agcj;,b4 ,exam9ation &   
treatm5t = em]g5cy m$ical conditions &  
wom5 9 labor  7a7 ,m$ical scre5+        
exam9ations ,9 c>ry+ out ?is *apt]1 if  
any enroll$ vet]an reque/s1 or a reque/ 

is made on behalf ( ! vet]an1 =         
exam9ation or treatm5t = a m$ical       
condition1 reg>dless ( :e!r su*         
condition is s]vice-connect$1 at a      
hospital em]g5cy dep>tm5t ( a m$ical    
facility ( ! ,dep>tm5t1 ! ,secret>y %all
 ensure t ! vet]an is provid$ an        
appropriate m$ical scre5+ exam9ation )9 
! capability ( ! em]g5cy dep>tm5t1      
includ+ ancill>y s]vices r\t9ely        
available to ! em]g5cy dep>tm5t1 to     
det]m9e :e!r an em]g5cy m$ical condition
 exi/s4  7b7 ,necess>y /abiliz+ treatm5t
 = em]g5cy m$ical conditions & labor    
7#a7 ,if an enroll$ vet]an comes to a   
m$ical facility ( ! ,dep>tm5t & !       
,secret>y det]m9es t ! vet]an has an    
em]g5cy m$ical condition1 ! ,secret>y   
%all provide ei!r--  7,a7 su* fur!r     
m$ical exam9ation & su* treatm5t z may  
be requir$ to /abilize ! m$ical         
condition2 or  7,b7 = ! transf] ( !     
vet]an to ano!r m$ical facility ( !     
,dep>tm5t or a non-,dep>tm5t facility 9 
accordance ) subsection 7c74  7#b7 ,!   

,secret>y is deem$ to meet ! requirem5t 
( p>agraph 7#a77;,a7 ) respect to an    
enroll$ vet]an if ! ,secret>y (f]s !    
vet]an ! fur!r m$ical exam9ation &      
treatm5t describ$ 9 su* p>agraph & in=ms
 ! vet]an 7or an individual act+ on     
behalf ( ! vet]an7 ( ! risks & b5efits  
to ! vet]an ( su* exam9ation & treatm5t1
 b ! vet]an 7or individual7 refuses to  
cons5t to ! exam9ation & treatm5t4 ,!   
,secret>y %all take all reasonable /eps 
to secure ! writt5 in=m$ cons5t ( su*   
vet]an 7or individual7 to refuse su*    
exam9ation & treatm5t4  7#c7 ,!         
,secret>y is deem$ to meet ! requirem5t 
( p>agraph 7#a7 ) respect to an enroll$ 
vet]an if ! ,secret>y (f]s to transf] ! 
individual to ano!r m$ical facility 9   
accordance ) subsection 7c7 ( ?is       
section & in=ms ! vet]an 7or an         
individual act+ on behalf ( ! vet]an7 ( 
! risks & b5efits to ! vet]an ( su*     
transf]1 b ! vet]an 7or individual7     
refuses to cons5t to ! transf]4 ,!      
hospital %all take all reasonable /eps  

to secure ! writt5 in=m$ cons5t ( su*   
vet]an 7or individual7 to refuse su*    
transf]4  7c7 ,re/riction ( transf]s    
until vet]an /abiliz$  7#a7 ,if an      
enroll$ vet]an at a m$ical facility ( ! 
,dep>tm5t has an em]g5cy m$ical         
condition t has n be5 /abiliz$1 !       
,secret>y may n transf] ! vet]an to     
ano!r m$ical facility ( ! ,dep>tm5t or a
 non-,dep>tm5t facility unless--  7,a7  
7i7 ! vet]an 7or a legally responsible  
individual act+ on behalf ( ! vet]an71  
aft] be+ in=m$ ( ! obligation ( !       
,secret>y "u ?is section & ( ! risk (   
transf]1 reque/s 9 writ+ a transf] to   
ano!r m$ical facility2  7ii7 a physician
 has sign$ a c]tification 7includ+ a    
summ>y ( ! risks & b5efits7 t1 bas$ ^u !
 in=mation available at ! "t ( transf]1 
! m$ical b5efits reasonably expect$ f ! 
provision ( appropriate m$ical treatm5t 
at ano!r m$ical facility outweigh !     
increas$ risks to ! vet]an &1 9 ! case (
 labor1 to ! unborn *ild f effect+ !    
transf]2 or  7iii7 if a physician is n  

physically pres5t 9 ! em]g5cy dep>tm5t  
at ! "t a vet]an is transf]r$1 a        
qualifi$ m$ical p]son 7z def9$ by !     
,secret>y 9 regulations7 has sign$ a    
c]tification describ$ 9 clause 7ii7 aft]
 a physician1 9 consultation ) ! p]son1 
has made ! det]m9ation describ$ 9 su*   
clause1 & subsequ5tly c\nt]signs !      
c]tification2 &  7,b7 ! transf] is an   
appropriate transf] z describ$ 9        
p>agraph 7#b74  7#b7 ,an appropriate    
transf] to a m$ical facility is a       
transf]--  7,a7 9 :i* ! transf]r+ m$ical
 facility provides ! m$ical treatm5t )9 
! capacity ( ! facility t m9imizes !    
risks to ! heal? ( ! enroll$ vet]an &1 9
 ! case ( a woman 9 labor1 ! heal? ( !  
unborn *ild2  7,b7 9 :i* ! receiv+      
facility-- 7i7 has available space &    
qualifi$ p]sonnel = ! treatm5t ( !      
vet]an2 &  7ii7 has agre$ to accept     
transf] ( ! vet]an & to provide         
appropriate m$ical treatm5t2  7,c7 9 :i*
 ! transf]r+ facility s5ds to ! receiv+ 
facility all m$ical records 7or copies  

!re(71 relat$ to ! em]g5cy condition =  
:i* ! vet]an has pres5t$1 available at !
 "t ( ! transf]1 includ+ records relat$ 
to ! em]g5cy m$ical condition ( !       
vet]an1 obs]vations ( signs or symptoms1
 prelim9>y diagnosis1 treatm5t provid$1 
results ( any te/s & ! in=m$ writt5     
cons5t or c]tification 7or copy !re(7   
provid$ "u p>agraph 7#a77;,a71 & ! "n & 
address ( any on-call physician         
7describ$ 9 subsection 7d77#a77;,c7 (   
?is section7 :o has refus$ or fail$ to  
appe> )9 a reasonable "t to provide     
necess>y /abiliz+ treatm5t2  7,d7 9 :i* 
! transf] is effect$ ?r\gh qualifi$     
p]sonnel & transportation equipm5t1 z   
requir$ includ+ ! use ( necess>y &      
m$ically appropriate life support       
measures dur+ ! transf]2 &  7,e7 t meets
 su* o!r requirem5ts z ! ,secret>y may  
f9d necess>y 9 ! int]e/ ( ! heal? &     
safety ( vet]ans transf]r$4  7d7 ,*>ges 
7#a7 ,no?+ 9 ?is section may be con/ru$ 
to affect any *>ges t ! ,secret>y may   
collect f a vet]an or ?ird p>ty4  7#b7  

,! ,secret>y %all treat any c>e provid$ 
by a non-,dep>tm5t facility pursuant to 
?is section z c>e o!rwise provid$ by a  
non-,dep>tm5t facility pursuant to ?is  
*apt] = purposes ( pay+ su*             
non-,dep>tm5t facility = su* c>e4  7e7  
,nondiscrim9ation ,a m$ical facility ( !
 ,dep>tm5t or a non-,dep>tm5t facility1 
z ! case may be1 t has specializ$       
capabilities or facilities 7su* z burn  
units1 %ock-trauma units1 neonatal      
int5sive c>e units1 or 7) respect to    
rural areas7 regional ref]ral c5t]s z   
id5tifi$ by ! ,secret>y 9 regulation7   
%all n refuse to accept an appropriate  
transf] ( an enroll$ vet]an :o requires 
su* specializ$ capabilities or          
facilities if ! facility has ! capacity 
to treat ! vet]an4  7f7 ,no delay 9     
exam9ation or treatm5t ,a m$ical        
facility ( ! ,dep>tm5t or a             
non-,dep>tm5t facility1 z ! case may be1
 may n delay provision ( an appropriate 
m$ical scre5+ exam9ation requir$ "u     
subsection 7a7 or fur!r m$ical          

exam9ation & treatm5t requir$ "u        
subsection 7b7 ( ?is section 9 ord] to  
inquire ab\t ! me?od ( paym5t or        
insurance /atus ( an enroll$ vet]an4    
7g7 ,:i/lebl[] protections ,! ,secret>y 
may n take adv]se action aga9/ an       
employee ( ! ,dep>tm5t because !        
employee refuses to au?orize ! transf] (
 an enroll$ vet]an ) an em]g5cy m$ical  
condition t has n be5 /abiliz$ or       
because ! employee reports a violation (
 a requirem5t ( ?is section4  7h7       
,def9itions ,9 ?is section3 7#a7 ,! t]m 
em]g5cy m$ical condition means--  7,a7 a
 m$ical condition manife/+ itself by    
acute symptoms ( suffici5t sev]ity      
7includ+ sev]e pa97 su* t ! abs5ce (    
imm$iate m$ical att5tion c\ld reasonably
 be expect$ to result 9--  7i7 plac+ !  
heal? ( ! enroll$ vet]an 7or1 ) respect 
to an enroll$ vet]an :o is a pregnant   
woman1 ! heal? ( ! woman or h] unborn   
*ild7 9 s]i\s jeop>dy2  7ii7 s]i\s      
impairm5t to bodily functions2 or  7iii7
 s]i\s dysfunction ( any bodily organ or

 "p2 or  7,b7 ) respect to an enroll$   
vet]an :o is a pregnant woman hav+      
contractions-- 7i7 t !re is inadequate  
"t to effect a safe transf] to ano!r    
hospital be=e deliv]y2 or  7ii7 t       
transf] may pose a ?reat to ! heal? or  
safety ( ! woman or ! unborn *ild4  7#b7
 ,! t]m enroll$ vet]an means a vet]an :o
 is enroll$ 9 ! heal? c>e sy/em e/abli%$
 "u section #agje7;a7 ( ?is title4  7#c7
 ,! t]m to /abilize means1 ) respect to 
an em]g5cy m$ical condition describ$ 9  
p>agraph 7#a77;,a71 to provide su*      
m$ical treatm5t ( ! condition z may be  
necess>y to assure1 )9 reasonable m$ical
 probability1 t no mat]ial det]ioration 
( ! condition is likely to result f or  
occur dur+ ! transf] ( ! enroll$ vet]an 
f a facility1 or1 ) respect to an       
em]g5cy m$ical condition describ$ 9     
p>agraph 7#a77;,b71 to deliv] 7includ+ !
 plac5ta74  7#d7 ,! t]m /abiliz$ means1 
) respect to an em]g5cy m$ical condition
 describ$ 9 p>agraph 7#a77;,a71 t no    
mat]ial det]ioration ( ! condition is   

likely1 )9 reasonable m$ical            
probability1 to result f or occur dur+ !
 transf] ( ! individual f a facility1   
or1 ) respect to an em]g5cy m$ical      
condition describ$ 9 p>agraph 7#a77;,b71
 t ! woman has deliv]$ 7includ+ !       
plac5ta74  7#e7 ,! t]m transf] means !  
movem5t 7includ+ ! dis*>ge7 ( an enroll$
 vet]an outside ! facilities ( a m$ical 
facility ( ! ,dep>tm5t at ! direction ( 
any individual employ$ by 7or affiliat$ 
or associat$1 directly or indirectly1 )7
 ! ,dep>tm5t1 b does n include su* a    
movem5t ( an individual :o--  7,a7 has  
be5 decl>$ dead2 or  7,b7 leaves !      
facility )\t ! p]mission ( any su*      
p]son4  4  7b7 ,cl]ical am5dm5t ,! table
 ( sections ( su* *apt] is am5d$ by     
ins]t+ aft] ! item relat+ to section    
#agcj;,a ! foll[+ new item3  #agcj;,b4  
,exam9ation & treatm5t = em]g5cy m$ical 
conditions & wom5 9 labor4  4