I 
111TH CONGRESS 
1ST SESSION H. R. 1998 
To improve access to emergency medical services, and for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
APRIL 21, 2009 
Mr. GORDON of Tennessee (for himself and Mr. DENT) introduced the 
following bill; which was referred to the Committee on Energy and Commerce 
A BILL 
To improve access to emergency medical services, and for 
other purposes. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Health Care Safety 
Net Enhancement Act of 2009’’. 
SEC. 2. FINDINGS. 
The Congress finds the following: 
(1) As noted in the 2006 Institute of Medicine 
report, ‘‘The Future of Emergency Care’’, the avail-
ability of on-call specialists is an acute problem in 
emergency departments and trauma centers requir-
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ing attention to identified barriers such as liability 
reform. 
(2) Also acknowledged in the 2006 IOM report, 
emergency and trauma care is delivered in an inher-
ently challenging environment, often requiring emer-
gency physicians and trauma surgeons to make life- 
and-death decisions with little time or information or 
without a standing relationship with the patient. For 
these reasons, physicians providing emergency and 
trauma care face extraordinary exposure to medical 
liability claims, which are far higher than for those 
physicians who do not provide such care. 
(3) Younger surgeons, who often take the on- 
call shifts at trauma centers, are leaving States with 
the most severe liability problems. For example, ac-
cording to the Project on Medical Liability in Penn-
sylvania, funded by the Pew Charitable Trust, resi-
dent physicians in high-risk fields such as general 
surgery and emergency medicine named malpractice 
costs as the reason for leaving the State three times 
more often than any other factor. 
(4) Further, an American Hospital Association 
study found that more than 50 percent of hospitals 
in medical liability crisis States now have trouble re-
cruiting physicians, and 40 percent say the liability 
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situation has resulted in less physician coverage for 
their emergency departments. The crisis has even 
forced the closure of trauma centers in Florida, Mis-
sissippi, Nevada, Pennsylvania, and West Virginia at 
various times in recent years. 
(5) Specialties that have experienced particu-
larly high premium increases, including neuro-
surgery, orthopaedics, and general surgery, are also 
among those services that emergency patients most 
frequently require. 
(6) According to a report from the General Ac-
countability Office, soaring medical liability pre-
miums have led specialists to reduce or stop on-call 
services to hospital emergency departments, seri-
ously inhibiting patient access to emergency surgical 
services. 
(7) The Department of Health and Human 
Services’ congressionally created EMTALA technical 
advisory group (TAG) recognized that professional 
liability insurance is a concern for providers and 
that having protections would increase coverage in 
the emergency department. The TAG recommended 
that the Department of Health and Human Services 
act to support amending the EMTALA statute to in-
clude liability protection for hospitals, physicians, 
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and other licensed independent practitioners who 
provide services to patients covered by EMTALA. 
SEC. 3. CONSTITUTIONAL AUTHORITY. 
The constitutional authority upon which this Act 
rests is the power of the Congress to provide for the gen-
eral welfare, to regulate commerce, and to make all laws 
which shall be necessary and proper for carrying into exe-
cution Federal powers, as enumerated in section 8 of arti-
cle I of the Constitution of the United States. 
SEC. 4. PROTECTION FOR EMERGENCY AND RELATED 
SERVICES 
FURNISHED 
PURSUANT 
TO 
EMTALA. 
Section 224(g) of the Public Health Service Act (42 
U.S.C. 233(g)) is amended— 
(1) in paragraph (4), by striking ‘‘An entity’’ 
and inserting ‘‘Subject to paragraph (6), an entity’’; 
and 
(2) by adding at the end the following: 
‘‘(6)(A) For purposes of this section— 
‘‘(i) an entity described in subparagraph 
(B) shall be considered to be an entity de-
scribed in paragraph (4); and 
‘‘(ii) the provisions of this section shall 
apply to an entity described in subparagraph 
(B) in the same manner as such provisions 
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apply to an entity described in paragraph (4), 
except that— 
‘‘(I) 
notwithstanding 
paragraph 
(1)(B), the deeming of any entity described 
in subparagraph (B), or of an officer, gov-
erning board member, employee, con-
tractor, or on-call provider of such an enti-
ty, to be an employee of the Public Health 
Service for purposes of this section shall 
apply only with respect to items and serv-
ices that are furnished to an individual 
pursuant to section 1867 of the Social Se-
curity Act and to post stabilization services 
(as defined in subparagraph (D)) furnished 
to such an individual; 
‘‘(II) nothing in paragraph (1)(D) 
shall be construed as preventing a physi-
cian or physician group described in sub-
paragraph (B)(ii) from making the appli-
cation referred to in such paragraph or as 
conditioning the deeming of a physician or 
physician group that makes such an appli-
cation upon receipt by the Secretary of an 
application from the hospital or emergency 
department that employs or contracts with 
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the physician or group, or enlists the phy-
sician or physician group as an on-call pro-
vider; 
‘‘(III) notwithstanding paragraph (3), 
this paragraph shall apply only with re-
spect to causes of action arising from acts 
or omissions that occur on or after Janu-
ary 1, 2010; 
‘‘(IV) paragraph (5) shall not apply to 
a physician or physician group described in 
subparagraph (B)(ii); 
‘‘(V) the Attorney General, in con-
sultation with the Secretary, shall make 
separate estimates under subsection (k)(1) 
with respect to entities described in sub-
paragraph (B) and entities described in 
paragraph (4) (other than those described 
in subparagraph (B)), and the Secretary 
shall establish separate funds under sub-
section (k)(2) with respect to such groups 
of entities, and any appropriations under 
this subsection for entities described in 
subparagraph (B) shall be separate from 
the amounts authorized by subsection 
(k)(2); 
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‘‘(VI) 
notwithstanding 
subsection 
(k)(2), the amount of the fund established 
by the Secretary under such subsection 
with respect to entities described in sub-
paragraph (B) may exceed a total of 
$10,000,000 for a fiscal year; and 
‘‘(VII) subsection (m) shall not apply 
to entities described in subparagraph (B). 
‘‘(B) An entity described in this subparagraph 
is— 
‘‘(i) a hospital or an emergency depart-
ment to which section 1867 of the Social Secu-
rity Act applies; and 
‘‘(ii) a physician or physician group that is 
employed by, is under contract with, or is an 
on-call provider of such hospital or emergency 
department, to furnish items and services to in-
dividuals under such section. 
‘‘(C) For purposes of this paragraph, the term 
‘on-call provider’ means a physician or physician 
group that— 
‘‘(i) has full, temporary, or locum tenens 
staff privileges at a hospital or emergency de-
partment to which section 1867 of the Social 
Security Act applies; and 
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‘‘(ii) is not employed by or under contract 
with such hospital or emergency department, 
but agrees to be ready and available to provide 
services pursuant to section 1867 of the Social 
Security Act or post-stabilization services to in-
dividuals being treated in the hospital or emer-
gency department with or without compensation 
from the hospital or emergency department. 
‘‘(D) For purposes of this paragraph, the term 
‘post stabilization services’ means, with respect to an 
individual who has been treated by an entity de-
scribed in subparagraph (B) for purposes of com-
plying with section 1867 of the Social Security Act, 
services that are— 
‘‘(i) related to the condition that was so 
treated; and 
‘‘(ii) provided after the individual is sta-
bilized in order to maintain the stabilized condi-
tion or to improve or resolve the condition of 
the individual. 
‘‘(E)(i) Nothing in this paragraph (or in any 
other provision of this section as such provision ap-
plies to entities described in subparagraph (B) by 
operation of subparagraph (A)) shall be construed as 
authorizing or requiring the Secretary to make pay-
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ments to such entities, the budget authority for 
which is not provided in advance by appropriation 
Acts. 
‘‘(ii) The Secretary shall limit the total amount 
of payments under this paragraph for a fiscal year 
to the total amount appropriated in advance by ap-
propriation Acts for such purpose for such fiscal 
year. If the total amount of payments that would 
otherwise be made under this paragraph for a fiscal 
year exceeds such total amount appropriated, the 
Secretary shall take such steps as may be necessary 
to ensure that the total amount of payments under 
this paragraph for such fiscal year does not exceed 
such total amount appropriated.’’. 
Æ 
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