An Act to protect certain rights of healthcare providers.

Be it enacted by the Legislature of the State of South Dakota:

Section 1. That a NEW SECTION be added to a NEW CHAPTER in title 34:

Terms used in this chapter mean:

(1) "Conscience," the ethical, moral, or religious beliefs or principles held by a healthcare provider, which, for an entity described in subsections 2(b) and 2(c) of this section, are determined by reference to the entity’s articles of incorporation, bylaws, constitution, directives, guidelines, mission statement, policies, regulations, and other governing documents;

(2) "Healthcare provider," any:

(a) Allied health professional; counselor; employee of a hospital, clinic, nursing home, or pharmacy; faculty or student of a medical school, nursing school, or school of counseling or psychology; laboratory technician; medical assistant; medical researcher; mental health professional; nurse, nurse aide, or nurse practitioner; pharmacist or pharmacy technician; physician or physician assistant; psychologist; social worker; or other individual who is authorized to participate, in any way, in any medical service;

(b) Agency, association, corporation, joint venture, network, organization, partnership, sole proprietorship, or other entity, which provides any medical service; or

(c) Employer, health maintenance organization, health plan, insurance company, management services organization, or any other entity that arranges for payment of, contracts for, reimburses, remunerates, or otherwise pays for, in whole or in part, any medical service; and

(3) "Medical service," administering, dispensing, or prescribing a device, drug, medication, or treatment; arranging or preparing for a surgical procedure; counseling or providing therapy; diagnosing; making records; performing medical research; referring; testing; treating; or providing any other healthcare-related service to any client or patient.

Section 2. That a NEW SECTION be added to a NEW CHAPTER in title 34:

A healthcare provider may not be required to participate in or pay for a medical service that violates the provider's conscience. The right protected in this section:

(1) Is limited to a particular medical service;

(2) Does not modify or waive any duty a provider may have to provide or pay for a medical service that does not violate the provider's conscience; and

(3) Does not allow a provider to decline payment for a medical service it is contractually obligated to pay for under the terms of a contract with an insured party.

Section 3. That a NEW SECTION be added to a NEW CHAPTER in title 34:

A healthcare provider may not be discriminated against:

(1) As a result of exercising the right protected in section 2 of this Act;

(2) Engaging in protected speech pursuant to section 4 of this Act;

(3) Because the provider:

(a) Provided or caused to be provided, or is about to provide or cause to be provided, information relating to any act or omission the provider reasonably believes to be a violation of this chapter to the provider's employer, the attorney general, the United States Department of Health and Human Services, the United States Department of Health and Human Services' Office for Civil Rights, or any other state or federal agency charged with protecting healthcare rights; or

(b) Assisted, participated, or testified in, or is about to assist, participate, or testify in, a proceeding concerning a violation of this chapter; or

(4) Unless disclosure is specifically prohibited by law or concerns a lawful exercise of discretionary decision-making authority, for disclosing information related to a matter of conscience, protected by section 2 of this Act, which the provider reasonably believes is evidence of:

(a) A violation of any applicable law, regulation, or rule;

(b) A violation of any applicable ethical guideline for the provision of a medical service; or

(c) An abuse of authority or methods of treatment or practices that may put patient health at risk; gross mismanagement; a gross waste of funds; or a substantial and specific danger to public health or safety.

For purposes of this section, "discriminated against" means any adverse action taken against, or any threat of adverse action communicated to, a healthcare provider, which includes any executed or threatened discipline, penalty, or retaliation. Discrimination does not include good-faith efforts by an employer to accommodate the right of conscience, protected by section 2 of this Act, of an employee, including reassignment of duties or modification of schedules; an employment action taken after establishing undue hardship on the conduct of the business; or the negotiation or purchase of, or the refusal to purchase or use, insurance coverage or a medical service by an individual or nongovernmental entity.

Section 4. That a NEW SECTION be added to a NEW CHAPTER in title 34:

The Department of Health, the State Board of Medical and Osteopathic Examiners, or any other state agency that regulates any medical service in this state:

(1) May not reprimand or sanction a healthcare provider; deny, revoke, or threaten to deny or revoke a provider's certification, license, or registration; or discriminate against a provider, as described in section 3 of this Act, for a provider's engagement in or exercise of association, expression, or speech that is protected from government interference by the First Amendment to the United States Constitution, unless the state agency demonstrates by clear and convincing evidence that the provider's association, expression, or speech was the direct cause of harm to a patient or client with whom the provider had a provider-patient relationship or provider-client relationship within the three years immediately preceding the harm; and

(2) May not approve, contract with, recognize, or require an individual to obtain credentials issued or approved by, a specialty board or other credentialing body that revokes the credentials of, or refuses to issue credentials to, a provider solely because the provider engaged in protected conduct described in subdivision (1).

Within twenty-one days after receiving any complaint alleging that a provider engaged in conduct that is protected pursuant to subdivision (1), a state agency or credentialing body must furnish the provider with a copy of the complaint. If the copy is not timely furnished, the state agency or credentialing body must pay the provider an administrative penalty of five hundred dollars for each day exceeding the twenty-first day, until the copy is furnished.

Section 5. That a NEW SECTION be added to a NEW CHAPTER in title 34:

Nothing in this chapter may be interpreted to undermine the right of a religious healthcare provider to make administrative, admitting privilege, contracting, employment, and staffing decisions consistent with the provider's religious beliefs if the provider:

(1) Is held out to the public as religious; and

(2) Has policies, procedures, or governing documents, which reflect the provider's religious purpose or mission.

Section 6. That a NEW SECTION be added to a NEW CHAPTER in title 34:

Nothing in this chapter may be construed to conflict with the requirements of the Emergency Medical Treatment and Labor Act, 42 U.S.C. § 1395dd (January 1, 2026).

Section 7. That a NEW SECTION be added to a NEW CHAPTER in title 34:

A healthcare provider may not be held administratively, civilly, or criminally liable for:

(1) Exercising the right protected in section 2 of this Act; or

(2) The exercise of the right protected in section 2 of this Act by another healthcare provider that is contracted with, employed by, or granted admitting privileges by the provider.

Section 8. That a NEW SECTION be added to a NEW CHAPTER in title 34:

Any person aggrieved by a violation of this chapter may commence a civil action and is entitled, upon the court's finding of a violation, to injunctive and declaratory relief and to recover damages, together with the costs of the action and reasonable attorney fees. Damages recovered pursuant to this section are cumulative and may not be limited by any other remedy available under federal, state, or local law.

Any additional burden or expense on another healthcare provider arising from the exercise of the right protected in section 2 of this Act is not a defense against a claim for violation of this Act.

A civil action may not be brought against an individual who declines to use or purchase a medical service from a specific healthcare provider due to the provider's exercise of the right protected in section 2 of this Act.