HB1153 creates a new chapter in South Dakota law protecting a healthcare provider’s “conscience” rights. The bill defines healthcare provider broadly to include individual clinicians, healthcare employees, students, and healthcare-related entities such as hospitals, insurers, health plans, and other organizations involved in arranging or paying for medical services. It also defines medical service broadly to include prescribing, dispensing, counseling, diagnosing, testing, treating, referring, research, and other healthcare-related activities.
The bill generally prohibits requiring a provider to participate in or pay for a medical service that violates the provider’s conscience, while preserving existing contractual payment obligations. It also bars discrimination or retaliation against providers for exercising these rights, reporting alleged violations, or disclosing certain information about conscience-related matters. In addition, it limits state agencies from disciplining providers for protected speech or association under the First Amendment unless the agency proves by clear and convincing evidence that the speech directly caused harm to a patient or client within the prior three years, and it restricts state recognition of credentialing bodies that revoke credentials for protected conduct. The bill includes civil remedies, damages, attorney fees, and administrative penalties for delayed complaint disclosure.
HB1153 would affect state regulation of healthcare licensing, discipline, employment practices, and credentialing by the Department of Health, the State Board of Medical and Osteopathic Examiners, and other state agencies regulating medical services. It also preserves religious healthcare providers’ ability to make staffing, contracting, and admitting decisions consistent with their religious mission, and it expressly states that the chapter cannot be read to conflict with EMTALA. The bill creates a private right of action for aggrieved persons and allows injunctive relief, declaratory relief, damages, costs, and attorney fees.
The available voting history suggests the bill was controversial and did not advance cleanly: it passed one vote 8-5 on a “Do Pass Amended” motion but later failed on a 25-41 vote on another “Do Pass Amended” motion. No committee transcript was provided, so the record does not show detailed floor or committee debate, but the broad scope of conscience protections and the limits on agency discipline likely drove concern from opponents, while supporters appear to have framed the measure as protecting provider autonomy, free speech, and religious liberty.
The main points of contention are likely the bill’s expansive definition of protected providers and services, its strong anti-discrimination and anti-retaliation provisions, and its restriction on state disciplinary authority over speech and association. Critics may view it as allowing providers to refuse participation in certain care or to avoid professional consequences for conduct that conflicts with institutional or patient-care standards, while supporters likely see it as preventing compelled participation in controversial medical services and protecting religious and moral objections in healthcare.
HB1153 would add a new chapter to Title 34 establishing statutory conscience protections for healthcare providers, limiting when providers can be compelled to participate in or pay for medical services and creating new anti-discrimination, speech-protection, and enforcement provisions. It would constrain state agencies’ licensing and disciplinary authority, create liability exposure for violations, and provide a private civil cause of action with damages, fees, and injunctive relief. The bill also preserves religious-provider autonomy and expressly avoids conflict with EMTALA.
The bill appears to have generated mixed to negative sentiment in the legislative process, with one amended do-pass vote succeeding narrowly and a later amended do-pass vote failing by a wide margin. That pattern suggests some support for conscience and free-speech protections, but substantial concern about the breadth of the bill and its effects on healthcare regulation, patient access, and professional oversight. No transcript is available to identify specific speakers or arguments.
The most notable contention is over the scope of the conscience exemption: the bill allows a wide range of healthcare workers and entities to refuse participation in or payment for medical services that conflict with their beliefs. Another major point of dispute is the restriction on state discipline for protected speech or association, which limits agency action unless direct patient harm is shown by clear and convincing evidence. Opponents are likely to focus on patient access, nondiscrimination, and regulatory enforcement, while supporters emphasize religious liberty, free speech, and protection from compelled participation in contested medical care.