Most TCPA claims involve cell phones, but the statute’s first two prohibitions protect emergency lines and the phones in hospital and nursing home rooms. An autodialed or prerecorded call to one of those lines is barred whatever the message says, unless it’s for an emergency or made with consent. The rule reaches business-to-business marketing to doctors’ offices, which many companies assume the TCPA leaves alone. A business that didn’t know a number was an emergency line still has a strong answer to treble damages.
Which lines does the TCPA protect?
Three groups, listed in 47 U.S.C. § 227(b)(1)(A). The first covers “any emergency telephone line (including any “911” line and any emergency line of a hospital, medical physician or service office, health care facility, poison control center, or fire protection or law enforcement agency).” The second covers “the telephone line of any guest room or patient room of a hospital, health care facility, elderly home, or similar establishment.” The third, in § 227(b)(1)(A)(iii), covers cell phones and “any telephone number assigned to a paging service,” among others.
The prohibition applies to “any call (other than a call made for emergency purposes or made with the prior express consent of the called party)” that uses an automatic telephone dialing system or an artificial or prerecorded voice. The statute doesn’t limit it to telemarketing. A prerecorded payment reminder, survey, or appointment message to a covered line is inside the rule if the other conditions are met.
That breadth is the trap. The Do Not Call rules exempt calls to businesses, and plenty of marketers stop reading there. The emergency-line and patient-room rules contain no business exception at all.
How did the Eleventh Circuit apply the emergency-line rule?
It treated one fax as two violations. In Lary v. Trinity Physician Financial & Insurance Services, 780 F.3d 1101 (11th Cir. 2015), a physician alleged that “he practices medicine in his health care facility in Madison County, Alabama, where he maintains a fax machine connected to an emergency telephone line.” The defendants defaulted, and the appeal was about damages.
The court held that the junk fax rule and the emergency-line rule are separate prohibitions. The opinion explains that by autodialing an emergency line, the senders “committed a violation of the Act, regardless of what message they transmitted,” and that sending an ad over the same call was “another violation of the Act.” The court added that “Section 227(b)(1) has no language limiting the recovery to $500 per “call” or “fax.””
For a business, that means a single transmission to a covered line can count twice. The statute allows up to $500 in statutory damages per violation, and a court may increase that to up to three times the amount if it finds the violation was willful or knowing, under § 227(b)(3).
Does a business face treble damages if it didn’t know the line was an emergency line?
Lary says no. The court held that “The requirement of “willful[] or knowing[]” conduct requires the violator to know he was performing the conduct that violates the statute.” For the emergency-line rule, the defendant had to know it was autodialing and that the call was going to an emergency line.
The plaintiff lost the treble damages argument on that point. The opinion notes that the complaint “never alleged” that the senders knew they had called an emergency line, and that the plaintiff’s own affidavit suggested a third party sent the ads, “which suggests that Hong and Trinity might have had no knowledge that Lary received a particular fax.” The court called a bare allegation of willfulness “a legal conclusion, not an allegation of fact.”
That’s one of the better defense rulings in TCPA damages law. A business that bought a list of medical office numbers, with nothing marking any of them as an emergency line, has a strong argument against trebling.
Has Duguid narrowed these claims?
Yes, for autodialer theories. Lary was decided in 2015, before the Supreme Court held in Facebook, Inc. v. Duguid that an automatic telephone dialing system must use a random or sequential number generator. A business that dials from a stored list of numbers now has a strong defense to the autodialer half of an emergency-line or patient-room claim. The earlier post on autodialer defenses after Duguid covers that ruling.
The prerecorded-voice half is untouched. Duguid didn’t address artificial or prerecorded voice calls, so a prerecorded message to a hospital room phone or a doctor’s emergency line still needs an emergency purpose or prior express consent. Businesses that run prerecorded campaigns to health care facilities should treat this as the live risk.
What is the PSAP Do-Not-Call registry?
A separate list for 911 call centers, with much larger penalties. Congress directed the FCC to create it in 2012, and 47 U.S.C. § 1473 told the agency to set penalties for autodialing registered numbers “of not less than $10,000 per call nor more than $100,000 per call.” The registry is open only to operators of autodialing equipment, and no private right of action appears in that section.
The FCC’s rule, 47 C.F.R. § 64.1202, bars an operator of autodialing equipment from using it to contact any registered public safety answering point number “other than for an emergency purpose,” and it applies to “both voice and text calls.” The rule requires an operator to use a version of the registry obtained “no more than 31 days prior to the date any call is made” and to keep records showing it did.
Very few businesses access this registry, and most don’t need to. A company that autodials large volumes of numbers it didn’t collect from customers should ask its platform whether it does.
| Line | Rule | Exposure | Defenses that answer it |
|---|---|---|---|
| Emergency line of a hospital, physician, or agency | 47 U.S.C. § 227(b)(1)(A)(i) | Up to $500 per violation, up to three times that if willful or knowing | Emergency purpose, consent, no autodialer after Duguid, no knowledge of the line’s status |
| Hospital, health care, or elderly home room phone | 47 U.S.C. § 227(b)(1)(A)(ii) | Same as above | Emergency purpose, consent, no prerecorded voice, no autodialer |
| Paging service number | 47 U.S.C. § 227(b)(1)(A)(iii) | Same as above | Consent, emergency purpose, no autodialer |
| Registered 911 center number | 47 C.F.R. § 64.1202 | FCC penalties set by statute at $10,000 to $100,000 per call | Registry accessed within 31 days, number added after last access, emergency purpose |
What to collect when an emergency-line or patient-room claim arrives
- Preserve the dialer and platform records for the claimant’s number, including whether each call used a prerecorded message and how the system selected the number.
- Pull any opt-out or do-not-call request tied to the number, with dates.
- Gather the Registry scrub records, and the PSAP registry access log if the business has one, with the version dates for each campaign.
- Collect the list vendor contracts and the source data for each number, including anything that labeled it as a main line, a fax line, or an emergency line.
- Have a lawyer review the file before the business responds to the demand or makes any offer to the claimant.
Step four is where the knowledge defense lives. Lawyers defending emergency-line TCPA claims will want to show the business had no reason to think a number was an emergency line. The earlier posts on TCPA claims over business phone numbers and on junk fax defense cover the other claims these calls usually bring.
Questions about calls to emergency and patient lines
Does a hospital’s main number count as an emergency line?
Not by default. The statute protects “any emergency line” of a hospital or medical office, and a main switchboard isn’t automatically one. Plaintiffs argue that any line the facility uses for urgent calls qualifies. The facts about how the facility designates and staffs the line usually decide the point, and a business should ask for them early.
Can a hospital call its own patients’ room phones with prerecorded messages?
Only with consent or for an emergency purpose. The patient-room rule has no exception for a facility’s own calls. A recorded care reminder or survey sent to room phones should be tied to the patient’s consent at admission. The earlier post on the TCPA’s health care exemption covers the FCC’s health care rules.
Can a marketing call ever have an emergency purpose?
No. The FCC’s rules define an emergency purpose as a call “made necessary in any situation affecting the health and safety of any person,” in the PSAP registry rule. A sales pitch doesn’t fit that definition. The earlier post on the TCPA’s emergency purposes exception covers which alerts courts accept.
Do these rules apply to text messages?
The PSAP rule says so expressly. For the § 227(b)(1)(A) lines, a text to an emergency or room line is rare, since those lines are almost always landlines that can’t receive texts. The claim that does show up is a prerecorded voice call or a fax.
Defending emergency-line and patient-room claims
If your company is accused of sending prerecorded calls or faxes to a medical office’s emergency line or a facility’s room phones, the source of each number and what the business knew about it usually decide both liability and the damages multiplier. Rosenberger + Kawabata represents businesses defending TCPA lawsuits and class actions through its business litigation practice, including claims involving prerecorded calls to health care facility lines. Contact Rosenberger + Kawabata online for a confidential consultation, or call (310) 894-6921.
Sources
The statutes are the Telephone Consumer Protection Act, 47 U.S.C. § 227, and the PSAP registry provision, 47 U.S.C. § 1473. The FCC’s rule is 47 C.F.R. § 64.1202, in the version in effect on July 20, 2026.
The decision discussed is Lary v. Trinity Physician Financial & Insurance Services, 780 F.3d 1101 (11th Cir. 2015).
This post is general information about the Telephone Consumer Protection Act and related laws as of July 26, 2026. It is not legal advice, and reading it does not create an attorney-client relationship. Courts and the FCC change the rules in this area often, and the outcome of any claim depends on its facts. Past results do not guarantee future outcomes.