HB 1041

1	A bill to be entitled
2	An act relating to women's health care; providing a
3	popular name; amending s. 390.012, F.S.; revising
4	requirements for rules of the Agency for Health Care
5	Administration relating to abortion clinics performing
6	abortions after the first trimester of pregnancy;
7	requiring rules that prescribe standards for physical
8	facilities, supplies and equipment, personnel, screening
9	and evaluation, the abortion procedure, recovery, follow-up
10	care, and incident reporting; providing that rules
11	regulating abortion clinics may not impose an
12	unconstitutional burden rather than a legally significant
13	burden on a woman's right to choose to terminate her
14	pregnancy; providing for severability; providing an
15	effective date.
16
17	WHEREAS, abortion is an invasive surgical procedure that
18	can lead to numerous and serious medical complications,
19	including, but not limited to, bleeding, hemorrhage, infection,
20	uterine perforation, blood clots, cervical tears, incomplete
21	abortion and retained tissue, failure to actually terminate the
22	pregnancy, free fluid in the abdomen, missed ectopic
23	pregnancies, cardiac arrest, sepsis, respiratory arrest,
24	reactions to anesthesia, fertility problems, emotional problems,
25	and even death, and
26	WHEREAS, the state has a legitimate interest in ensuring
27	that abortions, like any other medical procedure, be performed
28	under circumstances that ensure maximum safety for the patient,
29	and
30	WHEREAS, the risks for abortion are greater after the first
31	trimester of pregnancy, and
32	WHEREAS, the risk of hemorrhage, in particular, is greater
33	after the first trimester of pregnancy, and the resultant
34	complications may require a hysterectomy, other reparative
35	surgery, or a blood transfusion, NOW, THEREFORE,
36
37	Be It Enacted by the Legislature of the State of Florida:
38
39	Section 1.  This act may be cited as the "Women's Health
40	and Safety Act."
41	Section 2.  Section 390.012, Florida Statutes, is amended
42	to read:
43	390.012  Powers of agency; rules; disposal of fetal
44	remains.--
45	(1)  The agency shall have the authority to develop and
46	enforce rules for the health, care, and treatment of persons in
47	abortion clinics and for the safe operation of such clinics.
48	These rules shall be comparable to rules which apply to all
49	surgical procedures requiring approximately the same degree of
50	skill and care as the performance of first trimester abortions.
51	(a)  The rules shall be reasonably related to the
52	preservation of maternal health of the clients.
53	(b)  The rules shall be in accordance with s. 797.03 and
54	may not impose an unconstitutional a legally significant burden
55	on a woman's freedom to decide whether to terminate her
56	pregnancy.
57	(c)  The rules shall provide for:
58	1.(a)  The performance of pregnancy termination procedures
59	only by a licensed physician.
60	2.(b)  The making, protection, and preservation of patient
61	records, which shall be treated as medical records under chapter
62	458.
63	(2)  For clinics that perform abortions in the first
64	trimester of pregnancy only, these rules shall be comparable to
65	rules that apply to all surgical procedures requiring
66	approximately the same degree of skill and care as the
67	performance of first trimester abortions.
68	(3)  For clinics that perform or claim to perform abortions
69	after the first trimester of pregnancy, the agency shall adopt
70	rules pursuant to ss. 120.536(1) and 120.54 to implement the
71	provisions of this chapter, including the following:
72	(a)  Rules for an abortion clinic's physical facilities. At
73	a minimum, these rules shall prescribe standards for:
74	1.  Adequate private space that is specifically designated
75	for interviewing, counseling, and medical evaluations.
76	2.  Dressing rooms for staff and patients.
77	3.  Appropriate lavatory areas.
78	4.  Areas for preprocedure hand washing.
79	5.  Private procedure rooms.
80	6.  Adequate lighting and ventilation for abortion
81	procedures.
82	7.  Surgical or gynecological examination tables and other
83	fixed equipment.
84	8.  Postprocedure recovery rooms that are equipped to meet
85	the patients' needs.
86	9.  Emergency exits to accommodate a stretcher or gurney.
87	10.  Areas for cleaning and sterilizing instruments.
88	11.  Adequate areas for the secure storage of medical
89	records and necessary equipment and supplies.
90	12.  The display in the abortion clinic, in a place that is
91	conspicuous to all patients, of the clinic's current license
92	issued by the agency.
93	(b)  Rules to prescribe abortion clinic supplies and
94	equipment standards, including supplies and equipment that are
95	required to be immediately available for use or in an emergency.
96	At a minimum, these rules shall:
97	1.  Prescribe required clean and sterilized equipment and
98	supplies, including medications, required for the conduct, in an
99	appropriate fashion, of any abortion procedure that the medical
100	staff of the clinic anticipates performing and for monitoring
101	the progress of each patient throughout the procedure and
102	recovery period.
103	2.  Prescribe required equipment, supplies, and medications
104	that shall be available and ready for immediate use in an
105	emergency and requirements for written protocols and procedures
106	to be followed by staff in an emergency, such as the loss of
107	electrical power.
108	3.  Prescribe equipment and supplies for required
109	laboratory tests and requirements for protocols to calibrate and
110	maintain laboratory equipment or equipment operated by clinic
111	staff at the abortion clinic.
112	4.  Require ultrasound equipment.
113	5.  Require that all equipment is safe for the patient and
114	the staff, meets applicable federal standards, and is checked
115	annually to ensure safety and appropriate calibration.
116	(c)  Rules relating to abortion clinic personnel. At a
117	minimum, these rules shall require that:
118	1.  The abortion clinic designate a medical director who is
119	licensed to practice medicine and surgery in the state and who
120	has admitting privileges at an accredited hospital in the state
121	that is within 50 miles of the abortion clinic.
122	2.  If a physician is not present after an abortion is
123	performed, a registered nurse, licensed practical nurse,
124	advanced registered nurse practitioner, or physician assistant
125	shall be present and remain at the clinic to provide
126	postoperative monitoring and care until the patient is
127	discharged.
128	3.  Surgical assistants receive training in counseling,
129	patient advocacy, and the specific responsibilities associated
130	with the services the surgical assistants provide.
131	4.  Volunteers receive training in the specific
132	responsibilities associated with the services the volunteers
133	provide, including counseling and patient advocacy as provided
134	in the rules adopted by the director for different types of
135	volunteers based on their responsibilities.
136	(d)  Rules relating to the medical screening and evaluation
137	of each abortion clinic patient. At a minimum, these rules shall
138	require:
139	1.  A medical history including reported allergies to
140	medications, antiseptic solutions, or latex; past surgeries; and
141	an obstetric and gynecological history.
142	2.  A physical examination, including a bimanual
143	examination estimating uterine size and palpation of the adnexa.
144	3.  The appropriate laboratory tests, including:
145	a.  For an abortion in which an ultrasound examination is
146	not performed before the abortion procedure, urine or blood
147	tests for pregnancy performed before the abortion procedure.
148	b.  A test for anemia.
149	c.  Rh typing, unless reliable written documentation of
150	blood type is available.
151	d.  Other tests as indicated from the physical examination.
152	4.  An ultrasound evaluation for all patients who elect to
153	have an abortion after the first trimester. The rules shall
154	require that if a person who is not a physician performs an
155	ultrasound examination, that person shall have documented
156	evidence that he or she has completed a course in the operation
157	of ultrasound equipment as prescribed in rule. The physician,
158	registered nurse, licensed practical nurse, advanced registered
159	nurse practitioner, or physician assistant shall review, at the
160	request of the patient, the ultrasound evaluation results,
161	including an estimate of the probable gestational age of the
162	fetus, with the patient before the abortion procedure is
163	performed.
164	5.  That the physician is responsible for estimating the
165	gestational age of the fetus based on the ultrasound examination
166	and obstetric standards in keeping with established standards of
167	care regarding the estimation of fetal age as defined in rule
168	and shall write the estimate in the patient's medical history.
169	The physician shall keep original prints of each ultrasound
170	examination of a patient in the patient's medical history file.
171	(e)  Rules relating to the abortion procedure. At a
172	minimum, these rules shall require:
173	1.  That a physician, registered nurse, licensed practical
174	nurse, advanced registered nurse practitioner, or physician
175	assistant is available to all patients throughout the abortion
176	procedure.
177	2.  Standards for the safe conduct of abortion procedures
178	that conform to obstetric standards in keeping with established
179	standards of care regarding the estimation of fetal age as
180	defined in rule.
181	3.  Appropriate use of general and local anesthesia,
182	analgesia, and sedation if ordered by the physician.
183	4.  Appropriate precautions, such as the establishment of
184	intravenous access at least for patients undergoing post-first
185	trimester abortions.
186	5.  Appropriate monitoring of the vital signs and other
187	defined signs and markers of the patient's status throughout the
188	abortion procedure and during the recovery period until the
189	patient's condition is deemed to be stable in the recovery room.
190	(f)  Rules that prescribe minimum recovery room standards.
191	At a minimum, these rules shall require that:
192	1.  Postprocedure recovery rooms are supervised and staffed
193	to meet the patients' needs.
194	2.  Immediate postprocedure care consists of observation in
195	a supervised recovery room for as long as the patient's
196	condition warrants.
197	3.  The clinic arranges hospitalization if any complication
198	beyond the medical capability of the staff occurs or is
199	suspected.
200	4.  A registered nurse, licensed practical nurse, advanced
201	registered nurse practitioner, or physician assistant who is
202	trained in the management of the recovery area and is capable of
203	providing basic cardiopulmonary resuscitation and related
204	emergency procedures remains on the premises of the abortion
205	clinic until all patients are discharged.
206	5.  A physician shall sign the discharge order and be
207	readily accessible and available until the last patient is
208	discharged to facilitate the transfer of emergency cases if
209	hospitalization of the patient or viable fetus is necessary.
210	6.  A physician discusses Rho(D) immune globulin with each
211	patient for whom it is indicated and ensures that it is offered
212	to the patient in the immediate postoperative period or that it
213	will be available to her within 72 hours after completion of the
214	abortion procedure. If the patient refuses the Rho(D) immune
215	globulin, a refusal form approved by the agency shall be signed
216	by the patient and a witness and included in the medical record.
217	7.  Written instructions with regard to postabortion
218	coitus, signs of possible problems, and general aftercare are
219	given to each patient. Each patient shall have specific written
220	instructions regarding access to medical care for complications,
221	including a telephone number to call for medical emergencies.
222	8.  There is a specified minimum length of time that a
223	patient remains in the recovery room by type of abortion
224	procedure and duration of gestation.
225	9.  The physician ensures that a registered nurse, licensed
226	practical nurse, advanced registered nurse practitioner, or
227	physician assistant from the abortion clinic makes a good faith
228	effort to contact the patient by telephone, with the patient's
229	consent, within 24 hours after surgery to assess the patient's
230	recovery.
231	10.  Equipment and services are readily accessible to
232	provide appropriate emergency resuscitative and life support
233	procedures pending the transfer of the patient or viable fetus
234	to the hospital.
235	(g)  Rules that prescribe standards for followup care. At a
236	minimum, these rules shall require that:
237	1.  A postabortion medical visit that includes a medical
238	examination and a review of the results of all laboratory tests
239	is offered.
240	2.  A urine pregnancy test is obtained at the time of the
241	followup visit to rule out continuing pregnancy.
242	3.  If a continuing pregnancy is suspected, the patient
243	shall be evaluated and a physician who performs abortions shall
244	be consulted.
245	(h)  Rules to prescribe minimum abortion clinic incident
246	reporting. At a minimum, these rules shall require that:
247	1.  The abortion clinic records each incident that results
248	in serious injury to a patient or a viable fetus at an abortion
249	clinic and shall report an incident in writing to the agency
250	within 10 days after the incident occurs. For the purposes of
251	this paragraph, "serious injury" means an injury that occurs at
252	an abortion clinic and that creates a serious risk of
253	substantial impairment of a major bodily organ.
254	2.  If a patient's death occurs, other than a fetal death
255	properly reported pursuant to law, the abortion clinic reports
256	it to the department not later than the next department workday.
257	(4)  The rules adopted pursuant to this section shall not
258	limit the ability of a physician to advise a patient on any
259	health issue.
260	(5)  The provisions of this section and the rules adopted
261	pursuant hereto shall be in addition to any other laws, rules,
262	and regulations which are applicable to facilities defined as
263	abortion clinics under this section.
264	(6)(2)  The agency may adopt and enforce rules, in the
265	interest of protecting the public health, to ensure the prompt
266	and proper disposal of fetal remains and tissue resulting from
267	pregnancy termination.
268	(7)(3)  If any owner, operator, or employee of an abortion
269	clinic fails to dispose of fetal remains and tissue in a manner
270	consistent with the disposal of other human tissue in a
271	competent professional manner, the license of such clinic may be
272	suspended or revoked, and such person is guilty of a misdemeanor
273	of the first degree, punishable as provided in s. 775.082 or s.
274	775.083.
275	Section 3.  If any provision of this act or the application
276	thereof to any person or circumstance is held invalid, the
277	invalidity shall not affect other provisions or applications of
278	the act which can be given effect without the invalid provision
279	or application. To this end, the provisions of this act are
280	declared severable.
281	Section 4.  This act shall take effect July 1, 2005.

CODING: Words stricken are deletions; words underlined are additions.