Florida Senate - 2011                        COMMITTEE AMENDMENT
       Bill No. CS for SB 1744
                                Barcode 858676                          
                              LEGISLATIVE ACTION                        
                    Senate             .             House              

       The Committee on Budget (Flores) recommended the following:
    1         Senate Amendment (with title amendment)
    3         Delete everything after the enacting clause
    4  and insert:
    5         Section 1. Subsection (3) of section 390.0111, Florida
    6  Statutes, is amended, and subsections (12) and (13) are added to
    7  that section, to read:
    8         390.0111 Termination of pregnancies.—
    9         (3) CONSENTS REQUIRED.—A termination of pregnancy may not
   10  be performed or induced except with the voluntary and informed
   11  written consent of the pregnant woman or, in the case of a
   12  mental incompetent, the voluntary and informed written consent
   13  of her court-appointed guardian.
   14         (a) Except in the case of a medical emergency, consent to a
   15  termination of pregnancy is voluntary and informed only if:
   16         1. The physician who is to perform the procedure, or the
   17  referring physician, has, at a minimum, orally, in person,
   18  informed the woman of:
   19         a. The nature and risks of undergoing or not undergoing the
   20  proposed procedure that a reasonable patient would consider
   21  material to making a knowing and willful decision of whether to
   22  terminate a pregnancy.
   23         b. The probable gestational age of the fetus, verified by
   24  an ultrasound, at the time the termination of pregnancy is to be
   25  performed.
   26         (I) The ultrasound must be performed by the physician who
   27  is to perform the abortion or by a person having documented
   28  evidence that he or she has completed a course in the operation
   29  of ultrasound equipment as prescribed by rule and who is working
   30  in conjunction with the physician.
   31         (II) The person performing the ultrasound must offer the
   32  woman the opportunity to view the live ultrasound images and
   33  hear an explanation of them. If the woman accepts the
   34  opportunity to view the images and hear the explanation, a
   35  physician or a registered nurse, licensed practical nurse,
   36  advanced registered nurse practitioner, or physician assistant
   37  working in conjunction with the physician must contemporaneously
   38  review and explain the images to the woman before the woman
   39  gives informed consent to having an abortion procedure
   40  performed.
   41         (III) The woman has a right to decline to view and hear the
   42  explanation of the live ultrasound images after she is informed
   43  of her right and offered an opportunity to view the images and
   44  hear the explanation. If the woman declines, the woman shall
   45  complete a form acknowledging that she was offered an
   46  opportunity to view and hear the explanation of the images but
   47  that she declined that opportunity. The form must also indicate
   48  that the woman’s decision was not based on any undue influence
   49  from any person to discourage her from viewing the images or
   50  hearing the explanation and that she declined of her own free
   51  will.
   52         (IV) Unless requested by the woman, the person performing
   53  the ultrasound may not offer the opportunity to view the images
   54  and hear the explanation and the explanation may not be given,
   55  if, at the time the woman schedules or arrives for her
   56  appointment to obtain an abortion, a copy of a restraining
   57  order, police report, medical record, or other court order or
   58  documentation is presented which provides evidence that the
   59  woman is obtaining the abortion because the woman is a victim of
   60  rape, incest, domestic violence, or human trafficking, or that
   61  the woman has been diagnosed as having a condition that, on the
   62  basis of a physician’s good faith clinical judgment, would
   63  create a serious risk of substantial and irreversible impairment
   64  of a major bodily function if the woman delayed terminating her
   65  pregnancy.
   66         c. The medical risks to the woman and fetus of carrying the
   67  pregnancy to term.
   68         2.Printed materials prepared and provided by the department
   69  have been provided to the pregnant woman, if she chooses to view
   70  these materials, including:
   71         a. A description of the fetus, including a description of
   72  the various stages of development.
   73         b. A list of entities agencies that offer alternatives to
   74  terminating the pregnancy.
   75         c. Detailed information on the availability of medical
   76  assistance benefits for prenatal care, childbirth, and neonatal
   77  care.
   78         3. The woman acknowledges in writing, before the
   79  termination of pregnancy, that the information required to be
   80  provided under this subsection has been provided.
   82  Nothing in this paragraph is intended to prohibit a physician
   83  from providing any additional information that which the
   84  physician deems material to the woman’s informed decision to
   85  terminate her pregnancy.
   86         (b) If In the event a medical emergency exists and a
   87  physician cannot comply with the requirements for informed
   88  consent, a physician may terminate a pregnancy if he or she has
   89  obtained at least one corroborative medical opinion attesting to
   90  the medical necessity for emergency medical procedures and to
   91  the fact that to a reasonable degree of medical certainty the
   92  continuation of the pregnancy would threaten the life of the
   93  pregnant woman. If a In the event no second physician is not
   94  available for a corroborating opinion, the physician may proceed
   95  but shall document reasons for the medical necessity in the
   96  patient’s medical records.
   97         (c) Violation of this subsection by a physician constitutes
   98  grounds for disciplinary action under s. 458.331 or s. 459.015.
   99  Substantial compliance or reasonable belief that complying with
  100  the requirements of informed consent would threaten the life or
  101  health of the patient is a defense to any action brought under
  102  this paragraph.
  103         (12) DISCIPLINARY ACTION.—Failure to comply with the
  104  requirements of this section shall constitute grounds for
  105  disciplinary action under each respective practice act and under
  106  s. 456.072.
  107         (13) RULES.—The applicable boards, or the department where
  108  there is no board, shall adopt rules necessary to administer the
  109  provisions of this section.
  110         Section 2. Paragraph (d) of subsection (3) of section
  111  390.012, Florida Statutes, is amended to read:
  112         390.012 Powers of agency; rules; disposal of fetal
  113  remains.—
  114         (3) For clinics that perform or claim to perform abortions
  115  after the first trimester of pregnancy, the agency shall adopt
  116  rules pursuant to ss. 120.536(1) and 120.54 to implement the
  117  provisions of this chapter, including the following:
  118         (d) Rules relating to the medical screening and evaluation
  119  of each abortion clinic patient. At a minimum, these rules shall
  120  require:
  121         1. A medical history including reported allergies to
  122  medications, antiseptic solutions, or latex; past surgeries; and
  123  an obstetric and gynecological history.
  124         2. A physical examination, including a bimanual examination
  125  estimating uterine size and palpation of the adnexa.
  126         3. The appropriate laboratory tests, including:
  127         a. For an abortion in which an ultrasound examination is
  128  not performed before the abortion procedure, Urine or blood
  129  tests for pregnancy performed before the abortion procedure.
  130         b. A test for anemia.
  131         c. Rh typing, unless reliable written documentation of
  132  blood type is available.
  133         d. Other tests as indicated from the physical examination.
  134         4. An ultrasound evaluation for all patients who elect to
  135  have an abortion after the first trimester. The rules shall
  136  require that if a person who is not a physician performs an
  137  ultrasound examination, that person shall have documented
  138  evidence that he or she has completed a course in the operation
  139  of ultrasound equipment as prescribed in rule. The rules shall
  140  require clinics to ensure compliance with s. 390.0111. The
  141  physician, registered nurse, licensed practical nurse, advanced
  142  registered nurse practitioner, or physician assistant shall
  143  review, at the request of the patient, the ultrasound evaluation
  144  results, including an estimate of the probable gestational age
  145  of the fetus, with the patient before the abortion procedure is
  146  performed.
  147         5. That the physician is responsible for estimating the
  148  gestational age of the fetus based on the ultrasound examination
  149  and obstetric standards in keeping with established standards of
  150  care regarding the estimation of fetal age as defined in rule
  151  and shall write the estimate in the patient’s medical history.
  152  The physician shall keep original prints of each ultrasound
  153  examination of a patient in the patient’s medical history file.
  154         Section 3. If any provision of this act or the application
  155  thereof to any person or circumstance is held invalid, the
  156  invalidity does not affect other provisions or applications of
  157  the act which can be given effect without the invalid provision
  158  or application, and to this end the provisions of this act are
  159  severable.
  160         Section 4. This act shall take effect July 1, 2011.
  162  ================= T I T L E  A M E N D M E N T ================
  163         And the title is amended as follows:
  164         Delete everything before the enacting clause
  165  and insert:
  166                        A bill to be entitled                      
  167         An act relating to abortions; amending s. 390.0111,
  168         F.S.; requiring that an ultrasound be performed on a
  169         woman obtaining an abortion; specifying who must
  170         perform an ultrasound; requiring that the ultrasound
  171         be reviewed with the patient before the woman gives
  172         informed consent for the abortion procedure;
  173         specifying who must review the ultrasound with the
  174         patient; requiring that the woman certify in writing
  175         that she declined to review the ultrasound and did so
  176         of her own free will and without undue influence;
  177         providing an exemption from the requirement to view
  178         the ultrasound for women who are the victims of rape,
  179         incest, domestic violence, or human trafficking or for
  180         women who have a serious medical condition
  181         necessitating the abortion; revising requirements for
  182         written materials; providing that failure to comply
  183         with the requirements of the act are grounds for
  184         disciplinary action; requiring rulemaking; amending s.
  185         390.012, F.S.; requiring an ultrasound for all
  186         patients regardless of when the abortion is performed;
  187         requiring that live ultrasound images be reviewed and
  188         explained to the patient; requiring the agency to
  189         adopt rules requiring clinics to ensure compliance
  190         with s. 390.0111, F.S.; providing for severability;
  191         providing an effective date.