Florida Senate - 2011                             CS for SB 1744
       By the Committee on Health Regulation; and Senator Storms
       588-03807-11                                          20111744c1
    1                        A bill to be entitled                      
    2         An act relating to abortions; amending s. 390.0111,
    3         F.S.; requiring that an ultrasound be performed on a
    4         woman obtaining an abortion; specifying who must
    5         perform an ultrasound; requiring that the ultrasound
    6         be reviewed with the patient before the woman gives
    7         informed consent for the abortion procedure;
    8         specifying who must review the ultrasound with the
    9         patient; requiring that the woman certify in writing
   10         that she declined to review the ultrasound and did so
   11         of her own free will and without undue influence;
   12         providing an exemption from the requirement to view
   13         the ultrasound for women who are the victims of rape,
   14         incest, domestic violence, or human trafficking or for
   15         women who have a serious medical condition
   16         necessitating the abortion; revising requirements for
   17         written materials; amending s. 390.012, F.S.;
   18         requiring an ultrasound for all patients regardless of
   19         when the abortion is performed; requiring that live
   20         ultrasound images be reviewed and explained to the
   21         patient; requiring that all other provisions in s.
   22         390.0111, F.S., be complied with if the patient
   23         declines to view her live ultrasound images; providing
   24         for severability; providing an effective date.
   26  Be It Enacted by the Legislature of the State of Florida:
   28         Section 1. Subsection (3) of section 390.0111, Florida
   29  Statutes, is amended to read:
   30         390.0111 Termination of pregnancies.—
   31         (3) CONSENTS REQUIRED.—A termination of pregnancy may not
   32  be performed or induced except with the voluntary and informed
   33  written consent of the pregnant woman or, in the case of a
   34  mental incompetent, the voluntary and informed written consent
   35  of her court-appointed guardian.
   36         (a) Except in the case of a medical emergency, consent to a
   37  termination of pregnancy is voluntary and informed only if:
   38         1. The physician who is to perform the procedure, or the
   39  referring physician, has, at a minimum, orally, in person,
   40  informed the woman of:
   41         a. The nature and risks of undergoing or not undergoing the
   42  proposed procedure that a reasonable patient would consider
   43  material to making a knowing and willful decision of whether to
   44  terminate a pregnancy.
   45         b. The probable gestational age of the fetus, verified by
   46  an ultrasound, at the time the termination of pregnancy is to be
   47  performed.
   48         (I) The ultrasound must be performed by the physician who
   49  is to perform the abortion or by a person having documented
   50  evidence that he or she has completed a course in the operation
   51  of ultrasound equipment as prescribed by rule and who is working
   52  in conjunction with the physician.
   53         (II) The person performing the ultrasound must allow the
   54  woman to view the live ultrasound images, and a physician or a
   55  registered nurse, licensed practical nurse, advanced registered
   56  nurse practitioner, or physician assistant working in
   57  conjunction with the physician must contemporaneously review and
   58  explain the live ultrasound images to the woman before the woman
   59  gives informed consent to having an abortion procedure
   60  performed. However, this sub-sub-subparagraph does not apply if,
   61  at the time the woman schedules or arrives for her appointment
   62  to obtain an abortion, a copy of a restraining order, police
   63  report, medical record, or other court order or documentation is
   64  presented which provides evidence that the woman is obtaining
   65  the abortion because the woman is a victim of rape, incest,
   66  domestic violence, or human trafficking or that the woman has
   67  been diagnosed as having a condition that, on the basis of a
   68  physician’s good faith clinical judgment, would create a serious
   69  risk of substantial and irreversible impairment of a major
   70  bodily function if the woman delayed terminating her pregnancy.
   71         (III) The woman has a right to decline to view the
   72  ultrasound images after she is informed of her right and offered
   73  an opportunity to view them. If the woman declines to view the
   74  ultrasound images, the woman shall complete a form acknowledging
   75  that she was offered an opportunity to view her ultrasound but
   76  that she rejected that opportunity. The form must also indicate
   77  that the woman’s decision not to view the ultrasound was not
   78  based on any undue influence from any third party to discourage
   79  her from viewing the images and that she declined to view the
   80  images of her own free will.
   81         c. The medical risks to the woman and fetus of carrying the
   82  pregnancy to term.
   83         2. Printed materials prepared and provided by the
   84  department have been provided to the pregnant woman, if she
   85  chooses to view these materials, including:
   86         a. A description of the fetus, including a description of
   87  the various stages of development.
   88         b. A list of entities agencies that offer alternatives to
   89  terminating the pregnancy.
   90         c. Detailed information on the availability of medical
   91  assistance benefits for prenatal care, childbirth, and neonatal
   92  care.
   93         3. The woman acknowledges in writing, before the
   94  termination of pregnancy, that the information required to be
   95  provided under this subsection has been provided.
   97  Nothing in this paragraph is intended to prohibit a physician
   98  from providing any additional information which the physician
   99  deems material to the woman’s informed decision to terminate her
  100  pregnancy.
  101         (b) If In the event a medical emergency exists and a
  102  physician cannot comply with the requirements for informed
  103  consent, a physician may terminate a pregnancy if he or she has
  104  obtained at least one corroborative medical opinion attesting to
  105  the medical necessity for emergency medical procedures and to
  106  the fact that to a reasonable degree of medical certainty the
  107  continuation of the pregnancy would threaten the life of the
  108  pregnant woman. If a In the event no second physician is not
  109  available for a corroborating opinion, the physician may proceed
  110  but shall document reasons for the medical necessity in the
  111  patient’s medical records.
  112         (c) Violation of this subsection by a physician constitutes
  113  grounds for disciplinary action under s. 458.331 or s. 459.015.
  114  Substantial compliance or reasonable belief that complying with
  115  the requirements of informed consent would threaten the life or
  116  health of the patient is a defense to any action brought under
  117  this paragraph.
  118         Section 2. Paragraph (d) of subsection (3) of section
  119  390.012, Florida Statutes, is amended to read:
  120         390.012 Powers of agency; rules; disposal of fetal
  121  remains.—
  122         (3) For clinics that perform or claim to perform abortions
  123  after the first trimester of pregnancy, the agency shall adopt
  124  rules pursuant to ss. 120.536(1) and 120.54 to implement the
  125  provisions of this chapter, including the following:
  126         (d) Rules relating to the medical screening and evaluation
  127  of each abortion clinic patient. At a minimum, these rules shall
  128  require:
  129         1. A medical history including reported allergies to
  130  medications, antiseptic solutions, or latex; past surgeries; and
  131  an obstetric and gynecological history.
  132         2. A physical examination, including a bimanual examination
  133  estimating uterine size and palpation of the adnexa.
  134         3. The appropriate laboratory tests, including:
  135         a. For an abortion in which an ultrasound examination is
  136  not performed before the abortion procedure, Urine or blood
  137  tests for pregnancy performed before the abortion procedure.
  138         b. A test for anemia.
  139         c. Rh typing, unless reliable written documentation of
  140  blood type is available.
  141         d. Other tests as indicated from the physical examination.
  142         4. An ultrasound evaluation for all patients who elect to
  143  have an abortion after the first trimester. The rules shall
  144  require that if a person who is not a physician performs an
  145  ultrasound examination, that person shall have documented
  146  evidence that he or she has completed a course in the operation
  147  of ultrasound equipment as prescribed in rule. The physician,
  148  registered nurse, licensed practical nurse, advanced registered
  149  nurse practitioner, or physician assistant shall review and
  150  explain, at the request of the patient, the live ultrasound
  151  images evaluation results, including an estimate of the probable
  152  gestational age of the fetus, with the patient before the
  153  abortion procedure is performed, unless the patient declines
  154  pursuant to s. 390.0111. If the patient declines to view the
  155  live ultrasound images, the rules shall require that s. 390.0111
  156  be complied with in all other respects.
  157         5. That the physician is responsible for estimating the
  158  gestational age of the fetus based on the ultrasound examination
  159  and obstetric standards in keeping with established standards of
  160  care regarding the estimation of fetal age as defined in rule
  161  and shall write the estimate in the patient’s medical history.
  162  The physician shall keep original prints of each ultrasound
  163  examination of a patient in the patient’s medical history file.
  164         Section 3. If any provision of this act or its application
  165  to any person or circumstance is held invalid, the invalidity
  166  does not affect other provisions or applications of the act
  167  which can be given effect without the invalid provision or
  168  application, and to this end the provisions of this act are
  169  severable.
  170         Section 4. This act shall take effect July 1, 2011.