Florida Senate - 2015                          SENATOR AMENDMENT
       Bill No. HB 633, 1st Eng.
                              LEGISLATIVE ACTION                        
                    Senate             .             House              
                 Floor: WD/2R          .                                
             04/23/2015 12:01 PM       .                                

       Senator Clemens moved the following:
    1         Senate Substitute for Amendment (465434) (with title
    2  amendment)
    4         Delete everything after the enacting clause
    5  and insert:
    6         Section 1. Paragraph (a) of subsection (3) of section
    7  390.0111, Florida Statutes, is amended 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, while physically
   18  present in the same room, and at least 24 hours before the
   19  procedure in person, informed the woman of:
   20         a. The nature and risks of undergoing or not undergoing the
   21  proposed procedure that a reasonable patient would consider
   22  material to making a knowing and willful decision of whether to
   23  terminate a pregnancy.
   24         b. The probable gestational age of the fetus, verified by
   25  an ultrasound, at the time the termination of pregnancy is to be
   26  performed.
   27         (I) The ultrasound must be performed by the physician who
   28  is to perform the abortion or by a person having documented
   29  evidence that he or she has completed a course in the operation
   30  of ultrasound equipment as prescribed by rule and who is working
   31  in conjunction with the physician.
   32         (II) The person performing the ultrasound must offer the
   33  woman the opportunity to view the live ultrasound images and
   34  hear an explanation of them. If the woman accepts the
   35  opportunity to view the images and hear the explanation, a
   36  physician or a registered nurse, licensed practical nurse,
   37  advanced registered nurse practitioner, or physician assistant
   38  working in conjunction with the physician must contemporaneously
   39  review and explain the images to the woman before the woman
   40  gives informed consent to having an abortion procedure
   41  performed.
   42         (III) The woman has a right to decline to view and hear the
   43  explanation of the live ultrasound images after she is informed
   44  of her right and offered an opportunity to view the images and
   45  hear the explanation. If the woman declines, the woman shall
   46  complete a form acknowledging that she was offered an
   47  opportunity to view and hear the explanation of the images but
   48  that she declined that opportunity. The form must also indicate
   49  that the woman’s decision was not based on any undue influence
   50  from any person to discourage her from viewing the images or
   51  hearing the explanation and that she declined of her own free
   52  will.
   53         (IV) Unless requested by the woman, the person performing
   54  the ultrasound may not offer the opportunity to view the images
   55  and hear the explanation and the explanation may not be given
   56  if, at the time the woman schedules or arrives for her
   57  appointment to obtain an abortion, a copy of a restraining
   58  order, police report, medical record, or other court order or
   59  documentation is presented which provides evidence that the
   60  woman is obtaining the abortion because the woman is a victim of
   61  rape, incest, domestic violence, or human trafficking or that
   62  the woman has been diagnosed as having a condition that, on the
   63  basis of a physician’s good faith clinical judgment, would
   64  create a serious risk of substantial and irreversible impairment
   65  of a major bodily function if the woman delayed terminating her
   66  pregnancy.
   67         c. The medical risks to the woman and fetus of carrying the
   68  pregnancy to term.
   70         The physician may provide the information required in this
   71  subparagraph within 24 hours before the procedure if requested
   72  by the woman at the time she schedules or arrives for her
   73  appointment to obtain an abortion and if she presents to the
   74  physician a copy of a restraining order, police report, medical
   75  record, or other court order or documentation evidencing that
   76  she is obtaining the abortion because she is a victim of rape,
   77  incest, domestic violence, or human trafficking. The woman may
   78  waive the requirements of this subparagraph if she attests that
   79  she is aware of the risk and has had 24 hours to consider her
   80  decision to terminate the pregnancy. If a woman exercises her
   81  right to waive the state-mandated delay, her health care
   82  provider is not subject to any criminal, civil or administrative
   83  penalties for failure to secure consent 24 hours in advance of
   84  the procedure. The woman’s signed acknowledgement that she has
   85  exercised her right to waive certain requirements is sufficient
   86  proof of provider compliance. This subsection does not alter the
   87  health care provider’s duty to obtain voluntary and informed
   88  consent as otherwise required by this section.
   89         2. Printed materials prepared and provided by the
   90  department have been provided to the pregnant woman, if she
   91  chooses to view these materials, including:
   92         a. A description of the fetus, including a description of
   93  the various stages of development.
   94         b. A list of entities that offer alternatives to
   95  terminating the pregnancy.
   96         c. Detailed information on the availability of medical
   97  assistance benefits for prenatal care, childbirth, and neonatal
   98  care.
   99         3. The woman acknowledges in writing, before the
  100  termination of pregnancy, that the information required to be
  101  provided under this subsection has been provided.
  103         Nothing in this paragraph is intended to prohibit a
  104  physician from providing any additional information which the
  105  physician deems material to the woman’s informed decision to
  106  terminate her pregnancy.
  107         Section 2. For the purpose of incorporating the amendment
  108  made by this act to section 390.0111, Florida Statutes, in a
  109  reference thereto, paragraph (d) of subsection (3) of section
  110  390.012, Florida Statutes, is reenacted to read:
  111         390.012 Powers of agency; rules; disposal of fetal
  112  remains.—
  113         (3) For clinics that perform or claim to perform abortions
  114  after the first trimester of pregnancy, the agency shall adopt
  115  rules pursuant to ss. 120.536(1) and 120.54 to implement the
  116  provisions of this chapter, including the following:
  117         (d) Rules relating to the medical screening and evaluation
  118  of each abortion clinic patient. At a minimum, these rules shall
  119  require:
  120         1. A medical history including reported allergies to
  121  medications, antiseptic solutions, or latex; past surgeries; and
  122  an obstetric and gynecological history.
  123         2. A physical examination, including a bimanual examination
  124  estimating uterine size and palpation of the adnexa.
  125         3. The appropriate laboratory tests, including:
  126         a. Urine or blood tests for pregnancy performed before the
  127  abortion procedure.
  128         b. A test for anemia.
  129         c. Rh typing, unless reliable written documentation of
  130  blood type is available.
  131         d. Other tests as indicated from the physical examination.
  132         4. An ultrasound evaluation for all patients. The rules
  133  shall require that if a person who is not a physician performs
  134  an ultrasound examination, that person shall have documented
  135  evidence that he or she has completed a course in the operation
  136  of ultrasound equipment as prescribed in rule. The rules shall
  137  require clinics to be in compliance with s. 390.0111.
  138         5. That the physician is responsible for estimating the
  139  gestational age of the fetus based on the ultrasound examination
  140  and obstetric standards in keeping with established standards of
  141  care regarding the estimation of fetal age as defined in rule
  142  and shall write the estimate in the patient’s medical history.
  143  The physician shall keep original prints of each ultrasound
  144  examination of a patient in the patient’s medical history file.
  145         Section 3. This act shall take effect July 1, 2015.
  147  ================= T I T L E  A M E N D M E N T ================
  148  And the title is amended as follows:
  149         Delete everything before the enacting clause
  150  and insert:
  151                        A bill to be entitled                      
  152         An act relating to informed patient consent; amending
  153         s. 390.0111, F.S.; revising conditions for the
  154         voluntary and informed consent to a termination of
  155         pregnancy; reenacting s. 390.012(3)(d), F.S., relating
  156         to Agency for Health Care Administration rules
  157         regarding medical screening and evaluation of abortion
  158         clinic patients, to incorporate the amendment made by
  159         this act to s. 390.0111, F.S., in a reference thereto;
  160         providing an effective date.