2023 Legislature                    CS for SB 254, 2nd Engrossed
    2         An act relating to treatments for sex reassignment;
    3         amending s. 61.517, F.S.; granting courts of this
    4         state temporary emergency jurisdiction over a child
    5         present in this state if the child has been subjected
    6         to or is threatened with being subjected to sex
    7         reassignment prescriptions or procedures; amending s.
    8         61.534, F.S.; providing that, for purposes of warrants
    9         to take physical custody of a child in certain child
   10         custody enforcement proceedings, serious physical harm
   11         to the child includes, but is not limited to, being
   12         subjected to sex-reassignment prescriptions or
   13         procedures; creating s. 286.31, F.S.; defining the
   14         term “governmental entity”; prohibiting certain public
   15         entities from expending state funds for the provision
   16         of sex-reassignment prescriptions or procedures;
   17         amending s. 456.001, F.S.; defining the terms “sex”
   18         and “sex-reassignment prescriptions or procedures”;
   19         creating s. 456.52, F.S.; prohibiting sex-reassignment
   20         prescriptions and procedures for patients younger than
   21         18 years of age; providing an exception; requiring the
   22         Board of Medicine and the Board of Osteopathic
   23         Medicine to adopt certain emergency rules within a
   24         specified timeframe; requiring the boards to consider
   25         specified factors in developing such rules; requiring
   26         that such prescriptions and procedures for patients
   27         older than 18 years of age be prescribed,
   28         administered, or performed only with the voluntary and
   29         informed consent of the patient; providing criteria
   30         for what constitutes voluntary and informed consent;
   31         providing that only a physician may prescribe,
   32         administer, or perform such prescriptions and
   33         procedures; defining the term “physician”; providing
   34         applicability; providing for disciplinary action;
   35         providing criminal penalties; requiring the Board of
   36         Medicine and the Board of Osteopathic Medicine to
   37         adopt certain emergency rules; providing that such
   38         emergency rules remain in effect until they are
   39         replaced by nonemergency rules; amending s. 456.074,
   40         F.S.; requiring the department to immediately suspend
   41         the license of a health care practitioner who is
   42         arrested for committing or attempting, soliciting, or
   43         conspiring to commit specified violations related to
   44         sex-reassignment prescriptions or procedures for a
   45         patient younger than 18 years of age; creating s.
   46         766.318, F.S.; creating a cause of action to recover
   47         damages for personal injury or death resulting from
   48         the provision of sex-reassignment prescriptions or
   49         procedures to a minor; providing that certain
   50         limitations on punitive damages do not apply to such
   51         actions; specifying the timeframe within which such
   52         actions may be commenced; providing construction and
   53         applicability; providing severability; providing a
   54         directive to the Division of Law Revision; providing
   55         an effective date.
   57  Be It Enacted by the Legislature of the State of Florida:
   59         Section 1. Subsection (1) of section 61.517, Florida
   60  Statutes, is amended to read:
   61         61.517 Temporary emergency jurisdiction.—
   62         (1) A court of this state has temporary emergency
   63  jurisdiction if the child is present in this state and:
   64         (a) The child has been abandoned; or
   65         (b) It is necessary in an emergency to protect the child
   66  because the child, or a sibling or parent of the child, is
   67  subjected to or threatened with mistreatment or abuse; or
   68         (c) It is necessary in an emergency to protect the child
   69  because the child has been subjected to or is threatened with
   70  being subjected to sex-reassignment prescriptions or procedures,
   71  as defined in s. 456.001.
   72         Section 2. Subsection (1) of section 61.534, Florida
   73  Statutes, is amended to read:
   74         61.534 Warrant to take physical custody of child.—
   75         (1) Upon the filing of a petition seeking enforcement of a
   76  child custody determination, the petitioner may file a verified
   77  application for the issuance of a warrant to take physical
   78  custody of the child if the child is likely to imminently suffer
   79  serious physical harm or removal from this state. Serious
   80  physical harm includes, but is not limited to, being subjected
   81  to sex-reassignment prescriptions or procedures as defined in s.
   82  456.001.
   83         Section 3. Section 286.31, Florida Statutes, is created to
   84  read:
   85         286.31 Prohibited use of state funds.—
   86         (1) As used in this section, the term “governmental entity”
   87  means the state or any political subdivision thereof, including
   88  the executive, legislative, and judicial branches of government;
   89  the independent establishments of the state, counties,
   90  municipalities, districts, authorities, boards, or commissions;
   91  and any agencies that are subject to chapter 286.
   92         (2) A governmental entity, a public postsecondary
   93  educational institution as described in s. 1000.04, the state
   94  group health insurance program, a managing entity as defined in
   95  s. 394.9082, or a managed care plan providing services under
   96  part IV of chapter 409 may not expend state funds as described
   97  in s. 215.31 for sex-reassignment prescriptions or procedures as
   98  defined in s. 456.001.
   99         Section 4. Subsections (8) and (9) are added to section
  100  456.001, Florida Statutes, to read:
  101         456.001 Definitions.—As used in this chapter, the term:
  102         (8) “Sex” means the classification of a person as either
  103  male or female based on the organization of the human body of
  104  such person for a specific reproductive role, as indicated by
  105  the person’s sex chromosomes, naturally occurring sex hormones,
  106  and internal and external genitalia present at birth.
  107         (9)(a) “Sex-reassignment prescriptions or procedures”
  108  means:
  109         1. The prescription or administration of puberty blockers
  110  for the purpose of attempting to stop or delay normal puberty in
  111  order to affirm a person’s perception of his or her sex if that
  112  perception is inconsistent with the person’s sex as defined in
  113  subsection (8).
  114         2. The prescription or administration of hormones or
  115  hormone antagonists to affirm a person’s perception of his or
  116  her sex if that perception is inconsistent with the person’s sex
  117  as defined in subsection (8).
  118         3. Any medical procedure, including a surgical procedure,
  119  to affirm a person’s perception of his or her sex if that
  120  perception is inconsistent with the person’s sex as defined in
  121  subsection (8).
  122         (b) The term does not include:
  123         1. Treatment provided by a physician who, in his or her
  124  good faith clinical judgment, performs procedures upon or
  125  provides therapies to a minor born with a medically verifiable
  126  genetic disorder of sexual development, including any of the
  127  following:
  128         a. External biological sex characteristics that are
  129  unresolvably ambiguous.
  130         b. A disorder of sexual development in which the physician
  131  has determined through genetic or biochemical testing that the
  132  patient does not have a normal sex chromosome structure, sex
  133  steroid hormone production, or sex steroid hormone action for a
  134  male or female, as applicable.
  135         2. Prescriptions or procedures to treat an infection, an
  136  injury, a disease, or a disorder that has been caused or
  137  exacerbated by the performance of any sex-reassignment
  138  prescription or procedure, regardless of whether such
  139  prescription or procedure was performed in accordance with state
  140  or federal law.
  141         3. Prescriptions or procedures provided to a patient for
  142  the treatment of a physical disorder, physical injury, or
  143  physical illness that would, as certified by a physician
  144  licensed under chapter 458 or chapter 459, place the individual
  145  in imminent danger of death or impairment of a major bodily
  146  function without the prescription or procedure.
  147         Section 5. Section 456.52, Florida Statutes, is created to
  148  read:
  149         456.52 Sex-reassignment prescriptions and procedures;
  150  prohibitions; informed consent.—
  151         (1) Sex-reassignment prescriptions and procedures are
  152  prohibited for patients younger than 18 years of age, except
  153  that:
  154         (a) The Board of Medicine and the Board of Osteopathic
  155  Medicine shall, within 60 days after the effective date of this
  156  act, adopt emergency rules pertaining to standards of practice
  157  under which a patient younger than 18 years of age may continue
  158  to be treated with a prescription consistent with those
  159  referenced under s. 456.001(9)(a)1. or 2. if such treatment for
  160  sex reassignment was commenced before, and is still active on,
  161  the effective date of this act. In developing rules under this
  162  paragraph, the boards shall consider requirements for physicians
  163  to obtain informed consent from such patient′s parent or legal
  164  guardian, consistent with the parameters of informed consent
  165  under subsections (2) and (4), for such prescription treatment,
  166  and shall consider the provision of professional counseling
  167  services for such patient by a board-certified psychiatrist
  168  licensed under chapter 458 or chapter 459 or a psychologist
  169  licensed under chapter 490 in conjunction with such prescription
  170  treatment.
  171         (b) A patient meeting the criteria of paragraph (a) may
  172  continue to be treated by a physician with such prescriptions
  173  according to rules adopted under paragraph (a) or nonemergency
  174  rules adopted under paragraph (6)(b).
  175         (2) If sex-reassignment prescriptions or procedures are
  176  prescribed for or administered or performed on patients 18 years
  177  of age or older, consent must be voluntary, informed, and in
  178  writing on forms adopted in rule by the Board of Medicine and
  179  the Board of Osteopathic Medicine. Consent to sex-reassignment
  180  prescriptions or procedures is voluntary and informed only if
  181  the physician who is to prescribe or administer the
  182  pharmaceutical product or perform the procedure has, at a
  183  minimum, while physically present in the same room:
  184         (a) Informed the patient of the nature and risks of the
  185  prescription or procedure in order for the patient to make a
  186  prudent decision;
  187         (b) Provided the informed consent form, as adopted in rule
  188  by the Board of Medicine and the Board of Osteopathic Medicine,
  189  to the patient; and
  190         (c) Received the patient’s written acknowledgment, before
  191  the prescription or procedure is prescribed, administered, or
  192  performed, that the information required to be provided under
  193  this subsection has been provided.
  194         (3) Sex-reassignment prescriptions or procedures may not be
  195  prescribed, administered, or performed except by a physician.
  196  For the purposes of this section, the term “physician” is
  197  defined as a physician licensed under chapter 458 or chapter 459
  198  or a physician practicing medicine or osteopathic medicine in
  199  the employment of the Federal Government.
  200         (4) Consent required under subsection (2) does not apply to
  201  renewals of prescriptions consistent with those referenced under
  202  s. 456.001(9)(a)1. and 2. if a physician and his or her patient
  203  have met the requirements for consent for the initial
  204  prescription or renewal. However, separate consent is required
  205  for any new prescription for a pharmaceutical product not
  206  previously prescribed to the patient.
  207         (5)(a) Violation of this section constitutes grounds for
  208  disciplinary action under this chapter and chapter 458 or
  209  chapter 459, as applicable.
  210         (b) Any health care practitioner who willfully or actively
  211  participates in a violation of subsection (1) commits a felony
  212  of the third degree, punishable as provided in s. 775.082, s.
  213  775.083, or s. 775.084.
  214         (c) Any health care practitioner who violates subsection
  215  (2), subsection (3), or subsection (4) commits a misdemeanor of
  216  the first degree, punishable as provided in s. 775.082 or s.
  217  775.083.
  218         (6)(a) The Board of Medicine and the Board of Osteopathic
  219  Medicine shall adopt emergency rules to implement this section.
  220         (b) Any emergency rules adopted under this section are
  221  exempt from s. 120.54(4)(c) and shall remain in effect until
  222  replaced by rules adopted under the nonemergency rulemaking
  223  procedures of the Administrative Procedure Act.
  224         Section 6. Present paragraphs (c) through (gg) of
  225  subsection (5) of section 456.074, Florida Statutes, are
  226  redesignated as paragraphs (d) through (hh), respectively, and a
  227  new paragraph (c) is added to that subsection, to read:
  228         456.074 Certain health care practitioners; immediate
  229  suspension of license.—
  230         (5) The department shall issue an emergency order
  231  suspending the license of any health care practitioner who is
  232  arrested for committing or attempting, soliciting, or conspiring
  233  to commit any act that would constitute a violation of any of
  234  the following criminal offenses in this state or similar
  235  offenses in another jurisdiction:
  236         (c) Section 456.52(5)(b), relating to prescribing,
  237  administering, or performing sex-reassignment prescriptions or
  238  procedures for a patient younger than 18 years of age.
  239         Section 7. Section 766.318, Florida Statutes, is created to
  240  read:
  241         766.318 Civil liability for provision of sex-reassignment
  242  prescriptions or procedures to minors.—
  243         (1) A cause of action exists to recover damages for
  244  personal injury or death resulting from the provision of sex
  245  reassignment prescriptions or procedures, as defined in s.
  246  456.001, to a person younger than 18 years of age which are
  247  prohibited by s. 456.52(1).
  248         (2) The limitations on punitive damages in s. 768.73(1) do
  249  not apply to actions brought under this section.
  250         (3) An action brought under this section:
  251         (a) May be commenced within 20 years after the cessation or
  252  completion of the sex-reassignment prescription or procedure.
  253         (b) Is in addition to any other remedy authorized by law.
  254         (4) The cause of action created by this section does not
  255  apply to:
  256         (a) Treatment with sex-reassignment prescriptions if such
  257  treatment is consistent with s. 456.001(9)(a)1. or 2. and was
  258  commenced on or before, and is still active on, the effective
  259  date of this act.
  260         (b) Sex-reassignment prescriptions or procedures that were
  261  ceased or completed on or before the effective date of this act.
  262         Section 8. If any provision of this act or its application
  263  to any person or circumstance is held invalid, the invalidity
  264  does not affect other provisions or applications of this act
  265  which can be given effect without the invalid provision or
  266  application, and to this end the provisions of this act are
  267  severable.
  268         Section 9. The Division of Law Revision is directed to
  269  replace the phrase “the effective date of this act” wherever it
  270  occurs in this act with the date this act becomes a law.
  271         Section 10. This act shall take effect upon becoming a law.