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

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