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

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