CS/HB 257

1	A bill to be entitled
2	An act relating to abortion; amending s. 390.0111, F.S.;
3	requiring that third trimester abortions be performed in a
4	hospital; providing for disciplinary action for violation
5	of specified provisions; requiring an ultrasound to be
6	performed on any woman obtaining an abortion; specifying
7	who must perform an ultrasound; providing that the
8	ultrasound must be reviewed with the patient prior to the
9	woman giving informed consent; specifying who must review
10	the ultrasound with the patient; providing that the woman
11	must certify in writing that she declined to review the
12	ultrasound and did so of her own free will and without
13	undue influence; providing an exemption to view the
14	ultrasound for women who are the victims of rape, incest,
15	domestic violence, or human trafficking or for women who
16	have a serious medical condition necessitating the
17	abortion; revising requirements for printed materials;
18	amending s. 390.01114, F.S.; revising provisions relating
19	to parental notice of abortion; requiring the appointment
20	of a guardian ad litem for a minor who petitions for a
21	waiver of the notice requirements; specifying factors to
22	be considered in determining whether a minor is
23	sufficiently mature to waive the notice requirements;
24	revising provisions relating to confidentiality of
25	hearings; requiring that an annual report concerning
26	waiver proceedings provide additional information;
27	amending s. 390.012, F.S.; correcting a cross-reference;
28	providing that agency rules shall prohibit the performance
29	of third trimester abortions other than in a hospital;
30	conforming provisions; requiring ultrasounds for all
31	patients; requiring that live ultrasound images be
32	reviewed and explained to the patient; requiring that all
33	other provisions in s. 390.0111, F.S., must be complied
34	with should the patient decline to view her live
35	ultrasound images; providing for severability; providing
36	an effective date.
37
38	Be It Enacted by the Legislature of the State of Florida:
39
40	Section 1.  Subsections (1) and (3) of section 390.0111,
41	Florida Statutes, are amended to read:
42	390.0111  Termination of pregnancies.--
43	(1)  TERMINATION IN THIRD TRIMESTER; WHEN ALLOWED.--
44	(a)  No termination of pregnancy shall be performed on any
45	human being in the third trimester of pregnancy unless:
46	1.(a)  The abortion is performed in a hospital; and
47	2.a.  Two physicians certify in writing to the fact that,
48	to a reasonable degree of medical probability, the termination
49	of pregnancy is necessary to save the life or preserve the
50	health of the pregnant woman; or
51	b.(b)  The physician certifies in writing to the medical
52	necessity for legitimate emergency medical procedures for
53	termination of pregnancy in the third trimester, and another
54	physician is not available for consultation.
55	(b)  Violation of this subsection by a physician
56	constitutes grounds for disciplinary action under s. 458.331 or
57	s. 459.015.
58	(3)  CONSENTS REQUIRED.--A termination of pregnancy may not
59	be performed or induced except with the voluntary and informed
60	written consent of the pregnant woman or, in the case of a
61	mental incompetent, the voluntary and informed written consent
62	of her court-appointed guardian.
63	(a)  Except in the case of a medical emergency, consent to
64	a termination of pregnancy is voluntary and informed only if:
65	1.  The physician who is to perform the procedure, or the
66	referring physician, has, at a minimum, orally, in person,
67	informed the woman of:
68	a.  The nature and risks of undergoing or not undergoing
69	the proposed procedure that a reasonable patient would consider
70	material to making a knowing and willful decision of whether to
71	terminate a pregnancy.
72	b.  The probable gestational age of the fetus, verified by
73	an ultrasound, at the time the termination of pregnancy is to be
74	performed.
75	(I)  The ultrasound must be performed by the physician who
76	is to perform the abortion or by a person having documented
77	evidence that he or she has completed a course in the operation
78	of ultrasound equipment as prescribed by rule and who is working
79	in conjunction with the physician.
80	(II)  The person performing the ultrasound must allow the
81	woman to view the live ultrasound images, and a physician or a
82	registered nurse, licensed practical nurse, advanced registered
83	nurse practitioner, or physician assistant working in
84	conjunction with the physician must contemporaneously review and
85	explain the live ultrasound images to the woman, prior to the
86	woman giving informed consent to having an abortion procedure
87	performed. However, this sub-sub-subparagraph does not apply if,
88	at the time the woman schedules or arrives for her appointment
89	to obtain an abortion, a copy of a restraining order, police
90	report, medical record, or other court order or documentation is
91	presented that evidences that the woman is obtaining the
92	abortion because the woman is a victim of rape, incest, domestic
93	violence, or human trafficking or that the woman has been
94	diagnosed with a condition that, on the basis of a physician's
95	good faith clinical judgment, would create a serious risk of
96	substantial and irreversible impairment of a major bodily
97	function if the woman delayed terminating her pregnancy.
98	(III)  The woman has a right to decline to view the
99	ultrasound images after she is informed of her right and offered
100	an opportunity to view them. If the woman declines to view the
101	ultrasound images, the woman shall complete a form acknowledging
102	that she was offered an opportunity to view her ultrasound but
103	that she rejected that opportunity. The form must also indicate
104	that the woman's decision not to view the ultrasound was not
105	based on any undue influence from any third party to discourage
106	her from viewing the images and that she declined to view the
107	images of her own free will.
108	c.  The medical risks to the woman and fetus of carrying
109	the pregnancy to term.
110	2.  Printed materials prepared and provided by the
111	department have been provided to the pregnant woman, if she
112	chooses to view these materials, including:
113	a.  A description of the fetus, including a description of
114	the various stages of development.
115	b.  A list of entities agencies that offer alternatives to
116	terminating the pregnancy.
117	c.  Detailed information on the availability of medical
118	assistance benefits for prenatal care, childbirth, and neonatal
119	care.
120	3.  The woman acknowledges in writing, before the
121	termination of pregnancy, that the information required to be
122	provided under this subsection has been provided.
123
124	Nothing in this paragraph is intended to prohibit a physician
125	from providing any additional information which the physician
126	deems material to the woman's informed decision to terminate her
127	pregnancy.
128	(b)  In the event a medical emergency exists and a
129	physician cannot comply with the requirements for informed
130	consent, a physician may terminate a pregnancy if he or she has
131	obtained at least one corroborative medical opinion attesting to
132	the medical necessity for emergency medical procedures and to
133	the fact that to a reasonable degree of medical certainty the
134	continuation of the pregnancy would threaten the life of the
135	pregnant woman. In the event no second physician is available
136	for a corroborating opinion, the physician may proceed but shall
137	document reasons for the medical necessity in the patient's
138	medical records.
139	(c)  Violation of this subsection by a physician
140	constitutes grounds for disciplinary action under s. 458.331 or
141	s. 459.015. Substantial compliance or reasonable belief that
142	complying with the requirements of informed consent would
143	threaten the life or health of the patient is a defense to any
144	action brought under this paragraph.
145	Section 2.  Subsection (3), paragraphs (a), (c), and (e) of
146	subsection (4), and subsection (6) of section 390.01114, Florida
147	Statutes, are amended to read:
148	390.01114  Parental Notice of Abortion Act.--
149	(3)  NOTIFICATION REQUIRED.--
150	(a)1.a.  Actual notice shall be provided by the physician
151	performing or inducing the termination of pregnancy before the
152	performance or inducement of the termination of the pregnancy of
153	a minor. The notice may be given by a referring physician. The
154	physician who performs or induces the termination of pregnancy
155	must receive the written statement of the referring physician
156	certifying that the referring physician has given notice. If
157	actual notice is provided by telephone, the physician must
158	actually speak with the parent or guardian and must record in
159	the minor's medical file the name of the parent or guardian
160	provided notice, the phone number dialed, and the date and time
161	of the call.
162	b.  If actual notice is not possible after a reasonable
163	effort has been made, the physician performing or inducing the
164	termination of pregnancy or the referring physician must give
165	constructive notice. If constructive notice is given, the
166	physician must document that notice by placing copies of any
167	document related to the constructive notice, including, but not
168	limited to, a copy of the letter and the return receipt, in the
169	minor's medical file.
170	2.  Notice given under this subsection by the physician
171	performing or inducing the termination of pregnancy must include
172	the name and address of the facility providing the termination
173	of pregnancy and the name of the physician providing notice.
174	Notice given under this subsection by a referring physician must
175	include the name and address of the facility where he or she is
176	referring the minor and the name of the physician providing
177	notice. If actual notice is provided by telephone, the physician
178	must actually speak with the parent or guardian, and must record
179	in the minor's medical file the name of the parent or guardian
180	provided notice, the phone number dialed, and the date and time
181	of the call. If constructive notice is given, the physician must
182	document that notice by placing copies of any document related
183	to the constructive notice, including, but not limited to, a
184	copy of the letter and the return receipt, in the minor's
185	medical file.
186	(b)  Notice is not required if:
187	1.  In the physician's good faith clinical judgment, a
188	medical emergency exists and there is insufficient time for the
189	attending physician to comply with the notification
190	requirements. If a medical emergency exists, the physician may
191	proceed but must document reasons for the medical necessity in
192	the patient's medical records;
193	2.  Notice is waived in writing by the person who is
194	entitled to notice;
195	3.  Notice is waived by the minor who is or has been
196	married or has had the disability of nonage removed under s.
197	743.015 or a similar statute of another state;
198	4.  Notice is waived by the patient because the patient has
199	a minor child dependent on her; or
200	5.  Notice is waived under subsection (4).
201	(c)  Violation of this subsection by a physician
202	constitutes grounds for disciplinary action under s. 458.331 or
203	s. 459.015.
204	(4)  PROCEDURE FOR JUDICIAL WAIVER OF NOTICE.--
205	(a)  A minor may petition any circuit court in a judicial
206	circuit within the jurisdiction of the District Court of Appeal
207	in which she resides for a waiver of the notice requirements of
208	subsection (3) and may participate in proceedings on her own
209	behalf. The petition may be filed under a pseudonym or through
210	the use of initials, as provided by court rule. The petition
211	must include a statement that the petitioner is pregnant and
212	notice has not been waived. The court shall advise the minor
213	that she has a right to court-appointed counsel and shall
214	provide her with counsel upon her request at no cost to the
215	minor. The court shall appoint a guardian ad litem for the
216	minor.
217	(c)  If the court finds, by clear and convincing evidence,
218	that the minor is sufficiently mature to decide whether to
219	terminate her pregnancy, the court shall issue an order
220	authorizing the minor to consent to the performance or
221	inducement of a termination of pregnancy without the
222	notification of a parent or guardian.
223	1.  Factors a court shall consider when determining whether
224	a minor is sufficiently mature include, but are not limited to,
225	the following:
226	a.  Whether the minor is mature enough to make her abortion
227	decision, as evidenced by:
228	(I)  The minor's age.
229	(II)  The minor's credibility and demeanor as a witness.
230	(III)  The minor's emotional development; and
231	b.  Whether the minor is well informed enough to make the
232	decision on her own, as evidenced by:
233	(I)  The minor's ability to assess both the immediate and
234	long-range consequences of her choices.
235	(II)  The minor's ability to understand and explain the
236	nature and risks of undergoing or not undergoing a procedure to
237	terminate her pregnancy and to apply that understanding to her
238	decision.
239	2.  The court should also take into consideration whether
240	there has been any undue influence by another on the minor's
241	decision to have an abortion.
242
243	If the court does not make the finding specified in this
244	paragraph or paragraph (d), it must dismiss the petition.
245	(e)  A court that conducts proceedings under this section
246	shall:
247	1.  Provide for a written transcript of all testimony and
248	proceedings.
249	2.  Issue a written final order containing all factual
250	findings and legal conclusions, including factual findings and
251	legal conclusions as to whether the petitioner is sufficiently
252	mature based on the factors set forth in subparagraph(c)1.
253	3.  Order that a confidential record be maintained as
254	required under s. 390.01116. All hearings under this section,
255	including appeals, shall remain confidential and closed to the
256	public, as provided by court rule. A court that conducts
257	proceedings under this section shall provide for a written
258	transcript of all testimony and proceedings and issue written
259	and specific factual findings and legal conclusions supporting
260	its decision and shall order that a confidential record be
261	maintained, as required under s. 390.01116. At the hearing, the
262	court shall hear evidence relating to the emotional development,
263	maturity, intellect, and understanding of the minor, and all
264	other relevant evidence. All hearings under this section,
265	including appeals, shall remain confidential and closed to the
266	public, as provided by court rule.
267	(6)  REPORT.--The Supreme Court, through the Office of the
268	State Courts Administrator, shall report by February 1 of each
269	year to the Governor, the President of the Senate, and the
270	Speaker of the House of Representatives on the number of
271	petitions filed under subsection (4) for the preceding year, and
272	the timing and manner of disposal of such petitions by each
273	circuit court. For each petition, the report shall also state
274	the judicial circuit within which the minor resided; whether the
275	petition was granted or denied based on the minor's maturity or
276	the best interest of the minor, or both; whether the minor was
277	represented by court-appointed or private counsel; and the age
278	of the minor.
279	Section 3.  Subsection (1) and paragraph (d) of subsection
280	(3) of section 390.012, Florida Statutes, are amended to read:
281	390.012  Powers of agency; rules; disposal of fetal
282	remains.--
283	(1)  The agency may develop and enforce rules pursuant to
284	ss. 390.011-390.018 390.001-390.018 and part II of chapter 408
285	for the health, care, and treatment of persons in abortion
286	clinics and for the safe operation of such clinics.
287	(a)  The rules shall be reasonably related to the
288	preservation of maternal health of the clients.
289	(b)  The rules shall be in accordance with s. 797.03 and
290	may not impose an unconstitutional burden on a woman's freedom
291	to decide whether to terminate her pregnancy.
292	(c)  The rules shall prohibit the performance of abortions
293	in the third trimester other than in a hospital.
294	(d)(c)  The rules shall provide for:
295	1.  The performance of pregnancy termination procedures
296	only by a licensed physician.
297	2.  The making, protection, and preservation of patient
298	records, which shall be treated as medical records under chapter
299	458.
300	(3)  For clinics that perform or claim to perform abortions
301	after the first trimester of pregnancy, the agency shall adopt
302	rules pursuant to ss. 120.536(1) and 120.54 to implement the
303	provisions of this chapter, including the following:
304	(d)  Rules relating to the medical screening and evaluation
305	of each abortion clinic patient. At a minimum, these rules shall
306	require:
307	1.  A medical history including reported allergies to
308	medications, antiseptic solutions, or latex; past surgeries; and
309	an obstetric and gynecological history.
310	2.  A physical examination, including a bimanual
311	examination estimating uterine size and palpation of the adnexa.
312	3.  The appropriate laboratory tests, including:
313	a.  For an abortion in which an ultrasound examination is
314	not performed before the abortion procedure, Urine or blood
315	tests for pregnancy performed before the abortion procedure.
316	b.  A test for anemia.
317	c.  Rh typing, unless reliable written documentation of
318	blood type is available.
319	d.  Other tests as indicated from the physical examination.
320	4.  An ultrasound evaluation for all patients who elect to
321	have an abortion after the first trimester. The rules shall
322	require that if a person who is not a physician performs an
323	ultrasound examination, that person shall have documented
324	evidence that he or she has completed a course in the operation
325	of ultrasound equipment as prescribed in rule. The physician,
326	registered nurse, licensed practical nurse, advanced registered
327	nurse practitioner, or physician assistant shall review and
328	explain, at the request of the patient, the live ultrasound
329	images evaluation results, including an estimate of the probable
330	gestational age of the fetus, with the patient before the
331	abortion procedure is performed, unless the patient declines
332	pursuant to s. 390.0111. If the patient declines to view the
333	live ultrasound images, the rules shall require that s. 390.0111
334	be complied with in all other respects.
335	5.  That the physician is responsible for estimating the
336	gestational age of the fetus based on the ultrasound examination
337	and obstetric standards in keeping with established standards of
338	care regarding the estimation of fetal age as defined in rule
339	and shall write the estimate in the patient's medical history.
340	The physician shall keep original prints of each ultrasound
341	examination of a patient in the patient's medical history file.
342	Section 4.  If any provision of this act or the application
343	thereof to any person or circumstance is held invalid, the
344	invalidity does not affect other provisions or applications of
345	the act which can be given effect without the invalid provision
346	or application, and to this end the provisions of this act are
347	declared severable.
348	Section 5.  This act shall take effect July 1, 2008.

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