1

The Committee on Health Regulation (Aronberg) recommended the

2

following amendment:

3

4

     Senate Amendment (with title amendment)

5

     Delete everything after the enacting clause

6

and insert:

7

     Section 1. This act may be cited as the "Prevention First

8

Act."

9

     Section 2. Treatment for survivors of rape.--

10

     (1) DEFINITIONS.--As used in this section, the term:

11

     (a) "Agency" means the Agency for Health Care

12

Administration.

13

     (b) "Care to a rape survivor" means medical examinations,

14

procedures, and services provided to a rape survivor.

15

     (c) "Department" means the Department of Health.

16

     (d) "Emergency contraception" means one or more

17

prescription drugs used separately or in combination to be

18

administered to or self-administered by a patient to prevent

19

pregnancy within a medically recommended amount of time after

20

sexual intercourse and dispensed for that purpose, in accordance

21

with professional standards of practice, and determined to be

22

safe by the United States Food and Drug Administration.

23

     (e) "Health care facility" means a facility licensed under

24

chapter 395, Florida Statutes.

25

     (f) "Incest" means a sexual offense described in s. 826.04,

26

Florida Statutes.

27

     (g) "Medically and factually accurate" means information

28

that is supported by the weight of research conducted in

29

compliance with accepted scientific methods and that is

30

recognized as accurate and objective by leading professional

31

organizations and agencies having relevant expertise in the

32

field.

33

     (h) "Rape" means sexual battery as described in ss. 794.011

34

and 827.071, Florida Statutes.

35

     (i) "Rape survivor" means a person who alleges or is

36

alleged to have been raped or who is the victim of alleged incest

37

and because of the alleged offense seeks treatment as a patient.

38

     (2) DUTIES OF LICENSED PRACTITIONERS AND FACILITIES.--

39

     (a) A health care practitioner licensed under chapter 458,

40

chapter 459, or chapter 464, Florida Statutes, or a health care

41

facility licensed under chapter 395, Florida Statutes, providing

42

care to a rape survivor shall:

43

     1. Provide each female rape survivor with medically and

44

factually accurate, clear, and concise information concerning

45

emergency contraception, including its indications and

46

contraindications and the risks associated with its use.

47

     2. Inform each female rape survivor of her medical option

48

to receive emergency contraception.

49

     (b) If emergency contraception is requested, the health

50

care practitioner or health care facility shall immediately

51

provide the female rape survivor with the complete regimen of

52

emergency contraception, unless contraindicated as determined by

53

a pregnancy test approved by the United States Food and Drug

54

Administration.

55

     (c) The Agency for Health Care Administration, with input

56

from the Florida Hospital Association and the Florida Council

57

Against Sexual Violence, shall adopt a protocol to implement the

58

requirements of this subsection.

59

     (3) PATIENT INFORMATION.--

60

     (a) The department shall:

61

     1. Develop, prepare, and produce informational materials

62

relating to emergency contraception for the prevention of

63

pregnancy for distribution to and use in all health care

64

facilities in the state that provide care to rape survivors, in

65

quantities sufficient to comply with the requirements of this

66

section, to the extent that funds are available.

67

     2. Develop, prepare, and post information on the

68

department's Internet website relating to the duty of licensed

69

health care practitioners and health care facilities to provide

70

emergency contraception to female rape survivors.

71

     (b) Information provided to female rape survivors or female

72

victims of sexual assault must:

73

     1. Be medically and factually accurate;

74

     2. Be clearly written, readily comprehensible, and

75

culturally appropriate as determined by the department, in

76

collaboration with community sexual assault programs and other

77

relevant stakeholders; and

78

     3. Explain the nature of emergency contraception, including

79

its use, safety, efficacy, and availability.

80

     (4) ENFORCEMENT AND PENALTIES.--

81

     (a) In addition to any other remedies provided by law, the

82

agency shall respond to complaints, using all available

83

investigative tools, and shall periodically review whether a

84

health care facility is in compliance with this section. If the

85

agency finds that a health care facility is not in compliance

86

with this section, the agency shall:

87

     1. Impose a fine of $5,000 per woman who is:

88

     a. Denied medically and factually accurate and objective

89

information about emergency contraception;

90

     b. Not informed of her medical option to receive emergency

91

contraception; or

92

     c. Not provided the complete regimen of emergency

93

contraception, if emergency contraception is requested.

94

     2. Impose a fine of $5,000 for failure to comply with this

95

section. For every 30 days that a health care facility is not in

96

compliance with this section, an additional fine of $5,000 shall

97

be imposed.

98

     (b) The agency shall adopt rules as necessary to administer

99

the provisions of this section.

100

     Section 3.  Subsection (9) is added to section 390.011,

101

Florida Statutes, to read:

102

     390.011  Definitions.--As used in this chapter, the term:

103

     (9) "Contraception" means any drug or device approved by

104

the United States Food and Drug Administration to prevent

105

pregnancy.

106

     Section 4.  Section 390.027, Florida Statutes, is created to

107

read:

108

     390.027 Access to contraception.--The provision of

109

contraception is not subject to or governed by this chapter.

110

     Section 5.  Section 465.190, Florida Statutes, is created to

111

read:

112

     465.190 Patient contraceptive protection.--

113

     (1) DEFINITIONS.--As used in this section, the term:

114

     (a) "Contraception" or "contraceptive" means any

115

prescription drug or over-the-counter oral contraceptive approved

116

by the United States Food and Drug Administration to prevent

117

pregnancy.

118

     (b) "Employee" means a person hired, by contract or any

119

other form of agreement, by a pharmacy.

120

     (c) "Product" means a drug or device approved by the United

121

States Food and Drug Administration.

122

     (d) "Professional clinical judgment" means the use of

123

professional knowledge and skills to form a clinical judgment in

124

accordance with prevailing medical standards.

125

     (e) "Without delay," with respect to a pharmacy dispensing

126

a prescription for contraception, means within the pharmacy's

127

customary timeframe for dispensing the prescription for other

128

products.

129

     (2) DUTIES OF LICENSED PHARMACIES.--

130

     (a) If a patient requests a contraceptive that is in stock,

131

the pharmacy shall ensure that the contraceptive is provided to

132

the patient or patient representative without delay.

133

     (b) A pharmacy shall ensure that its employees do not:

134

     1. Intimidate, threaten, or harass a patient in the

135

delivery of services relating to a request for contraception;

136

     2. Interfere with or obstruct the delivery of services

137

relating to a request for contraception;

138

     3. Intentionally misrepresent or deceive a patient about

139

the availability of contraception or its mechanism of action;

140

     4. Breach medical confidentiality with respect to a request

141

for contraception or threaten to breach such confidentiality; or

142

     5. Refuse to return a valid, lawful prescription for

143

contraception upon a patient's or patient representative's

144

request.

145

     (c) This section does not prohibit a pharmacy from refusing

146

to provide a contraceptive to a patient if:

147

     1. It is unlawful to dispense the contraceptive to the

148

patient without a valid, lawful prescription and such

149

prescription is not presented;

150

     2. The patient or patient representative is unable to pay

151

for the contraceptive; or

152

     3. The employee of the pharmacy refuses to provide the

153

contraceptive on the basis of a professional clinical judgment.

154

     (e) This section does not prevent a pharmacist or other

155

person from refusing to furnish any in-stock contraceptive for

156

religious reasons so long as the pharmacy reasonably accommodates

157

the patient or patient representative without delay and in

158

compliance with this section.

159

     (f) This section does not alter any standard established

160

under the Florida Civil Rights Act of 1992.

161

     (g) Any person who believes that a violation of this

162

section has occurred may file a complaint with the Department of

163

Health.

164

     (h) If the Attorney General has reasonable cause to believe

165

that any person or group of persons is being, has been, or may be

166

injured by conduct constituting a violation of this section, the

167

Attorney General may bring a civil action in the name of the

168

state, as parens patriae on behalf of natural persons residing in

169

the state.

170

     Section 6.  Paragraph (t) is added to subsection (1) of

171

section 465.016, Florida Statutes, to read:

172

     465.016  Disciplinary actions.--

173

     (1)  The following acts constitute grounds for denial of a

174

license or disciplinary action, as specified in s. 456.072(2):

175

     (t) Violating the provisions of s. 465.190.

176

     Section 7.  Paragraph (f) is added to subsection (1) of

177

section 465.023, Florida Statutes, to read:

178

     465.023  Pharmacy permittee; disciplinary action.--

179

     (1)  The department or the board may revoke or suspend the

180

permit of any pharmacy permittee, and may fine, place on

181

probation, or otherwise discipline any pharmacy permittee who

182

has:

183

     (f) Violated the provisions of s. 465.190.

184

     Section 8. If any provision of this act or the application

185

thereof to any person or circumstance is held invalid, the

186

invalidity does not affect other provisions or applications of

187

the act which can be given effect without the invalid provision

188

or application, and to this end the provisions of this act are

189

severable.

190

     Section 9.  This act shall take effect upon becoming a law.

191

192

================ T I T L E  A M E N D M E N T ================

193

And the title is amended as follows:

194

     Delete everything before the enacting clause

195

and insert:

196

A bill to be entitled

197

An act relating to reproductive health services and family

198

planning; creating the "Prevention First Act"; providing

199

definitions; providing duties of licensed health care

200

practitioners and facilities relating to the treatment of

201

rape survivors; requiring the Department of Health to

202

provide certain information; requiring the Agency for

203

Health Care Administration to provide for enforcement and

204

impose penalties; requiring the agency to adopt rules;

205

amending s. 390.011, F.S.; defining the term

206

"contraception"; creating s. 390.027, F.S.; specifying

207

that the provision of contraception is not subject to ch.

208

390, F.S., relating to the termination of pregnancies;

209

creating s. 465.190, F.S.; providing definitions;

210

requiring licensed pharmacies to dispense certain forms of

211

contraception without delay; specifying conditions under

212

which a pharmacy may refuse to provide a contraceptive;

213

providing for a person to file a complaint with the

214

Department of Health if he or she believes that a

215

violation of such provisions has occurred; providing for

216

the Attorney General to bring a civil action; amending ss.

217

465.016 and 465.023, F.S.; providing that a violation of

218

requirements for dispensing contraception constitutes

219

grounds for the Department of Health or the Board of

220

Pharmacy to impose disciplinary action or suspend or

221

revoke a pharmacist's license or permit; providing for

222

severability; providing an effective date.

223

224

     WHEREAS, although the Centers for Disease Control and

225

Prevention included family planning in its published list of Ten

226

Great Public Health Achievements in the 20th Century, the United

227

States still has one of the highest rates of unintended

228

pregnancies among industrialized nations, and

229

     WHEREAS, the Legislature finds that family planning is basic

230

health care for women and that access to contraception helps

231

women prevent unintended pregnancy and control the timing and

232

spacing of planned births, and

233

     WHEREAS, 46.3 percent of pregnancies among women in this

234

state are unintended according to the Florida Pregnancy Risk

235

Assessment Monitoring System initiated by the United States

236

Centers for Disease Control and Prevention and the Florida

237

Department of Health, and

238

     WHEREAS, currently more than 1.7 million women in Florida

239

are in need of contraceptive services and supplies, and

240

     WHEREAS, the Legislature finds that the victimization of

241

women through rape is compounded by the possibility that the rape

242

survivors may suffer unintended pregnancies, and half of such

243

pregnancies end in abortion, and

244

     WHEREAS, women rely on prescription contraceptives for a

245

range of medical purposes in addition to birth control, such as

246

regulation of menstrual cycles and the treatment of

247

endometriosis, and

248

     WHEREAS, the Legislature further finds that providing access

249

to family planning information, services, and birth control will

250

prevent abortions and unintended pregnancies, thereby

251

significantly reducing the number of women and teens who need

252

medical assistance, Medicaid, Kidcare, and other social services,

253

and

254

     WHEREAS, the Legislature recognizes that the most recent

255

study of women in need of family planning services by the Florida

256

State University Center for Prevention and Early Intervention

257

Policy found that only 26 percent of women in this state who are

258

in need of such services are currently receiving them, and

259

     WHEREAS, according to the Department of Health's Family

260

Planning Program, for every dollar spent on family planning

261

services, up to $24 is saved as a result of averting expenditures

262

for public programs that support women who have unintended

263

pregnancies and their infants, NOW, THEREFORE,

4/14/2008  9:04:00 AM     588-07411-08