SESSION OF 2023
SUPPLEMENTAL NOTE ON HOUSE BILL NO. 2263
As Amended by Senate Committee on Public
Health and Welfare

Brief*
HB 2263, as amended, would amend a provision in the
Pharmacy Act of the State of Kansas to allow pharmacy
technicians to administer vaccinations and would create the
Kansas Child Mutilation Prevention Act (Act).
In regard to the administration of vaccines, the bill would
add pharmacy technicians, at least 18 years of age and under
the direct supervision and control of a pharmacist, to the list
of those authorized to administer vaccinations after
successfully completing a course of study and training in
vaccination storage, protocols, injection technique,
emergency procedures, recordkeeping, and cardiopulmonary
resuscitation (CPR).
In regard to the Kansas Child Mutilation Prevention Act,
the bill would allow an individual who had gender
reassignment service performed as a child to bring a civil
cause of action under the Act against the physician who
performed such service. The bill would establish the statute of
limitations for such cause of action, the medically verifiable
disorders of sex development to which the Act would not
apply, the relief that could be sought, and the time frame to
which the Act would apply. The provisions of the Act would
not apply if the child was born with a medically verifiable
disorder of sex development, as defined in the bill. The bill
also would require the Kansas State Board of Healing Arts
(Board) to revoke the license of a physician who performed a
childhood gender reassignment service.
____________________
*Supplemental notes are prepared by the Legislative Research
Department and do not express legislative intent. The supplemental
note and fiscal note for this bill may be accessed on the Internet at
http://www.kslegislature.org
Pharmacy Act Amendments—Vaccine Administration
The bill would require a pharmacist, pharmacy student,
or pharmacy intern to be at least 18 years of age to
administer a vaccine.
Pharmacy technicians would be added to pharmacists,
pharmacy students, and pharmacy interns as:
● Authorized to administer:
○ The influenza vaccine to persons six years of
age or older; and
○ Vaccines, other than the influenza vaccine, to
persons 12 years of age or older pursuant to
a vaccination protocol;
● Required to record the immunization to the
appropriate physician for the individual receiving
the immunization; and
● Prohibited from delegating authority to administer a
vaccination.
Kansas Child Mutilation Prevention Act
Definitions
The bill would define the following terms:
● “Childhood gender reassignment service” would
mean performing, or causing to be performed, acts
including, but not limited to, any of the following
performed on a child under 18 years of age for the
purpose of attempting to affirm the child’s
perception of the child’s sex or gender, if that
perception is inconsistent with the child’s sex:
○ A surgery that sterilizes or is intended to result
in sterilization, including, but not limited to,
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 castration, vasectomy, hysterectomy,
oophorectomy, orchiectomy, and penectomy;
○ A surgery that artificially constructs tissue with
the appearance of genitalia, including, but not
limited to, metoidioplasty, phalloplasty, and
vaginoplasty;
○ A mastectomy;
○ Prescribing, dispensing, administering, or
otherwise supplying the following
medications:
– Puberty-blocking medication to delay,
hinder, stop, or reverse normal puberty;
– Supraphysiologic doses of testosterone
to females; or
– Supraphysiologic doses of estrogen to
males; or
○ Removing any body part or tissue;
● “Physician” would mean a person licensed by the
Board to practice medicine and surgery;
● “Sex” would mean the biological state of being
female or male based on the individual’s sex
organs, chromosomes and endogenous hormone
profiles; and
● “Supraphysiologic doses” would mean a
pharmacologic dosage regimen that produces
blood concentrations greater than the accepted
range for a child’s age and sex.
Medically Verifiable Disorder of Sex Development
The bill would specify the Act would not apply if a child
was born with a medically verifiable disorder of sex
development, including, but not limited to:

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 ● A child with external biological sex characteristics
that are irresolvably ambiguous, such as a child
born having 46,XX chromosomes with virilization,
46,XY chromosomes with undervirilization, or both
ovarian and testicular tissue; or
● When a physician has otherwise diagnosed a
disorder of sexual development, determined
through genetic or biochemical testing, that the
child does not have the normal sex chromosome
structure, sex steroid hormone production, or sex
steroid hormone action for a male or female of the
child’s age.
Civil Cause of Action
Statute of limitations. The bill would allow a civil cause
of action under the Act to be commenced no more than three
years after the date the individual attains 18 years of age.
Time frame for actions. The Act would apply to:
● Any action commenced on or after July 1, 2023,
including any action that would be barred by the
period of limitation applicable prior to such date;
and
● Any action commenced prior to July 1, 2023, and
pending on such date.
Available relief. The bill would provide that an individual
who brings a civil cause of action under the Act could seek
actual damages, exemplary or punitive damages, injunctive
relief, and other appropriate relief. The bill would require the
court to award the prevailing plaintiff the cost of the suit
including reasonable attorney fees.


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Physician License Revocation
The bill would require the Board to revoke a physician’s
license upon a finding that the physician had performed a
childhood gender reassignment service, as defined by the
Act.

Background
HB 2263 was introduced by the House Committee on
Health and Human Services at the request of Representative
Eplee on behalf of the Kansas Pharmacists Association
(KPhA). The Senate Committee on Public Health and Welfare
amended the bill to add the contents of SB 233, as
recommended by the Senate Committee on Public Health
and Welfare (Kansas Child Mutilation Prevention Act).

HB 2263 (Vaccine Administration)

House Committee on Health and Human Services
In the House Committee hearing, a representative of the
KPhA provided proponent testimony, stating that the bill
would allow pharmacy technicians to continue to administer
vaccinations after completing training as had been permitted
under the federal Public Readiness and Emergency
Preparedness Act (PREP Act) after it expires in October
2024. The representative noted that an amendment was
requested to clarify that pharmacy technicians needed to be
18 years of age or older to administer vaccinations.
Additional proponent testimony was heard from a
pharmacy technician and a pharmacist who stated the
number of vaccines they had been able to administer in their
communities due to the PREP Act and how adding pharmacy
technicians would continue to benefit their communities.

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 Written-only proponent testimony was submitted by a
representative of the Kansas Board of Pharmacy (Board).
Neutral testimony was offered by a representative of
Kansas Medical Society who also expressed support for
specifying an age requirement.
The House Committee amended the bill to add “18
years of age or older” as a requirement for those permitted to
administer vaccinations.

Senate Committee on Public Health and Welfare
In the Senate Committee hearing on March 15, 2023,
proponent testimony was heard from representatives of the
Board and KPhA, and a pharmacist/pharmacy owner. The
proponents provided substantially similar testimony as in the
House Committee hearing.
Written-only proponent testimony was received from a
pharmacy technician, and representatives of Currus
Independent Pharmacies of Kansas, the Kansas Association
of Chain Drug Stores, and Walmart.
Written-only opponent testimony was received from a
private citizen.
The Senate Committee amended the bill to insert
contents pertaining to the Kansas Child Mutilation Prevention
Act (SB 233, as recommended by the Senate Committee).

SB 233 (Kansas Child Mutilation Prevention Act)

Senate Committee on Public Health and Welfare
In the Senate Committee hearing, proponent testimony
was provided by Senator Thompson, two private citizens, two
physicians, a member of the clergy, and a representative of
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MassResistance. The proponents generally stated the bill
would protect minors from medical and chemical procedures
used to change a child’s gender. The proponents stated the
decision to accede to gender reassignment services should
be made only by the individuals on whom the services would
be performed and who are at an age when they can take
responsibility for and fully understand the risks and impact of
such choices. Two proponents testified as to their negative
experiences with gender reassignment services.
Written-only proponent testimony was provided by an
endocrinologist, a representative of American Family Action of
Kansas and Missouri, two attorneys, and 28 additional
proponents.
Opponent testimony was provided by an advanced
practice registered nurse, a physician, and representatives of
the American Civil Liberties Union of Kansas, Kansas
Chapter of the American Academy of Pediatrics, and Kansas
Interfaith Action. The opponents generally stated the bill
would negatively affect the lives of transgender youth and
young adults, including directly causing an increase in
suicide-related deaths; would prevent parents from protecting
and caring for the health of their minor children and making
decisions in partnership with medical providers without
government infringement; and would cause physicians
practicing within their scope of practice with informed consent
from a patient, guardian, or both, to be fearful of losing their
license. One proponent spoke about a positive experience
with gender reassignment services.
Written-only opponent testimony was provided by
Representative Woodard, a licensed clinical professional
counselor, a representative of the University of Kansas
School of Social Welfare, and more than 130 additional
opponents.


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Fiscal Information

HB 2263 (Vaccine Administration)
According to the fiscal note prepared by the Division of
the Budget on the bill, as introduced, the Board states the bill
would expand state authority to match current federal
authority, which has been in place for two and half years. The
Board anticipates enactment of the bill would have no fiscal
effect on the Board.

SB 233 (Kansas Child Mutilation Prevention Act)
According to the fiscal note prepared by the Division of
the Budget on the bill, the Board states the enactment of the
bill could result in actionable complaints, which would
increase the staff workload of the Board. The total fiscal effect
cannot be estimated.
The Office of Judicial Administration (Office) states
enactment of the bill could increase the number of cases filed
in district court because it allows for a civil suit to be filed
against a physician who performed a childhood gender
reassignment service, which could result in more time spent
by district court judicial and nonjudicial personnel in
processing, researching, and hearing these cases. The Office
estimates enactment of the bill could result in the collection of
docket fees assessed in those cases filed under the bill’s
provisions. According to the Office, a fiscal effect cannot be
estimated.
Any fiscal effect associated with enactment of the bill is
not reflected in The FY 2024 Governor’s Budget Report.
Civil cause of action; gender reassignment services; Kansas Child Mutilation
Prevention Act; pharmacy act; pharmacy technician; pharmacist; physician licensure
revocation; State Board of Healing Arts; statute of limitations; vaccine


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Statutes affected:
As introduced: 65-1635a
As Amended by House Committee: 65-1635a
As Amended by Senate Committee: 65-1635a, 65-2836