HOUSE BILL NO. 2033 103RD GENERAL ASSEMBLY
INTRODUCED BY REPRESENTATIVE SCHMIDT.
5827H.01I JOSEPH ENGLER, Chief Clerk
AN ACT To repeal section 191.1720, RSMo, and to enact in lieu thereof one new section relating to gender transition procedures.
Be it enacted by the General Assembly of the state of Missouri, as follows:
Section A. Section 191.1720, RSMo, is repealed and one new section enacted in lieu 2 thereof, to be known as section 191.1720, to read as follows: 191.1720. 1. This section shall be known and may be cited as the "Missouri Save 2 Adolescents from Experimentation (SAFE) Act". 3 2. For purposes of this section, the following terms mean: 4 (1) "Biological sex", the biological indication of male or female in the context of 5 reproductive potential or capacity, such as sex chromosomes, naturally occurring sex 6 hormones, gonads, and nonambiguous internal and external genitalia present at birth, without 7 regard to an individual's psychological, chosen, or subjective experience of gender; 8 (2) "Cross-sex hormones", testosterone, estrogen, or other androgens given to an 9 individual in amounts that are greater or more potent than would normally occur naturally in a 10 healthy individual of the same age and sex; 11 (3) "Gender", the psychological, behavioral, social, and cultural aspects of being male 12 or female; 13 (4) "Gender transition", the process in which an individual transitions from 14 identifying with and living as a gender that corresponds to his or her biological sex to 15 identifying with and living as a gender different from his or her biological sex, and may 16 involve social, legal, or physical changes;
EXPLANATION — Matter enclosed in bold-faced brackets [thus] in the above bill is not enacted and is intended to be omitted from the law. Matter in bold-face type in the above bill is proposed language. HB 2033 2
17 (5) "Gender transition surgery", a surgical procedure performed for the purpose of 18 assisting an individual with a gender transition, including, but not limited to: 19 (a) Surgical procedures that sterilize, including, but not limited to, castration, 20 vasectomy, hysterectomy, oophorectomy, orchiectomy, or penectomy; 21 (b) Surgical procedures that artificially construct tissue with the appearance of 22 genitalia that differs from the individual's biological sex, including, but not limited to, 23 metoidioplasty, phalloplasty, or vaginoplasty; or 24 (c) Augmentation mammoplasty or subcutaneous mastectomy; 25 (6) "Health care provider", an individual who is licensed, certified, or otherwise 26 authorized by the laws of this state to administer health care in the ordinary course of the 27 practice of his or her profession; 28 (7) "Puberty-blocking drugs", gonadotropin-releasing hormone analogues or other 29 synthetic drugs used to stop luteinizing hormone secretion and follicle stimulating hormone 30 secretion, synthetic antiandrogen drugs to block the androgen receptor, or any other drug used 31 to delay or suppress pubertal development in children for the purpose of assisting an 32 individual with a gender transition. 33 3. A health care provider shall not knowingly perform a gender transition surgery on 34 any individual under eighteen years of age. 35 4. (1) A health care provider shall not knowingly prescribe or administer cross-sex 36 hormones or puberty-blocking drugs for the purpose of a gender transition for any individual 37 under eighteen years of age. 38 (2) Before March 1, 2027, the provisions of this subsection shall not apply to the 39 prescription or administration of cross-sex hormones or puberty-blocking drugs for any 40 individual under eighteen years of age who was prescribed or administered such hormones or 41 drugs prior to August 28, 2023, for the purpose of assisting the individual with a gender 42 transition. 43 [(3) The provisions of this subsection shall expire on August 28, 2027.] 44 5. The performance of a gender transition surgery or the prescription or 45 administration of cross-sex hormones or puberty-blocking drugs to an individual under 46 eighteen years of age in violation of this section shall be considered unprofessional conduct 47 and any health care provider doing so shall have his or her license to practice revoked by the 48 appropriate licensing entity or disciplinary review board with competent jurisdiction in this 49 state. 50 6. (1) The prescription or administration of cross-sex hormones or puberty-blocking 51 drugs to an individual under eighteen years of age for the purpose of a gender transition shall 52 be considered grounds for a cause of action against the health care provider. The provisions 53 of chapter 538 shall not apply to any action brought under this subsection. HB 2033 3
54 (2) An action brought pursuant to this subsection shall be brought within fifteen years 55 of the individual injured attaining the age of twenty-one or of the date the treatment of the 56 injury at issue in the action by the defendant has ceased, whichever is later. 57 (3) An individual bringing an action under this subsection shall be entitled to a 58 rebuttable presumption that the individual was harmed if the individual is infertile following 59 the prescription or administration of cross-sex hormones or puberty-blocking drugs and that 60 the harm was a direct result of the hormones or drugs prescribed or administered by the health 61 care provider. Such presumption may be rebutted only by clear and convincing evidence. 62 (4) In any action brought pursuant to this subsection, a plaintiff may recover 63 economic and noneconomic damages and punitive damages, without limitation to the amount 64 and no less than five hundred thousand dollars in the aggregate. The judgment against a 65 defendant in an action brought pursuant to this subsection shall be in an amount of three times 66 the amount of any economic and noneconomic damages or punitive damages assessed. Any 67 award of damages in an action brought pursuant to this subsection to a prevailing plaintiff 68 shall include attorney's fees and court costs. 69 (5) An action brought pursuant to this subsection may be brought in any circuit court 70 of this state. 71 (6) No health care provider shall require a waiver of the right to bring an action 72 pursuant to this subsection as a condition of services. The right to bring an action by or 73 through an individual under the age of eighteen shall not be waived by a parent or legal 74 guardian. 75 (7) A plaintiff to an action brought under this subsection may enter into a voluntary 76 agreement of settlement or compromise of the action, but no agreement shall be valid until 77 approved by the court. No agreement allowed by the court shall include a provision regarding 78 the nondisclosure or confidentiality of the terms of such agreement unless such provision was 79 specifically requested and agreed to by the plaintiff. 80 (8) If requested by the plaintiff, any pleadings, attachments, or exhibits filed with the 81 court in any action brought pursuant to this subsection, as well as any judgments issued by the 82 court in such actions, shall not include the personal identifying information of the plaintiff. 83 Such information shall be provided in a confidential information filing sheet 84 contemporaneously filed with the court or entered by the court, which shall not be subject 85 to public inspection or availability. 86 7. The provisions of this section shall not apply to any speech protected by the First 87 Amendment of the United States Constitution. 88 8. The provisions of this section shall not apply to the following: 89 (1) Services to individuals born with a medically-verifiable disorder of sex 90 development, including, but not limited to, an individual with external biological sex HB 2033 4
91 characteristics that are irresolvably ambiguous, such as those born with 46,XX chromosomes 92 with virilization, 46,XY chromosomes with undervirilization, or having both ovarian and 93 testicular tissue; 94 (2) Services provided when a physician has otherwise diagnosed an individual with a 95 disorder of sex development and determined through genetic or biochemical testing that the 96 individual does not have normal sex chromosome structure, sex steroid hormone production, 97 or sex steroid hormone action; 98 (3) The treatment of any infection, injury, disease, or disorder that has been caused by 99 or exacerbated by the performance of gender transition surgery or the prescription or 100 administration of cross-sex hormones or puberty-blocking drugs regardless of whether the 101 surgery was performed or the hormones or drugs were prescribed or administered in 102 accordance with state and federal law; or 103 (4) Any procedure undertaken because the individual suffers from a physical disorder, 104 physical injury, or physical illness that would, as certified by a physician, place the individual 105 in imminent danger of death or impairment of a major bodily function unless surgery is 106 performed. ✔
Statutes affected: