A bill

TO AMEND THE SOUTH CAROLINA CODE OF LAWS by ENACTing THE "SOUTH CAROLINA'S CHILDREN DESERVE HELP NOT HARM ACT" BY ADDING ARTICLE 3 TO CHAPTER 47, TITLE 40 SO AS TO PROHIBIT PHYSICIANS, OTHER HEALTH CARE PROVIDERS, AND HEALTH CARE FACILITIES FROM PROVIDING OR FACILITATING THE PROVISION OF GENDER TRANSITION PROCEDURES ON MINORS UNDER THE AGE OF EIGHTEEN, TO PROHIBIT THE USE OF PUBLIC FUNDS FOR such GENDER TRANSITION PROCEDURES, TO PROVIDE FOR PROFESSIONAL DISCIPLINE FOR VIOLATION of the provisions of this article, TO CREATE A PRIVATE RIGHT OF ACTION FOR VIOLATION OF THE PROVISIONS OF THIS ARTICLE AND TO ESTABLISH DAMAGES THAT MAY BE AWARDED, AND TO AUTHORIZE THE ATTORNEY GENERAL TO ENFORCE THE PROVISiONS OF THIS ARTICLE; BY ADDING SECTION 38-71-295 SO AS TO PROHIBIT HEALTH BENEFIT PLANS AND HEALTH CARRIERS FROM REIMBURSING  FOR GENDER TRANSITION PROCEDURES on MINORS under the age of eighteen; AND FOR OTHER PURPOSES.

Be it enacted by the General Assembly of the State of South Carolina:

SECTION 1.  This act may be cited as the "South Carolina's Children Deserve Help Not Harm Act".

SECTION 2.  Chapter 47, Title 40 of the S.C. Code is amended by adding:

    Article 3

    Gender Reassignment of Minors

    Section 40-47-310. For purposes of this article:

    (1) "Biological sex" means the biological indication of male or female in the context of reproductive potential or capacity, such as sex chromosomes, naturally occurring sex hormones, gonads, and nonambiguous internal and external genitalia present at birth, including secondary sex characteristics.

    (2) "Cross-sex hormones" means:

       (a) testosterone or other androgens given to biological females in amounts that create serum levels greater than would normally occur naturally in healthy biological females, which may include, but are not limited to, the following risks:

           (i) irreversible infertility;

           (ii) severe liver dysfunction;

           (iii) coronary artery disease, including heart attacks;

           (iv) increased risk of breast, cervical, and uterine cancers;

           (v) cerebrovascular disease, including strokes;

           (vi) hypertension;

           (vii) erythrocytosis, which is an increase in red blood cells;

           (viii) sleep apnea;

           (ix) type 2 diabetes;

           (x) bone density loss; and

           (xi) destabilization of psychiatric disorders; and

       (b) estrogen given to biological males in amounts that create serum levels greater than would normally occur naturally in healthy biological males, which may include, but are not limited to, the following risks:

           (i) irreversible infertility;

           (ii) thromboembolic disease, including blood clots;

           (iii) cholelithiasis, including gallstones;

           (iv) coronary artery disease, including heart attacks;

           (v) type 2 diabetes;

           (vi) breast cancer;

           (vii) macroprolactinoma, which is a tumor of the pituitary gland;

           (viii) cerebrovascular disease, including strokes; and

           (ix) hypertriglyceridemia, which is an elevated level of triglycerides in the blood.

    (3) "Gender" means the psychological, behavioral, social, and cultural aspects of being male or female.

    (4) "Gender reassignment surgery" means any surgical service that seeks to surgically alter or remove healthy physical or anatomical characteristics or features that are typical for the individual's biological sex in order to instill or create physiological or anatomical characteristics that resemble a sex different from the individual's biological sex including, but not limited to, genital or nongenital gender reassignment surgery performed for the purpose of assisting an individual with a gender transition.

    (5) "Gender transition" means the process in which an individual goes from identifying with and living as a gender that corresponds to his or her biological sex to identifying with and living as a gender different from his or her biological sex and may involve social, legal, or physical changes.

    (6)(a) "Gender transition procedure" means any medical or surgical service including, but not limited to, physician's services, inpatient and outpatient hospital services, puberty-blocking drugs, cross-sex hormones, or genital or nongenital gender reassignment surgery, that is provided or performed for the purpose of assisting an individual with a physical gender transition.

       (b) The term "gender transition procedure" does not include:

           (i) services to individuals born with a medically verifiable disorder of sex development including, but not limited to, an individual with external biological sex characteristics that are irresolvably ambiguous, such as those born with the conditions of 46, XX with virilization, 46, XY with undervirilization, or having both ovarian and testicular tissue;

           (ii) services provided when a physician has otherwise diagnosed an individual with a disorder of sexual development and determined through genetic or biochemical testing that the individual does not have normal sex chromosome structure, sex steroid production, or sex steroid hormone action;

           (iii) the acute or chronic treatment of any infection, injury, disease, or disorder that has been caused by or exacerbated by the performance of gender transition procedures regardless of whether the gender transition procedure was performed in accordance with state and federal law or whether funding for the gender transition procedure is permissible under Section 40-47-340; or

           (iv) any procedure undertaken because the individual suffers from a physical disorder, physical injury, or physical illness that would, as certified by a physician, place the individual in imminent danger of death or impairment of a major bodily function unless surgery is performed.

    (7) "Genital gender reassignment surgery" means a surgical procedure performed for the purpose of assisting an individual with a physical gender transition including, but not limited to:

       (a) surgical procedures such as penectomy, orchiectomy, vaginoplasty, clitoroplasty, or vulvoplasty for biologically male patients; or

       (b) surgical procedures such as hysterectomy, oophorectomy, reconstruction of the urethra, metoidioplasty or phalloplasty, vaginectomy, scrotoplasty, implantation of erection prostheses, or implantation of testicular prostheses for biologically female patients.

    (8) "Health care professional" means an individual who is licensed, certified, or otherwise authorized by the laws of this State to administer health care in the ordinary course of the practice of his or her profession, including mental health care providers.

    (9) "Nongenital gender reassignment surgery" means surgical procedures performed for the purpose of assisting an individual with a physical gender transition including, but not limited to:

       (a) surgical procedures for biologically male patients, such as augmentation mammoplasty, facial feminization surgery, liposuction, lipofilling, voice feminization surgery, thyroid cartilage reduction, gluteal augmentation, hair reconstruction, or various aesthetic procedures; or

       (b) surgical procedures for biologically female patients, such as subcutaneous mastectomy, voice masculinization surgery, liposuction, lipofilling, pectoral implants, or various aesthetic procedures.

    (10) "Physician" means an individual who is licensed to practice medicine in this State.

    (11) "Puberty-blocking drugs" means gonadotropin-releasing hormone analogues or other synthetic drugs used in biological males to stop luteinizing hormone secretion and therefore testosterone production, or synthetic drugs used in biological females that stop the production of estrogen and progesterone, when used to delay or suppress pubertal development in children for the purpose of assisting an individual with a gender transition.

    (12) "Public funds" means state, county, or local governmental monies, including any such monies deposited with or derived from any department, agency, or instrumentality authorized or appropriated under state law.

    Section 40-47-320. (A) A physician or other health care professional shall not provide gender transition procedures to any individual under eighteen years of age.

    (B) A health care institution or entity shall not facilitate the provision of gender transition procedures to any individual under eighteen years of age.

    Section 40-47-330. (A) A person or entity, including employees of other state governments, the federal gove