Bill Summary – FastDemocracy

67th Legislature                                                                                                  HB 113.2
                                                 HOUSE BILL NO. 113
                                             INTRODUCED BY J. FULLER
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   A BILL FOR AN ACT ENTITLED: “AN ACT PROVIDING FOR YOUTH HEALTH PROTECTION; PROVIDING
   DEFINITIONS; PROHIBITING CERTAIN MEDICATIONS AND MEDICAL PROCEDURES FOR THE
   TREATMENT OF GENDER DYSPHORIA IN MINORS; AND ESTABLISHING A CIVIL PENALTY FOR
   HEALTH CARE PROVIDERS PROVIDING PROHIBITED TREATMENT PROVIDING FOR ENFORCEMENT.”
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   BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MONTANA:
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              NEW SECTION. Section 1. Short title. [Sections 1 through 5] may be cited as the "Youth Health
   Protection Act".
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              NEW SECTION. Section 2. Purpose. The purpose of [sections 1 through 5] is to enhance the
   protection of minors, pursuant to Article II, section 15, of the Montana constitution, from any form of pressure to
   undergo irreversible medical procedures to change sex prior to attaining the age of majority WHO EXPERIENCE
   DISTRESS AT IDENTIFYING WITH THEIR BIOLOGICAL SEX FROM BEING SUBJECTS OF IRREVERSIBLE AND DRASTIC
   NONGENITAL GENDER REASSIGNMENT SURGERY AND IRREVERSIBLE, PERMANENTLY STERILIZING GENITAL GENDER
   REASSIGNMENT SURGERY DESPITE THE LACK OF STUDIES SHOWING THAT THE BENEFITS OF THESE EXTREME
   INTERVENTIONS OUTWEIGH THE RISKS.
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              NEW SECTION. Section 3. Definitions. As used in this part, unless the context clearly indicates
   otherwise, the following definitions apply:
              (1) "Cross-sex hormones" include antiandrogen, estrogen, and testosterone MEANS TESTOSTERONE OR
   OTHER ANDROGENS GIVEN TO BIOLOGICAL FEMALES AT DOSES THAT ARE PROFOUNDLY LARGER OR MORE POTENT THAN
   WOULD NORMALLY OCCUR NATURALLY IN HEALTHY BIOLOGICAL FEMALES OR ESTROGEN GIVEN TO BIOLOGICAL MALES AT
   DOSES THAT ARE PROFOUNDLY LARGER OR MORE POTENT THAN WOULD NORMALLY OCCUR NATURALLY IN HEALTHY
   BIOLOGICAL MALES.
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              (2) "GENDER" MEANS THE PSYCHOLOGICAL, BEHAVIORAL, SOCIAL, AND CULTURAL ASPECTS OF BEING MALE
   OR FEMALE.
              (2)(3) "Gender dysphoria" means a medical diagnosis based on a persistent, marked difference
   between a patient's expressed or experienced gender and the gender others would assign the patient causing
   clinically significant distress or impairment, as defined in the fifth edition of the Diagnostic and Statistical Manual
   of Mental Disorders.
              (3)(4) "Gender reassignment surgery" includes but is not limited to orchiectomy, vaginoplasty,
   mastectomy, hysterectomy, metoidioplasty, oophorectomy, penectomy, and phalloplasty MEANS ANY MEDICAL OR
   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
   BIRTH 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 WITH THE INDIVIDUAL'S BIOLOGICAL SEX TO IDENTIFYING WITH AND LIVING AS A
   GENDER DIFFERENT THAN THE INDIVIDUAL'S BIOLOGICAL SEX AND MAY INVOLVE SOCIAL, LEGAL, OR PHYSICAL CHANGES.
              (6) (A) "GENDER TRANSITION PROCEDURES" MEANS ANY MEDICAL OR SURGICAL SERVICE, INCLUDING BUT
   NOT LIMITED TO PHYSICIANS' SERVICES, INPATIENT AND OUTPATIENT HOSPITAL SERVICES, OR PRESCRIBED DRUGS
   RELATED TO GENDER TRANSITION, THAT SEEKS TO ALTER OR REMOVE PHYSICAL OR ANATOMICAL CHARACTERISTICS OR
   FEATURES THAT ARE TYPICAL FOR THE INDIVIDUAL'S BIOLOGICAL SEX AND TO INSTILL OR CREATE PHYSIOLOGICAL OR
   ANATOMICAL CHARACTERISTICS THAT RESEMBLE A SEX DIFFERENT FROM THE INDIVIDUAL'S BIRTH SEX.
              (B) GENDER TRANSITION PROCEDURES INCLUDE BUT ARE NOT LIMITED TO SERVICES THAT PROVIDE PUBERTY-
   BLOCKING DRUGS, CROSS-SEX HORMONES, OR OTHER MECHANISMS TO PROMOTE THE DEVELOPMENT OF FEMINIZING OR
   MASCULINIZING FEATURES IN THE OPPOSITE SEX, OR GENITAL OR NONGENITAL GENDER REASSIGNMENT SURGERY
   PERFORMED FOR THE PURPOSE OF ASSISTING AN INDIVIDUAL WITH A GENDER TRANSITION.
              (C)    GENDER TRANSITION PROCEDURES DO NOT INCLUDE:
              ( I)   SERVICES TO THOSE BORN WITH A MEDICALLY VERIFIABLE DISORDER OF SEX DEVELOPMENT, INCLUDING AN
   INDIVIDUAL WITH EXTERNAL BIOLOGICAL SEX CHARACTERISTICS THAT ARE IRRESOLVABLY AMBIGUOUS SUCH AS THOSE
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   BORN WITH 46,        XX CHROMOSOMES WITH VIRILIZATION, 46, XY CHROMOSOMES WITH UNDERVIRILIZATION, OR HAVING
   BOTH OVARIAN AND TESTICULAR TISSUES;
              (II)    SERVICES PROVIDED WHEN A PHYSICIAN HAS DIAGNOSED A DISORDER OF SEXUAL DEVELOPMENT IN WHICH
   THE PHYSICIAN HAS DETERMINED THROUGH GENETIC OR BIOCHEMICAL TESTING THAT THE INDIVIDUAL DOES NOT HAVE
   NORMAL SEX CHROMOSOME STRUCTURE, SEX STEROID HORMONE PRODUCTION, OR SEX STEROID HORMONE ACTION FOR
   A BIOLOGICAL MALE OR A BIOLOGICAL FEMALE;
              (III)   THE TREATMENT OF AN INFECTION, INJURY, DISEASE, OR DISORDER THAT HAS BEEN CAUSED BY OR
   EXACERBATED BY THE PERFORMANCE OF GENDER TRANSITION PROCEDURES, WHETHER OR NOT THE GENDER
   TRANSITION PROCEDURE WAS PERFORMED IN ACCORDANCE WITH STATE OR FEDERAL LAW; OR
              (IV)    A 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 MAJOR BODILY FUNCTION UNLESS SURGERY IS PERFORMED.
              (7) "GENITAL GENDER REASSIGNMENT SURGERY" INCLUDES BUT IS NOT LIMITED TO THE FOLLOWING
   SURGICAL PROCEDURES WHEN PERFORMED FOR THE PURPOSE OF ASSISTING AN INDIVIDUAL WITH A GENDER
   TRANSITION:
              ( A)     PENECTOMY, ORCHIECTOMY, VAGINOPLASTY, CLITOROPLASTY, OR VULVOPLASTY FOR BIOLOGICAL MALE
   PATIENTS; OR
              ( B)     HYSTERECTOMY/OOPHORECTOMY, RECONSTRUCTION OF THE FIXED PART OF THE URETHRA WITH OR
   WITHOUT A METOIDIOPLASTY OR A PHALLOPLASTY, VAGINECTOMY, SCROTOPLASTY, OR IMPLANTATION OF ERECTION OR
   TESTICULAR PROSTHESES FOR BIOLOGICALLY FEMALE PATIENTS.
              (4)(8)     "Health care provider" means a physician licensed under Title 37, chapter 3, an advanced
   practice registered nurse licensed under Title 37, chapter 8, or a physician assistant licensed under Title 37.
              (9) "NONGENITAL GENDER REASSIGNMENT SURGERY" INCLUDES BUT IS NOT LIMITED TO THE FOLLOWING
   SURGICAL PROCEDURES WHEN PERFORMED FOR THE PURPOSES OF ASSISTING AN INDIVIDUAL WITH A GENDER
   TRANSITION:
              ( A)     AUGMENTATION MAMMOPLASTY, FACIAL FEMINIZATION SURGERY, LIPOSUCTION, LIPOFILLING, VOICE
   SURGERY, THYROID CARTILAGE REDUCTION, GLUTEAL AUGMENTATION (IMPLANTS), HAIR RECONSTRUCTION, OR
   AESTHETIC PROCEDURES FOR BIOLOGICALLY MALE PATIENTS; OR
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              ( B)   SUBCUTANEOUS MASTECTOMY, VOICE SURGERY, LIPOSUCTION, LIPOFILLING, PECTORAL IMPLANTS, OR
   AESTHETIC PROCEDURES FOR BIOLOGICALLY FEMALE PATIENTS.
              (10) "PUBERTY-BLOCKING DRUGS" MEANS THE FOLLOWING DRUGS WHEN USED TO DELAY OR SUPPRESS
   PUBERTAL DEVELOPMENT IN CHILDREN FOR THE PURPOSE OF ASSISTING AN INDIVIDUAL WITH A GENDER TRANSITION:
              ( A)   GONADOTROPIN-RELEASING HORMONE (GNRH) ANALOGUES OR OTHER SYNTHETIC DRUGS USED IN
   BIOLOGICAL MALES TO STOP LUTEINIZING HORMONE SECRETION AND TESTOSTERONE SECRETION; OR
              ( B)   SYNTHETIC DRUGS USED IN BIOLOGICAL FEMALES TO STOP THE PRODUCTION OF ESTROGENS AND
   PROGESTERONE.
              (11) "SEX", "BIRTH SEX", OR "BIOLOGICAL SEX" REFER TO THE BIOLOGICAL INDICATION OF MALE OR FEMALE AS
   UNDERSTOOD IN THE CONTEXT OF REPRODUCTIVE POTENTIAL OR CAPACITY, INCLUDING SEX CHROMOSOMES,
   NATURALLY OCCURRING SEX HORMONES, GONADS, AND NONAMBIGUOUS INTERNAL AND EXTERNAL GENITALIA PRESENT
   AT BIRTH, WITHOUT REGARD TO AN INDIVIDUAL'S PSYCHOLOGICAL, CHOSEN, OR SUBJECTIVE EXPERIENCE OF GENDER.
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              NEW SECTION. Section 4. Medications and medical procedures prohibited. A health care
   provider may not:
              (1) prescribe, provide, or administer puberty-suppressing drugs or cross-sex hormones GENDER
   TRANSITION PROCEDURES       to a minor to treat gender dysphoria; OR
              (2) perform gender reassignment surgery on a minor to treat gender dysphoria; or
              (3) remove any otherwise healthy ornondiseasedbody part or tissue of a minor to treat gender
   dysphoria
              (2)    REFER A MINOR TO A HEALTH CARE PROVIDER FOR GENDER TRANSITION PROCEDURES.
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              NEW SECTION.Section 5. Civil penalties. A health care provider convicted of violating [section 4]
   shall be fined an amount not less than $500 or more than $50,000.Fines collected under this section must be
   deposited in the state general fund.
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              NEW SECTION. SECTION 5. ENFORCEMENT -- CAUSE OF ACTION. (1) A REFERRAL FOR OR PROVISION OF
   GENDER TRANSITION PROCEDURES TO A MINOR IS CONSIDERED UNPROFESSIONAL CONDUCT AND THE HEATH CARE
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   PROVIDER IS SUBJECT TO DISCIPLINE BY THE APPROPRIATE LICENSING ENTITY UNDER TITLE 37.
              (2) A PERSON MAY ASSERT AN ACTUAL OR THREATENED VIOLATION OF [SECTIONS 1 THROUGH 5] AS A CLAIM
   OR DEFENSE IN A JUDICIAL OR ADMINISTRATIVE PROCEEDING AND OBTAIN COMPENSATORY DAMAGES, INJUNCTIVE
   RELIEF, DECLARATORY RELIEF, OR ANY OTHER APPROPRIATE RELIEF.
              (3) (A) EXCEPT AS PROVIDED IN SUBSECTION (3)(B), A PERSON MAY NOT BRING A CLAIM FOR A VIOLATION OF
   [SECTIONS 1 THROUGH 5] LATER THAN 2 YEARS AFTER THE DAY THE CAUSE OF ACTION ACCRUES.
              ( B)   A MINOR MAY BRING A CAUSE OF ACTION THROUGH A PARENT OR NEXT FRIEND AND MAY BRING AN ACTION
   IN THE MINOR'S OWN NAME UPON REACHING MAJORITY. THE ACTION MUST BE COMMENCED BEFORE THE MINOR REACHES
   38 YEARS OF AGE.
              (4) AN ACTION UNDER [SECTIONS 1 THROUGH 5] MAY BE COMMENCED AND RELIEF GRANTED IN A JUDICIAL
   PROCEEDING REGARDLESS OF WHETHER THE PERSON COMMENCING THE ACTION HAS SOUGHT OR EXHAUSTED
   AVAILABLE ADMINISTRATIVE REMEDIES.
              (5) IN AN ACTION OR PROCEEDING TO ENFORCE A PROVISION OF [SECTIONS 1 THROUGH 5], A PREVAILING
   PARTY WHO ESTABLISHES A VIOLATION OF [SECTIONS 1 THROUGH 5] IS ENTITLED TO RECOVER REASONABLE ATTORNEY
   FEES.
              (6) THE ATTORNEY GENERAL MAY BRING AN ACTION TO ENFORCE COMPLIANCE WITH [SECTIONS 1 THROUGH
   5]. NOTHING IN [SECTIONS 1 THROUGH 5] MAY BE CONSTRUED TO DENY, IMPAIR, OR OTHERWISE AFFECT A RIGHT OR
   AUTHORITY OF THE ATTORNEY GENERAL, THE STATE OF MONTANA, OR AN AGENCY, OFFICER, OR EMPLOYEE OF THE
   STATE TO INSTITUTE OR INTERVENE IN A PROCEEDING.
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              NEW SECTION. Section 6. Codification instruction. [Sections 1 through 5] are intended to be
   codified as an integral part of Title 50, and the provisions of Title 50 apply to [sections 1 through 5].
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              NEW SECTION. Section 7. Severability. If a part of [this act] is invalid, all valid parts that are
   severable from the invalid part remain in effect. If a part of [this act] is invalid in one or more of its applications,
   the part remains in effect in all valid applications that are severable from the invalid applications.
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