OHIO LEGISLATIVE SERVICE COMMISSION
Office of Research Legislative Budget
www.lsc.ohio.gov and Drafting Office
H.B. 15 Bill Analysis
135th General Assembly
Click here for H.B. 15’s Fiscal Note
Version: As Introduced
Primary Sponsors: Reps. Gross and Lear
Effective date:
Amy L. Archer, Research Analyst
SUMMARY
“Abortion” definition change
 Amends the definition of “abortion” for purposes of the Revised Code to expressly
include the purposeful termination of a pregnancy by use of an abortion-inducing drug,
unless the context clearly requires otherwise.
Requirements before performing or inducing an abortion
 Adds the following to the conditions that must be satisfied before performing or
inducing an abortion:
 Providing ultrasound images and fetal heartbeat sounds.
 Informing the woman about breast cancer and psychological risks related to
abortion during the informed consent meeting required under existing law.
 Requires the physician who is to perform or induce the abortion or a qualified
technician to meet several requirements for providing ultrasound images and fetal
heartbeat sounds, including, for example, the following:
 Setting up equipment so that ultrasound images are within reasonable viewing
distance and heartbeat sounds are within reasonable hearing range from the
pregnant woman;
 Auscultating the fetal heartbeat so that the pregnant woman may hear the
heartbeat, if audible;
 Providing a medical description of ultrasound images.
 Requires the State Medical Board to take disciplinary action against a physician for
failure to (1) provide the pregnant woman the opportunity to view ultrasound images,
at no cost to the woman, or (2) offer to provide the pregnant woman with a physical
picture of the ultrasound image.
March 10, 2023
Office of Research and Drafting LSC Legislative Budget Office
 Requires, at the informed consent meeting, the physician to inform the pregnant
woman of the possible increased risk of breast cancer associated with women who have
undergone an abortion and of the risk of psychological or emotional harm that the
woman may endure from undergoing an abortion.
 Requires the physician who provides the information described above to possess
adequate training and education in the risks associated with abortion.
Informed consent materials
 Adds the possible increased risk of breast cancer and the risk of psychological or
emotional harm to the informed consent materials the Department of Health (ODH) is
required to publish on its website relating to pregnancy, family planning, available
assistance, and adoption.
 Requires the informed consent materials to either be prominently featured on the main
page of ODH’s website or directly accessible through easily identified hyperlinks on the
main page of ODH’s website.
Statute of limitations on abortion civil actions
 Permits a person to commence a civil action for (1) unlawful abortion or (2) performing
or inducing an abortion without satisfying certain pre-abortion conditions no later than
one year after the person reasonably should have discovered the injury, death, or loss to
person or property.
 Permits the defendant to use any affirmative defense available under the Revised Code
or Common Law and specifies that the defendant has the burden of proving any defense
by a preponderance of evidence.
 Specifies that when a person is imprisoned, the time of imprisonment cannot be
included as any part of any period of limitation within which a person must bring an
abortion civil action against the imprisoned person.
ODH requirements
 Requires ODH to annually audit all provider records to determine compliance with the
informed consent and education and training requirements regarding abortion.
 Requires ODH to prescribe a form for the pregnant woman to certify that she has
(1) viewed the ultrasound images and listened to the heartbeat, if audible, or declined
to do so, and (2) been presented with the following information the bill requires.
Auditor of State rules
 Requires the Auditor of State to adopt rules to establish procedures for auditing ODH’s
records of ODH audits of provider records, penalties for noncompliance, and procedures
for enforcing those penalties.
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As Introduced
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DETAILED ANALYSIS
“Abortion” definition change
The bill amends the definition of “abortion,” as used in the Revised Code, to include the
purposeful termination of a pregnancy by use of an abortion-inducing drug, unless the context
clearly requires otherwise. An “abortion-inducing drug,” under continuing law, is a drug or
regimen of drugs that causes the termination of a clinically diagnosable pregnancy, including
RU-486 (mifepristone). Under continuing law, “abortion” is still defined as the purposeful
termination of a human pregnancy by any person, including the pregnant woman, with an
intention other than to produce a live birth or to remove a dead fetus or embryo. 1
Requirements before performing or inducing an abortion
Under continuing law, an abortion can only be performed or induced if several
conditions are first satisfied, unless there is a medical emergency or medical necessity.2 The bill
amends those conditions by (1) adding requirements about providing ultrasound images and
fetal heartbeat sounds, as described below under “Providing ultrasound images and
fetal heartbeat sounds,” and (2) adding to the information the physician must provide
during the informed consent meeting required in continuing law, described below under
“Informed consent meeting with physician,”
Providing ultrasound images and fetal heartbeat sounds
Under the bill, before a pregnant woman gives informed consent for an abortion, the
physician who is to perform or induce the abortion or a qualified technician to whom the
physician delegates responsibility must do all of the following:
 Set up ultrasound equipment in a manner so that ultrasound images are within
reasonable viewing distance and heartbeat sounds are within reasonable hearing range
from the woman;
 Explain to the pregnant woman that the ultrasound images and fetal heartbeat sounds,
if the heartbeat is audible, will be provided to the pregnant woman during the
examination, and that the pregnant woman has the option to avert her eyes from
ultrasound images or request the volume of the heartbeat to be reduced or turned off;
 Provide a simultaneous explanation of what the ultrasound is depicting, which must
include the presence and location of the embryo or fetus within the uterus, the number
of embryos or fetuses depicted, and, if the ultrasound image indicates that fetal death
has occurred, that information;
 Display the ultrasound images so that the pregnant woman may view the images;
1 R.C. 2919.11; R.C. 2919.124(A)(1), not in the bill.
2 R.C. 2317.56(B).
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 Auscultate the fetal heartbeat of the embryo or fetus so that the pregnant woman may
hear the heartbeat, if it is audible;
 Provide a medical description of ultrasound images, which must include the dimensions
of the embryo or fetus and the presence of external members and internal organs, if
present and viewable;
 Offer to provide the pregnant woman a physical picture of the ultrasound image of the
embryo or fetus;
 Obtain the woman’s signature on the ODH-prescribed certification form (see below,
“Certification form”), and retain the signed certification in the woman’s medical
record, indicating that she was presented with the information the bill requires and has
viewed the ultrasound images and listened to the heartbeat, if audible, or declined to
do so.
The bill specifies that the requirement to provide an ultrasound so that the pregnant
woman may view the active ultrasound images of the embryo or fetus must be performed at no
additional charge to her.3
Under current law repealed by the bill, if an ultrasound is performed at any time before
the performance or inducement of an abortion, or the physician performing or inducing the
abortion determines that an ultrasound will be performed as part of the abortion procedure,
the physician, before performing or inducing the abortion and at no charge to the pregnant
woman, must provide the pregnant woman the opportunity to view the active ultrasound
image of the embryo or fetus and offer to provide her with a physical picture of the ultrasound
image.4
The bill defines the following terms: 5
 “Auscultate” is to examine by listening for sounds made by internal organs of the fetus,
specifically for a fetal heartbeat, utilizing an ultrasound transducer or a fetal heart rate
monitor.
 “Qualified technician” is a medical imaging technologist who is certified in obstetrics
and gynecology by the American Registry for Diagnostic Medical Sonography or a
certified nurse-midwife or certified nurse practitioner in obstetrics with certification in
obstetrical ultrasonography.
 “Ultrasound” is the use of ultrasonic waves for diagnostic or therapeutic purposes,
specifically to monitor a developing fetus.
3 R.C. 2317.56(B)(1).
4 R.C. 2317.561, repealed by the bill.
5 R.C. 2317.56(A)(1), (5), and (6).
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Disciplinary action for failure to comply with ultrasound requirement
Under the bill, the State Medical Board is required to take disciplinary action against a
physician who fails to do either of the following:
 Provide the pregnant woman the opportunity to view ultrasound images, at no cost to
the woman;
 Offer to provide the pregnant woman with a physical picture of the ultrasound image.6
The disciplinary action described above replaces the current one that applies when a
physician fails to provide a pregnant woman the opportunity to view the active ultrasound
image of the embryo or fetus or offer to provide her with a physical picture of the ultrasound
image when conducting an ultrasound before performing or inducing an abortion.7
Under continuing law, disciplinary action requires an affirmative vote of at least six
members of the Board. Those actions include, for example, limiting, revoking, suspending, or
refusing to renew the physician's license or reprimanding or placing the physician on probation.8
Informed consent meeting with physician
Continuing law requires, at least 24 hours before an abortion is performed or induced, a
physician to meet with the pregnant woman in person in an individual, private setting and give
her adequate opportunity to ask questions about the abortion. At the meeting, the physician
must inform the pregnant woman, verbally or, if she is hearing impaired, by other means of
communication, of statutorily required information. That includes information about the
particular abortion procedure to be used and associated medical risks; the probable gestational
age of the zygote, blastocyte, embryo, or fetus; and the medical risks associated with carrying
the pregnancy to term. Under the bill, the physician also must inform the pregnant woman of
the following:
 The possible increased risk of breast cancer that is associated with women who have
undergone an abortion;
 The short-term and long-term risk of psychological or emotional harm, including
depression, suicidal ideation, post-traumatic stress disorder, and guilt, that the woman
may endure from undergoing an abortion.
The bill requires that any physician who provides the new informed consent information
the bill requires must possess adequate training and education in the categories of risk
described in the new information, as well as any other risks associated with abortion. Evidence
6 R.C. 4731.22(B)(38).
7 R.C. 2317.561, repealed by the bill and 4731.22(B)(38).
8 R.C. 4731.22 (B).
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of adequate training includes successful completion of continuing education and professional
development courses or programs in the relevant subject areas.9
Informed consent materials
Continuing law requires the Department of Health (ODH) to publish on its website
materials that inform pregnant women of information related to pregnancy, family planning,
available assistance, and adoption. The bill requires the materials to also inform the pregnant
woman of the possible increased risk of breast cancer and risk of psychological or emotional
harm associated with abortion that must be discussed in the informed consent meeting with
the physician.
Under the bill, all of the materials must either be prominently featured on the main
page of ODH’s website or directly accessible through easily identified hyperlinks on the main
page of ODH’s website. Additionally, continuing law requires the materials to be published
(1) in English and in Spanish, (2) in a typeface large enough to be clearly legible, and (3) in an
easily comprehensible format.10
Statute of limitations on abortion civil actions
The bill provides that if a person who commences a civil action under continuing law
(described below) regarding an abortion, in the exercise of reasonable care and diligence, could
not have discovered that the person has suffered injury, death, or loss to person or property
resulting from the violation that is the basis of the action within one year as required under
continuing law, that person is permitted to commence the action no later than one year after
the person, with reasonable care and diligence, should have discovered the injury, death, or
loss to person or property.
Further, under the bill, the person against whom the civil action is commenced is
permitted to use any affirmative defense available under the Revised Code or Common Law,
including the affirmative defense of the action being brought past the statute of limitations.
The person has the burden of proving any defense that the person invokes by a preponderance
of evidence.11
The bill specifies that when a person is imprisoned for the commission of any offense,
the time of the person’s imprisonment cannot be included in the period within which a person
must bring an action against the imprisoned person.12
Under continuing law, any physician who performs or induces an abortion with actual
knowledge that the pre-conditions for performing an abortion (see above, “Requirements
before performing or inducing an abortion”), have not been satisfied or with
9 R.C. 2317.56(B)(2), with conforming changes in R.C. 2317.56(B)(3) to (6) and 3726.14.
10 R.C. 2317.56(C).
11 R.C. 2305.119; R.C. 2305.11, not in the bill.
12 R.C. 2305.15.
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heedless indifference as to whether those conditions have been satisfied is liable for
compensatory and exemplary damages to any person, or the representative of any person’s
estate, who sustains injury, death, or loss to person or property as a result of the failure to
satisfy those conditions. Additionally, a person who performs or induces an abortion without
the informed consent of the pregnant woman or who knowingly performs or induces an
abortion on a woman who is pregnant, unmarried, under 18 years of age, and unemancipated,
unless certain conditions are met is liable to the pregnant woman and her parents, guardian, or
custodian for civil compensatory and exemplary damages.13
ODH requirements
Audit of provider records
The bill requires ODH to annually audit all provider records to determine compliance
with the informed