Bill Summary – FastDemocracy

Enrolled Copy                                                                            S.B. 16
         TRANSGENDER MEDICAL TREATMENTS AND PROCEDURES
                                          AMENDMENTS
                                      2023 GENERAL SESSION
                                          STATE OF UTAH
                            Chief Sponsor: Michael S. Kennedy
                                   House Sponsor: Katy Hall
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 LONG TITLE
 General Description:
        This bill enacts provisions regarding transgender medical treatments and procedures.
 Highlighted Provisions:
        This bill:
        < defines terms;
        < requires the Department of Health and Human Services to conduct a systematic
 review of the medical evidence regarding hormonal transgender treatments and
 provide recommendations to the Legislature;
        < requires the Division of Professional Licensing to create a certification for
 providing hormonal transgender treatments;
        < requires a health care provider to meet certain requirements before providing a
 hormonal transgender treatment;
        < prohibits a health care provider from providing a hormonal transgender treatment to
 new patients who were not diagnosed with gender dysphoria before a certain date;
        < prohibits performing sex characteristic surgical procedures on a minor for the
 purpose of effectuating a sex change;
        < specifies that an individual may bring a medical malpractice action related to certain
 medical treatments and procedures;
        < specifies that an individual may disaffirm consent under certain circumstances;
        < allows an individual to bring a medical malpractice action for treatment provided to
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 the individual as a minor if the individual later disaffirms consent;
        < extends the medical malpractice statute of limitations related to providing certain
 medical treatments and procedures; and
        < makes technical changes.
 Money Appropriated in this Bill:
        None
 Other Special Clauses:
        This bill provides a special effective date.
        This bill provides revisor instructions.
 Utah Code Sections Affected:
 AMENDS:
        58-67-102, as last amended by Laws of Utah 2022, Chapter 233
        58-67-502, as last amended by Laws of Utah 2021, Chapter 337
        58-68-102, as last amended by Laws of Utah 2022, Chapter 233
        58-68-502, as last amended by Laws of Utah 2021, Chapter 337
 ENACTS:
        26B-1-214, Utah Code Annotated 1953
        58-1-603, Utah Code Annotated 1953
        58-1-603.1, Utah Code Annotated 1953
        78B-3-427, Utah Code Annotated 1953
 Utah Code Sections Affected by Revisor Instructions:
        58-1-603.1, Utah Code Annotated 1953
        78B-3-427, Utah Code Annotated 1953
52
 Be it enacted by the Legislature of the state of Utah:
        Section 1. Section 26B-1-214 is enacted to read:
        26B-1-214. Systematic medical evidence review of hormonal transgender
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 treatments.
        (1) As used in this section, "hormonal transgender treatment" means the same as that
 term is defined in Section 58-1-603.
        (2) The department, in consultation with the Division of Professional Licensing created
 in Section 58-1-103, the Physicians Licensing Board created in Section 58-67-201, the
 Osteopathic Physician and Surgeon's Licensing Board created in Section 58-68-201, the
 University of Utah, and a non-profit hospital system with multiple hospitals in Utah and
 experience in specialty pediatric care, shall conduct a systematic medical evidence review
 regarding the provision of hormonal transgender treatments to minors.
        (3) The purpose of the systematic medical evidence review is to provide the Legislature
 with recommendations to consider when deciding whether to lift the moratorium described in
 Section 58-1-603.1.
        (4) The systematic medical evidence review shall:
        (a) analyze hormonal transgender treatments that are prescribed to a minor with gender
 dysphoria, including:
        (i) analyzing any effects and side effects of the treatment; and
        (ii) whether each treatment has been approved by the federal Food and Drug
 Administration to treat gender dysphoria;
        (b) review the scientific literature regarding hormonal transgender treatments in
 minors, including short-term and long-term impacts, literature from other countries, and rates
 of desistence and time to desistence where applicable;
        (c) review the quality of evidence cited in any scientific literature including to analyze
 and report on the quality of the data based on techniques such as peer review, selection bias,
 self-selection bias, randomization, sample size, and other applicable best research practices;
        (d) include high quality clinical research assessing the short-term and long-term
 benefits and harms of hormonal transgender treatments prescribed to minors with gender
 dysphoria and the short-term and long-term benefits and harms of interrupting the natural
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 puberty and development processes of the child;
        (e) specify the conditions under which the department recommends that a treatment not
 be permitted;
        (f) recommend what information a minor and the minor's parent should understand
 before consenting to a hormonal transgender treatment;
        (g) recommend the best practices a health care provider should follow to provide the
 information described in Subsection (4)(f);
        (h) describe the assumptions and value determinations used to reach a
 recommendation; and
        (i) include any other information the department, in consultation with the entities
 described in Subsection (2), determines would assist the Legislature in enacting legislation
 related to the provision of hormonal transgender treatment to minors.
        (5) Upon the completion of the systematic medical evidence review, the department
 shall provide the systematic medical evidence review to the Health and Human Services
 Interim Committee.
        Section 2. Section 58-1-603 is enacted to read:
        58-1-603. Hormonal transgender treatment on minors -- Requirements.
        (1) As used in this section:
        (a) "Approved organization" means an organization with expertise regarding
 transgender health care for minors that is approved by the division.
        (b) "Biological sex at birth" means an individual's sex, as being male or female,
 according to distinct reproductive roles as manifested by sex and reproductive organ anatomy,
 chromosomal makeup, and endogenous hormone profiles.
        (c) "Disorder of sexual development" means a sexual development disorder where an
 individual:
        (i) is born with external biological sex characteristics that are irresolvably ambiguous;
        (ii) is born with 46, XX chromosomes with virilization;
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        (iii) is born with 46, XY chromosomes with undervirilization;
        (iv) has both ovarian and testicular tissue; or
        (v) has been diagnosed by a physician, based on genetic or biochemical testing, with
 abnormal:
        (A) sex chromosome structure;
        (B) sex steroid hormone production; or
        (C) sex steroid hormone action for a male or female.
        (d) "Health care provider" means:
        (i) a physician;
        (ii) a physician assistant licensed under Chapter 70a, Utah Physician Assistant Act; or
        (iii) an advanced practice registered nurse licensed under Subsection 58-31b-301(2)(e).
        (e) (i) "Hormonal transgender treatment" means administering, prescribing, or
 supplying for effectuating or facilitating an individual's attempted sex change:
        (A) to an individual whose biological sex at birth is female, a dose of testosterone or
 other androgens at levels above those normally found in an individual whose biological sex at
 birth is female;
        (B) to an individual whose biological sex at birth is male, a dose of estrogen or a
 synthetic compound with estrogenic activity or effect at levels above those normally found in
 an individual whose biological sex at birth is male; or
        (C) a puberty inhibition drug.
        (ii) "Hormonal transgender treatment" does not include administering, prescribing, or
 supplying a substance described in Subsection (1)(e)(i) to an individual if the treatment is
 medically necessary as a treatment for:
        (A) precocious puberty;
        (B) endometriosis;
        (C) a menstrual, ovarian, or uterine disorder;
        (D) a sex-hormone stimulated cancer; or
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        (E) a disorder of sexual development.
        (f) "Mental health professional" means any of the following:
        (i) a physician who is board certified for a psychiatry specialization recognized by the
 American Board of Medical Specialists or the American Osteopathic Association's Bureau of
 Osteopathic Specialists;
        (ii) a psychologist licensed under Chapter 61, Psychologist Licensing Act;
        (iii) a clinical social worker licensed under Chapter 60, Part 2, Social Worker
 Licensing Act;
        (iv) a marriage and family therapist licensed under Chapter 60, Part 3, Marriage and
 Family Therapist Licensing Act; or
        (v) a clinical mental health counselor licensed under Chapter 60, Part 4, Clinical
 Mental Health Counselor Licensing Act.
        (g) "Minor" means an individual who is less than 18 years old.
        (h) "Physician" means an individual licensed under:
        (i) Chapter 67, Utah Medical Practice Act; or
        (ii) Chapter 68, Utah Osteopathic Medical Practice Act.
        (i) "Puberty inhibition drug" means any of the following alone or in combination with
 aromatase inhibitors:
        (i) gonadotropin-releasing hormone agonists; or
        (ii) androgen receptor inhibitors.
        (j) "Transgender treatment certification" means a certification described in Subsection
 (2).
        (2) (a) The division shall create a transgender treatment certification on or before July
 1, 2023.
        (b) The division may issue the transgender treatment certification to an individual if the
 individual:
        (i) is a health care provider or a mental health professional; and
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       Enrolled Copy                                                                             S.B. 16
        (ii) has completed at least 40 hours of education related to transgender health care for
 minors from an approved organization.
        (c) The division may renew a transgender treatment certification:
        (i) at the time an individual renews the individual's license; and
        (ii) if the individual has completed at least 20 hours of continuing education related to
 transgender health care for minors from an approved organization during the individual's
 continuing education cycle.
        (d) Beginning January 1, 2024, providing a hormonal transgender treatment to a minor
 without a transgender treatment certification is unprofessional conduct.
        (3) (a) A health care provider may provide a hormonal transgender treatment to a
 minor only if the health care provider has been treating the minor for gender dysphoria for at
 least six months.
        (b) Beginning July 1, 2023, before providing a hormonal transgender treatment to a
 minor described in Subsection (3)(a), a health care provider shall:
        (i) determine if the minor has other physical or mental health conditions, identify and
 document any condition, and consider whether treating those conditions before treating the
 gender dysphoria would provide the minor the best long-term outcome;
        (ii) consider whether an alternative medical treatment or behavioral intervention to
 treat the minor's gender dysphoria would provide the minor the best long-term outcome;
        (iii) document in the medical record that:
        (A) the health care provider has complied with Subsections (3)(b)(i) and (ii); and
        (B) providing the hormonal transgender treatment will likely result in the best
 long-term outcome for the minor;
        (iv) obtain written consent from:
        (A) the minor; and
        (B) the minor's parent or guardian unless the minor is emancipated;
        (v) discuss with the minor:
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        (A) the risks of the hormonal transgender treatment;
        (B) the minor's short-term and long-term expectations regarding the effect that the
 hormonal transgender treatment will have on the minor; and
        (C) the likelihood that the hormonal transgender treatment will meet the short-term and
 long-term expectations described in Subsection (3)(b)(v)(B);
        (vi) unless the minor is emancipated, discuss with the minor's parent or guardian:
        (A) the risks of the hormonal transgender treatment;
        (B) the minor's short-term and long-term expectations regarding the effect that the
 hormonal transgender treatment will have on the minor;
        (C) the parent or guardian's short-term and long-term expectations regarding the effect
 that the hormonal transgender treatment will have on the minor; and
        (D) the likelihood that the hormonal transgender treatment will meet the short-term and
 long-term expectations described in Subsections (3)(b)(vi)(B) and (C);
        (vii) document in the medical record that the health care provider has provided the
 information described in Subsections (3)(b)(viii) and (ix);
        (viii) provide the minor the following information if providing the minor a puberty
 inhibition drug:
        (A) puberty inhibition drugs are not approved by the FDA for the treatment of gender
 dysphoria;
        (B) possible adverse outcomes of puberty blockers are known to include diminished
 bone density, pseudotumor cerebri and long term adult sexual dysfunction;
        (C) research on the long-term risks to children of prolonged treatment with puberty
 blockers for the treatment of gender dysphoria has not yet occurred; and
        (D) the full effects of puberty blockers on brain development and cognition are
 unknown;
        (ix) provide the minor the following information if providing a cross-sex hormone as
 described in Subsection (1)(e)(i)(A) or (B):
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        (A) the use of cross-sex hormones in males is associated with risks that include blood
 clots, gallstones, coronary artery disease, heart attacks, tumors of the pituitary gland, strokes,
 elevated levels of triglycerides in the blood, breast cancer, and irreversible infertility; and
        (B) the use of cross-sex hormones in females is associated with risks of erythrocytosis,
 severe liver dysfunction, coronary artery disease, hypertension, and increased risk of breast and
 uterine cancers; and
        (x) upon the completion of any relevant information privacy release, obtain a mental
 health evaluation of the minor as described in Subsection (4).
        (4) The mental health evaluation shall:
        (a) be performed by a mental health professional who:
        (i) beginning January 1, 2024, has a current transgender treatment certification; and
        (ii) is not the health care provider that is recommending or providing the hormonal
 transgender treatment;
        (b) contain a determination regarding whether the minor suffers from gender dysphoria
 in accordance with the fifth edition of the Diagnostic and Statistical Manual of Mental
 Disorders;
        (c) confirm that the minor and the mental health professional have had at least three
 therapy sessions; and
        (d) document all of the minor's mental health diagnoses and any significant life events
 that may be contributing to the diagnoses.
        (5) A violation of Subsection (3) is unprofessional conduct.
        Section 3. Section 58-1-603.1 is enacted to read:
        58-1-603.1. Hormonal transgender treatment moratorium.
        (1) As used in this section:
        (a) "Health care provider" means the same as that term is defined in Section 58-1-603.
        (b) "Hormonal transgender treatment" means the same as that term is defined in
 Section 58-1-603.
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