Bill Summary – FastDemocracy

LEGISLATIVE GENERAL COUNSEL                                          H.B. 132
Approved for Filing: C. Williams 6                           1st Sub. (Buff)
          6 01-22-23 8:06 PM 6
                     Representative Rex P. Shipp proposes the following substitute bill:
            PROHIBITING SEX TRANSITIONING PROCEDURES ON
                                              MINORS
                                     2023 GENERAL SESSION
                                         STATE OF UTAH
                                 Chief Sponsor: Rex P. Shipp
                              Senate Sponsor: Wayne A. Harper
 Cosponsors:                        Joseph Elison                       A. Cory Maloy
 Nelson T. Abbott Colin W. Jack Michael J. Petersen
 Cheryl K. Acton Tim Jimenez Thomas W. Peterson
 Carl R. Albrecht Dan N. Johnson Keven J. Stratton
 Bridger Bolinder Quinn Kotter Mark A. Strong
 Walt Brooks Trevor Lee Jordan D. Teuscher
 Jefferson S. Burton Steven J. Lund Christine F. Watkins
 Kay J. Christofferson Phil Lyman
15
 LONG TITLE
 General Description:
        This bill prohibits a health care provider from performing a medical procedure on a
 minor for the purpose of attempted sex transitioning or attempted sex change.                 1st Sub. H.B. 132
 Highlighted Provisions:
        This bill:
        < defines terms;
        < makes it unprofessional conduct for a health care provider to perform a medical
 procedure on a minor for the purpose of attempted sex transitioning or attempted
     *HB0132S01*
       1st Sub. (Buff) H.B. 132                                                  01-22-23 8:06 PM
 sex change under most circumstances; and
        < makes technical changes.
 Money Appropriated in this Bill:
        None
 Other Special Clauses:
        None
 Utah Code Sections Affected:
 AMENDS:
        58-31b-502, as last amended by Laws of Utah 2022, Chapter 290
        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
        58-70a-503, as last amended by Laws of Utah 2022, Chapter 290
 ENACTS:
        58-1-511, Utah Code Annotated 1953
41
 Be it enacted by the Legislature of the state of Utah:
        Section 1. Section 58-1-511 is enacted to read:
        58-1-511. Prohibition on hormonal transgender procedures on minors.
        (1) As used in this section:
        (a) "Administration of cross-sex hormones" means administering or supplying:
        (i) 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; or
        (ii) 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.
        (b) "Health care provider" means:
        (i) a physician licensed under:
        (A) Chapter 67, Utah Medical Practice Act; or
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       01-22-23 8:06 PM                                                   1st Sub. (Buff) H.B. 132
        (B) Chapter 68, Utah Osteopathic Medical Practice Act;
        (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(e).
        (c) "Hormonal transgender procedure" means:
        (i) administration of cross-sex hormones; or
        (ii) performing a puberty inhibition procedure.
        (d) "Minor" means an individual who:
        (i) is less than 18 years old; and
        (ii) is not emancipated under Title 80, Chapter 7, Emancipation.
        (e) (i) "Puberty inhibition procedure" means administering or supplying, alone or in
 combination with aromatase inhibitors:
        (A) gonadotropin-releasing hormone agonists;
        (B) progestins; or
        (C) androgen receptor inhibitors.
        (ii) "Puberty inhibition procedure" does not include administering or supplying a
 treatment described in Subsection (1)(e)(i) to an individual if the treatment is medically
 necessary as a treatment for:
        (A) precocious puberty;
        (B) idiopathic short stature;
        (C) endometriosis; or
        (D) a sex hormone-stimulated cancer.
        (2) Except as provided in Subsection (3), a health care provider may not perform a
 hormonal transgender procedure on a minor.
        (3) (a) A health care provider may continue to administer cross-sex hormones to a
 minor if the minor:
        (i) began receiving cross-sex hormones prior to May 3, 2021;
        (ii) has continuously received cross-sex hormones for at least two years; and
        (iii) affirmatively elects, in writing, to continue to receive cross-sex hormones.
        (b) For a minor who does not meet the criteria described in Subsection (3)(a), a health
 care provider who provides cross-sex hormones to the minor shall:
        (i) unless the minor elects to discontinue receiving cross-sex hormones by an earlier
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        1st Sub. (Buff) H.B. 132                                                     01-22-23 8:06 PM
 date, develop and implement a treatment plan to progressively decrease the dosage of cross-sex
 hormones so that cross-sex hormone treatment is ended by November 3, 2023; and
         (ii) consult with a mental health professional in order to monitor the minor's
 psychological and emotional state until November 3, 2023.
         Section 2. Section 58-31b-502 is amended to read:
         58-31b-502. Unprofessional conduct.
         (1) "Unprofessional conduct" includes:
         (a) failure to safeguard a patient's right to privacy as to the patient's person, condition,
 diagnosis, personal effects, or any other matter about which the licensee is privileged to know
 because of the licensee's or person with a certification's position or practice as a nurse or
 practice as a medication aide certified;
         (b) failure to provide nursing service or service as a medication aide certified in a
 manner that demonstrates respect for the patient's human dignity and unique personal character
 and needs without regard to the patient's race, religion, ethnic background, socioeconomic
 status, age, sex, or the nature of the patient's health problem;
         (c) engaging in sexual relations with a patient during any:
         (i) period when a generally recognized professional relationship exists between the
 person licensed or certified under this chapter and the patient; or
         (ii) extended period when a patient has reasonable cause to believe a professional
 relationship exists between the person licensed or certified under the provisions of this chapter
 and the patient;
         (d) (i) as a result of any circumstance under Subsection (1)(c), exploiting or using
 information about a patient or exploiting the licensee's or the person with a certification's
 professional relationship between the licensee or holder of a certification under this chapter and
 the patient; or
         (ii) exploiting the patient by use of the licensee's or person with a certification's
 knowledge of the patient obtained while acting as a nurse or a medication aide certified;
         (e) unlawfully obtaining, possessing, or using any prescription drug or illicit drug;
         (f) unauthorized taking or personal use of nursing supplies from an employer;
         (g) unauthorized taking or personal use of a patient's personal property;
         (h) unlawful or inappropriate delegation of nursing care;
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        01-22-23 8:06 PM                                                     1st Sub. (Buff) H.B. 132
        (i) failure to exercise appropriate supervision of persons providing patient care services
 under supervision of the licensed nurse;
        (j) employing or aiding and abetting the employment of an unqualified or unlicensed
 person to practice as a nurse;
        (k) failure to file or record any medical report as required by law, impeding or
 obstructing the filing or recording of such a report, or inducing another to fail to file or record
 such a report;
        (l) breach of a statutory, common law, regulatory, or ethical requirement of
 confidentiality with respect to a person who is a patient, unless ordered by a court;
        (m) failure to pay a penalty imposed by the division;
        (n) prescribing a Schedule II controlled substance without complying with the
 requirements in Section 58-31b-803, if applicable;
        (o) violating Section 58-31b-801;
        (p) violating the dispensing requirements of Section 58-17b-309 or Chapter 17b, Part
 8, Dispensing Medical Practitioner and Dispensing Medical Practitioner Clinic Pharmacy, if
 applicable;
        (q) falsely making an entry in, or altering, a medical record with the intent to conceal:
        (i) a wrongful or negligent act or omission of an individual licensed under this chapter
 or an individual under the direction or control of an individual licensed under this chapter; or
        (ii) conduct described in Subsections (1)(a) through (o) or Subsection 58-1-501(1); [or]
        (r) violating the requirements of Title 26, Chapter 61a, Utah Medical Cannabis Act[.];
 or
        (s) performing, or causing to be performed, a hormonal transgender procedure in
 violation of Section 58-1-511.
        (2) "Unprofessional conduct" does not include, in accordance with Title 26, Chapter
 61a, Utah Medical Cannabis Act, when registered as a qualified medical provider, or acting as
 a limited medical provider, as those terms are defined in Section 26-61a-102, recommending
 the use of medical cannabis.
        (3) Notwithstanding Subsection (2), the division, in consultation with the board and in
 accordance with Title 63G, Chapter 3, Utah Administrative Rulemaking Act, shall define
 unprofessional conduct for an advanced practice registered nurse described in Subsection (2).
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        1st Sub. (Buff) H.B. 132                                                    01-22-23 8:06 PM
         Section 3. Section 58-67-102 is amended to read:
         58-67-102. Definitions.
         In addition to the definitions in Section 58-1-102, as used in this chapter:
         (1) (a) "Ablative procedure" means a procedure that is expected to excise, vaporize,
 disintegrate, or remove living tissue, including the use of carbon dioxide lasers and erbium:
 YAG lasers.
         (b) "Ablative procedure" does not include hair removal.
         (2) "ACGME" means the Accreditation Council for Graduate Medical Education of the
 American Medical Association.
         (3) "Administrative penalty" means a monetary fine or citation imposed by the division
 for acts or omissions determined to constitute unprofessional or unlawful conduct, in
 accordance with a fine schedule established by the division in collaboration with the board, as a
 result of an adjudicative proceeding conducted in accordance with Title 63G, Chapter 4,
 Administrative Procedures Act.
         (4) "Associate physician" means an individual licensed under Section 58-67-302.8.
         (5) "Attempted sex change" means an attempt or effort to change an individual's body
 to present that individual as being of a sex or gender that is different from the individual's
 biological sex at birth.
         (6) "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.
         [(5)] (7) "Board" means the Physicians Licensing Board created in Section 58-67-201.
         [(6)] (8) "Collaborating physician" means an individual licensed under Section
 58-67-302 who enters into a collaborative practice arrangement with an associate physician.
         [(7)] (9) "Collaborative practice arrangement" means the arrangement described in
 Section 58-67-807.
         (10) "Cosmetic breast surgical procedure" means a breast reduction surgery or a breast
 augmentation surgery that is performed for a purpose other than:
         (a) medical necessity; or
         (b) to address a musculoskeletal problem.
         [(8)] (11) (a) "Cosmetic medical device" means tissue altering energy based devices
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        01-22-23 8:06 PM                                                     1st Sub. (Buff) H.B. 132
 that have the potential for altering living tissue and that are used to perform ablative or
 nonablative procedures, such as American National Standards Institute (ANSI) designated
 Class IIIb and Class IV lasers, intense pulsed light, radio frequency devices, and lipolytic
 devices, and excludes ANSI designated Class IIIa and lower powered devices.
           (b) Notwithstanding Subsection [(8)(a),] (11)(a), if an ANSI designated Class IIIa and
 lower powered device is being used to perform an ablative procedure, the device is included in
 the definition of cosmetic medical device under Subsection [(8)(a).] (11)(a).
           [(9)] (12) "Cosmetic medical procedure":
           (a) includes the use of cosmetic medical devices to perform ablative or nonablative
 procedures; and
           (b) does not include a treatment of the ocular globe such as refractive surgery.
           [(10)] (13) "Diagnose" means:
           (a) to examine in any manner another person, parts of a person's body, substances,
 fluids, or materials excreted, taken, or removed from a person's body, or produced by a person's
 body, to determine the source, nature, kind, or extent of a disease or other physical or mental
 condition;
           (b) to attempt to conduct an examination or determination described under Subsection
 [(10)(a);] (13)(a);
           (c) to hold oneself out as making or to represent that one is making an examination or
 determination as described in Subsection [(10)(a);] (13)(a); or
           (d) to make an examination or determination as described in Subsection [(10)(a)]
 (13)(a) upon or from information supplied directly or indirectly by another person, whether or
 not in the presence of the person making or attempting the diagnosis or examination.
           [(11)] (14) "LCME" means the Liaison Committee on Medical Education of the
 American Medical Association.
           [(12)] (15) "Medical assistant" means an unlicensed individual who may perform tasks
 as described in Subsection 58-67-305(6).
           [(13)] (16) "Medically underserved area" means a geographic area in which there is a
 shortage of primary care health services for residents, as determined by the Department of
 Health.
           [(14)] (17) "Medically underserved population" means a specified group of people
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        1st Sub. (Buff) H.B. 132                                                    01-22-23 8:06 PM
 living in a defined geographic area with a shortage of primary care health services, as
 determined by the Department of Health.
         [(15)] (18) (a) (i) "Nonablative procedure" means a procedure that is expected or
 intended to alter living tissue, but is not intended or expected to excise, vaporize, disintegrate,
 or remove living tissue.
         (ii) Notwithstanding Subsection [(15)(a)(i)] (18)(a)(i), nonablative procedure includes
 hair removal.
         (b) "Nonablative procedure" does not include:
         (i) a superficial procedure as defined in Section 58-1-102;
         (ii) the application of permanent make-up; or
         (iii) the use of photo therapy and lasers for neuromusculoskeletal treatments that are
 performed by an individual licensed under this title who is acting within the individual's scope
 of practice.
         [(16)] (19) "Physician" means both physicians and surgeons licensed under Section
 58-67-301, Utah Medical Practice Act, and osteopathic physicians and surgeons licensed under
 Section 58-68-301, Utah Osteopathic Medical Practice Act.
         [(17)] (20) (a) "Practice of medicine" means:
         (i) to diagnose, treat, correct, administer anesthesia, or prescribe for any human
 disease, ailment, injury, infirmity, deformity, pain or other condition, physical or mental, real
 or imaginary, including to perform cosmetic medical procedures, or to attempt to do so, by any
 means or instrumentality, and by an individual in Utah or outside the state upon or for any
 human within the state;
         (ii) when a person not licensed as a physician directs a licensee under this chapter to
 withhold or alter the health care services that the licensee has ordered;
         (iii) to maintain an office or place of business for the purpose of doing any of the acts
 described in Subsection [(17)(a)] (20)(a) whether or not for compensation; or
         (iv) to use, in the conduct of any occupation or profession pertaining to the diagnosis