Bill Text: MI HB4241 | 2015-2016 | 98th Legislature | Introduced

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Bill Title: Health; abortion; performing an abortion without first determining whether there is a detectable heartbeat; prohibit except in an emergency. Amends secs. 17015 & 17515 of 1978 PA 368 (MCL 333.17015 & 333.17515) & adds sec. 17015b.

Spectrum: Partisan Bill (Republican 15-0)

Status: (Introduced - Dead) 2015-02-26 - Printed Bill Filed 02/26/2015 [HB4241 Detail]

Download: Michigan-2015-HB4241-Introduced.html

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HOUSE BILL No. 4241

 

February 25, 2015, Introduced by Reps. Hooker, Howrylak, Crawford, Price, Rendon, Poleski, Goike, Gamrat, Courser, Somerville, Lauwers, Yonker, Cox, Garcia and Johnson and referred to the Committee on Health Policy.

 

     A bill to amend 1978 PA 368, entitled

 

"Public health code,"

 

by amending sections 17015 and 17515 (MCL 333.17015 and 333.17515),

 

as amended by 2012 PA 499, and by adding section 17015b.

 

THE PEOPLE OF THE STATE OF MICHIGAN ENACT:

 

     Sec. 17015. (1) Subject to subsection (10), a physician shall

 

not perform an abortion otherwise permitted by law without the

 

patient's informed written consent, given freely and without

 

coercion to abort.

 

     (2) For purposes of this section and section sections 17015a

 

and 17015b:

 

     (a) "Abortion" means the intentional use of an instrument,

 

drug, or other substance or device to terminate a woman's pregnancy

 

for a purpose other than to increase the probability of a live

 

birth, to preserve the life or health of the child after live

 

birth, or to remove a fetus that has died as a result of natural

 

causes, accidental trauma, or a criminal assault on the pregnant

 

woman. Abortion does not include the use or prescription of a drug

 

or device intended as a contraceptive or any medical treatment of a

 

woman who is experiencing a miscarriage or has been diagnosed with

 

an extrauterine pregnancy.

 

     (b) "Coercion to abort" means an act committed with the intent

 

to coerce an individual to have an abortion. , which act is

 

prohibited by section 213a of the Michigan penal code, 1931 PA 328,

 

MCL 750.213a.

 

     (c) "Domestic violence" means that term as defined in section

 

1 of 1978 PA 389, MCL 400.1501.

 

     (d) "Fetus" means an individual organism of the species homo

 

Homo sapiens in utero.

 

     (e) "Local health department representative" means a person

 

who meets 1 or more of the licensing requirements listed in

 

subdivision (h) and who is employed by, or under contract to

 

provide services on behalf of, a local health department.

 

     (f) "Medical emergency" means that a condition which, that, on

 

the basis of the physician's good faith clinical judgment, so

 

complicates the medical condition of a pregnant woman as to

 

necessitate the immediate abortion of her pregnancy to avert her

 

death or for which a delay will create serious risk of substantial

 

and irreversible impairment of a major bodily function.

 

     (g) "Medical service" means the provision of a treatment,

 

procedure, medication, examination, diagnostic test, assessment, or

 

counseling, including, but not limited to, a pregnancy test,

 

ultrasound, pelvic examination, or an abortion.

 

     (h) "Qualified person assisting the physician" means another

 

physician or a physician's assistant licensed under this part or

 

part 175, a fully licensed or limited licensed psychologist

 

licensed under part 182, a professional counselor licensed under

 

part 181, a registered professional nurse or a licensed practical

 

nurse licensed under part 172, or a social worker licensed under

 

part 185.

 

     (i) "Probable gestational age of the fetus" means the

 

gestational age of the fetus at the time an abortion is planned to

 

be performed.

 

     (j) "Provide the patient with a physical copy" means

 

confirming that the patient accessed the internet Internet website

 

described in subsection (5) and received a printed valid

 

confirmation form from the website and including that form in the

 

patient's medical record or giving a patient a copy of a required

 

document by 1 or more of the following means:

 

     (i) In person.

 

     (ii) By registered mail, return receipt requested.

 

     (iii) By parcel delivery service that requires the recipient to

 

provide a signature in order to receive delivery of a parcel.

 

     (iv) By facsimile transmission.

 

     (3) Subject to subsection (10), a physician or a qualified

 

person assisting the physician shall do all of the following not

 

less than 24 hours before that physician performs an abortion upon

 

a patient who is a pregnant woman:

 

     (a) Confirm that, according to the best medical judgment of a

 

physician, the patient is pregnant, and determine the probable

 

gestational age of the fetus.

 

     (b) Orally describe, in language designed to be understood by

 

the patient, taking into account her age, level of maturity, and

 

intellectual capability, each of the following:

 

     (i) The probable gestational age of the fetus she is carrying.

 

     (ii) Information about what to do and whom to contact should

 

medical complications arise from the abortion.

 

     (iii) Information about how to obtain pregnancy prevention

 

information through the department of community health.

 

     (c) Provide the patient with a physical copy of the written

 

standardized summary described in subsection (11)(b) that

 

corresponds to the procedure the patient will undergo and is

 

provided by the department of community health. If the procedure

 

has not been recognized by the department, but is otherwise allowed

 

under Michigan law, and the department has not provided a written

 

standardized summary for that procedure, the physician shall

 

develop and provide a written summary that describes the procedure,

 

any known risks or complications of the procedure, and risks

 

associated with live birth and meets the requirements of subsection

 

(11)(b)(iii) through (vii).

 

     (d) Provide the patient with a physical copy of a medically

 

accurate depiction, illustration, or photograph and description of

 

a fetus supplied by the department of community health pursuant to

 

subsection (11)(a) at the gestational age nearest the probable

 

gestational age of the patient's fetus.

 

     (e) Provide the patient with a physical copy of the prenatal

 

care and parenting information pamphlet distributed by the

 

department of community health under section 9161.

 

     (f) Provide the patient with a physical copy of the

 

prescreening summary on prevention of coercion to abort described

 

in subsection (11)(i).

 

     (4) The requirements of subsection (3) may be fulfilled by the

 

physician or a qualified person assisting the physician at a

 

location other than the health facility where the abortion is to be

 

performed. The requirement of subsection (3)(a) that a patient's

 

pregnancy be confirmed may be fulfilled by a local health

 

department under subsection (18). The requirements of subsection

 

(3) cannot be fulfilled by the patient accessing an internet

 

website other than the internet website that is maintained and

 

operated by the department under subsection (11)(g).

 

     (5) The requirements of subsection (3)(c) through (f) may be

 

fulfilled by a patient accessing the internet website that is

 

maintained and operated by the department under subsection (11)(g)

 

and receiving a printed, valid confirmation form from the website

 

that the patient has reviewed the information required in

 

subsection (3)(c) through (f) at least 24 hours before an abortion

 

being performed on the patient. The website shall not require any

 

information be supplied by the patient. The department shall not

 

track, compile, or otherwise keep a record of information that

 

would identify a patient who accesses this website. The patient

 

shall supply the valid confirmation form to the physician or

 

qualified person assisting the physician to be included in the

 

patient's medical record to comply with this subsection.

 

     (6) Subject to subsection (10), before obtaining the patient's

 

signature on the acknowledgment and consent form described in

 

subsection (11)(c), a physician personally and in the presence of

 

the patient shall do all of the following:

 

     (a) Provide the patient with the physician's name, confirm

 

with the patient that the coercion to abort screening required

 

under section 17015a was performed, and inform the patient of her

 

right to withhold or withdraw her consent to the abortion at any

 

time before performance of the abortion.

 

     (b) Orally describe, in language designed to be understood by

 

the patient, taking into account her age, level of maturity, and

 

intellectual capability, each of the following:

 

     (i) The specific risk, if any, to the patient of the

 

complications that have been associated with the procedure the

 

patient will undergo, based on the patient's particular medical

 

condition and history as determined by the physician.

 

     (ii) The specific risk of complications, if any, to the patient

 

if she chooses to continue the pregnancy based on the patient's

 

particular medical condition and history as determined by a

 

physician.

 

     (7) To protect a patient's privacy, the information set forth

 

in subsection (3) and subsection (6) shall not be disclosed to the

 

patient in the presence of another patient.

 

     (8) If at any time before the performance of an abortion, a

 

patient undergoes an ultrasound examination, or a physician

 

determines that ultrasound imaging will be used during the course

 

of a patient's abortion, the physician or qualified person

 

assisting the physician shall provide the patient with the

 

opportunity to view or decline to view an active ultrasound image

 

of the fetus, and offer to provide the patient with a physical

 

picture of the ultrasound image of the fetus before the performance

 

of the abortion. After the expiration of the 24-hour period

 

prescribed under subsection (3) but before performing an abortion

 

on a patient who is a pregnant woman, a physician or a qualified

 

person assisting the physician shall do all of the following:

 

     (a) Obtain the patient's signature on the acknowledgment and

 

consent form described in subsection (11)(c) confirming that she

 

has received the information required under subsection (3).

 

     (b) Provide the patient with a physical copy of the signed

 

acknowledgment and consent form described in subsection (11)(c).

 

     (c) Retain a copy of the signed acknowledgment and consent

 

form described in subsection (11)(c) and, if applicable, a copy of

 

the pregnancy certification form completed under subsection

 

(18)(b), in the patient's medical record.

 

     (9) This subsection does not prohibit notifying the patient

 

that payment for medical services will be required or that

 

collection of payment in full for all medical services provided or

 

planned may be demanded after the 24-hour period described in this

 

subsection has expired. A physician or an agent of the physician

 

shall not collect payment, in whole or in part, for a medical

 

service provided to or planned for a patient before the expiration

 

of 24 hours from the time the patient has done either or both of

 

the following, except in the case of a physician or an agent of a

 

physician receiving capitated payments or under a salary

 

arrangement for providing those medical services:

 

     (a) Inquired about obtaining an abortion after her pregnancy

 

is confirmed and she has received from that physician or a

 

qualified person assisting the physician the information required

 

under subsection (3)(c) and (d).

 

     (b) Scheduled an abortion to be performed by that physician.

 

     (10) If the attending physician, utilizing his or her

 

experience, judgment, and professional competence, determines that

 

a medical emergency exists and necessitates performance of an

 

abortion before the requirements of subsections (1), (3), and (6)

 

can be met, the physician is exempt from the requirements of

 

subsections (1), (3), and (6), may perform the abortion, and shall

 

maintain a written record identifying with specificity the medical

 

factors upon which the determination of the medical emergency is

 

based.

 

     (11) The department of community health shall do each of the

 

following:

 

     (a) Produce medically accurate depictions, illustrations, or

 

photographs of the development of a human fetus that indicate by

 

scale the actual size of the fetus at 2-week intervals from the

 

fourth week through the twenty-eighth week of gestation. Each

 

depiction, illustration, or photograph shall be accompanied by a

 

printed description, in nontechnical English, Arabic, and Spanish,

 

of the probable anatomical and physiological characteristics of the

 

fetus at that particular state of gestational development.

 

     (b) Subject to subdivision (e), develop, draft, and print, in

 

nontechnical English, Arabic, and Spanish, written standardized

 

summaries, based upon the various medical procedures used to abort

 

pregnancies, that do each of the following:

 

     (i) Describe, individually and on separate documents, those

 

medical procedures used to perform abortions in this state that are

 

recognized by the department.

 

     (ii) Identify the physical complications that have been

 

associated with each procedure described in subparagraph (i) and

 

with live birth, as determined by the department. In identifying

 

these complications, the department shall consider the annual

 

statistical report required under section 2835, and shall consider

 

studies concerning complications that have been published in a peer

 

review medical journal, with particular attention paid to the

 

design of the study, and shall consult with the federal centers

 

Centers for disease control Disease Control and prevention, the

 

American congress Congress of obstetricians Obstetricians and

 

gynecologists, Gynecologists, the Michigan state medical society,

 

State Medical Society, or any other source that the department

 

determines appropriate for the purpose.

 

     (iii) State that as the result of an abortion, some women may

 

experience depression, feelings of guilt, sleep disturbance, loss

 

of interest in work or sex, or anger, and that if these symptoms

 

occur and are intense or persistent, professional help is

 

recommended.

 

     (iv) State that not all of the complications listed in

 

subparagraph (ii) may pertain to that particular patient and refer

 

the patient to her physician for more personalized information.

 

     (v) Identify services available through public agencies to

 

assist the patient during her pregnancy and after the birth of her

 

child, should she choose to give birth and maintain custody of her

 

child.

 

     (vi) Identify services available through public agencies to

 

assist the patient in placing her child in an adoptive or foster

 

home, should she choose to give birth but not maintain custody of

 

her child.

 

     (vii) Identify services available through public agencies to

 

assist the patient and provide counseling should she experience

 

subsequent adverse psychological effects from the abortion.

 

     (c) Develop, draft, and print, in nontechnical English,

 

Arabic, and Spanish, an acknowledgment and consent form that

 

includes only the following language above a signature line for the

 

patient:

 

     "I, _____________________________ , voluntarily and willfully

 

hereby authorize Dr. __________________ ("the physician") and any

 

assistant designated by the physician to perform upon me the

 

following operation(s) or procedure(s):

 

     __________________________________________________________

 

     (Name of operation(s) or procedure(s))

 

     __________________________________________________________

 

     A. I understand that I am approximately _____ weeks pregnant.

 

I consent to an abortion procedure to terminate my pregnancy. I

 

understand that I have the right to withdraw my consent to the

 

abortion procedure at any time before performance of that

 

procedure.

 

     B. I understand that it is illegal for anyone to coerce me

 

into seeking an abortion.

 

     C. I acknowledge that at least 24 hours before the scheduled

 

abortion I have received a physical copy of each of the following:

 

     1. A medically accurate depiction, illustration, or photograph

 

of a fetus at the probable gestational age of the fetus I am

 

carrying.

 

     2. A written description of the medical procedure that will be

 

used to perform the abortion.

 

     3. A prenatal care and parenting information pamphlet.

 

     D. If any of the documents listed in paragraph C were

 

transmitted by facsimile, I certify that the documents were clear

 

and legible.

 

     E. I acknowledge that the physician who will perform the

 

abortion has orally described all of the following to me:

 

     1. The specific risk to me, if any, of the complications that

 

have been associated with the procedure I am scheduled to undergo.

 

     2. The specific risk to me, if any, of the complications if I

 

choose to continue the pregnancy.

 

     F. I acknowledge that I have received all of the following

 

information:

 

     1. Information about what to do and whom to contact in the

 

event that complications arise from the abortion.

 

     2. Information pertaining to available pregnancy related

 

services.

 

     G. I have been given an opportunity to ask questions about the

 

operation(s) or procedure(s).

 

     H. I certify that I have not been required to make any

 

payments for an abortion or any medical service before the

 

expiration of 24 hours after I received the written materials

 

listed in paragraph C, or 24 hours after the time and date listed

 

on the confirmation form if the information described in paragraph

 

C was viewed from the state of Michigan internet Internet

 

website.".

 

     (d) Make available to physicians through the Michigan board of

 

medicine and the Michigan board of osteopathic medicine and

 

surgery, and to any person upon request, the copies of medically

 

accurate depictions, illustrations, or photographs described in

 

subdivision (a), the written standardized summaries described in

 

subdivision (b), the acknowledgment and consent form described in

 

subdivision (c), the prenatal care and parenting information

 

pamphlet described in section 9161, the pregnancy certification

 

form described in subdivision (f), and the materials regarding

 

coercion to abort described in subdivision (i).

 

     (e) The department shall not develop In developing the written

 

standardized summaries for abortion procedures under subdivision

 

(b), that utilize include in the summaries only medication that has

 

not been approved by the United States food Food and drug

 

administration Drug Administration for use in performing an

 

abortion.

 

     (f) Develop, draft, and print a certification form to be

 

signed by a local health department representative at the time and

 

place a patient has a pregnancy confirmed, as requested by the

 

patient, verifying the date and time the pregnancy is confirmed.

 

     (g) Develop, operate, and maintain an internet Internet

 

website that allows a patient considering an abortion to review the

 

information required in subsection (3)(c) through (f). After the

 

patient reviews the required information, the department shall

 

assure that a confirmation form can be printed by the patient from

 

the internet Internet website that will verify the time and date

 

the information was reviewed. A confirmation form printed under

 

this subdivision becomes invalid 14 days after the date and time

 

printed on the confirmation form.

 

     (h) Include on the informed consent internet Internet website

 

operated under subdivision (g) a list of health care providers,

 

facilities, and clinics that offer to perform ultrasounds free of

 

charge. The list shall be organized geographically and shall

 

include the name, address, and telephone number of each health care

 

provider, facility, and clinic.

 

     (i) After considering the standards and recommendations of the

 

joint commission Joint Commission on accreditation Accreditation of

 

healthcare organizations, Healthcare Organizations, the Michigan

 

domestic and sexual violence prevention and treatment board, the

 

Michigan coalition Coalition to end domestic End Domestic and

 

sexual violence Sexual Violence or successor organization, and the

 

American medical association, Medical Association, do all of the

 

following:

 

     (i) Develop, draft, and print or make available in printable

 

format, in nontechnical English, Arabic, and Spanish, a notice that

 

is required to be posted in facilities and clinics under section

 

17015a. The notice shall be at least 8-1/2 inches by 14 inches,

 

shall be printed in at least 44-point type, and shall contain at a

 

minimum all of the following:

 

     (A) A statement that it is illegal under Michigan law to

 

coerce a woman to have an abortion.

 

     (B) A statement that help is available if a woman is being

 

threatened or intimidated; is being physically, emotionally, or

 

sexually harmed; or feels afraid for any reason.

 

     (C) The telephone number of at least 1 domestic violence

 

hotline and 1 sexual assault hotline.

 

     (ii) Develop, draft, and print or make available in printable

 

format, in nontechnical English, Arabic, and Spanish, a

 

prescreening summary on prevention of coercion to abort that, at a

 

minimum, contains the information required under subparagraph (i)

 

and notifies the patient that an oral screening for coercion to

 

abort will be conducted before her giving written consent to obtain

 

an abortion.

 

     (iii) Develop, draft, and print screening and training tools and

 

accompanying training materials to be utilized by a physician or

 

qualified person assisting the physician while performing the

 

coercion to abort screening required under section 17015a. The

 

screening tools shall instruct the physician or qualified person

 

assisting the physician to orally communicate information to the

 

patient regarding coercion to abort and to document the findings

 

from the coercion to abort screening in the patient's medical

 

record.

 

     (iv) Develop, draft, and print protocols and accompanying

 

training materials to be utilized by a physician or a qualified

 

person assisting the physician if a patient discloses coercion to

 

abort or that domestic violence is occurring, or both, during the

 

coercion to abort screening. The protocols shall instruct the

 

physician or qualified person assisting the physician to do, at a

 

minimum, all of the following:

 

     (A) Follow the requirements of section 17015a as applicable.

 

     (B) Assess the patient's current level of danger.

 

     (C) Explore safety options with the patient.

 

     (D) Provide referral information to the patient regarding law

 

enforcement and domestic violence and sexual assault support

 

organizations.

 

     (E) Document any referrals in the patient's medical record.

 

     (12) A physician's duty to inform the patient under this

 

section does not require disclosure of information beyond what a

 

reasonably well-qualified physician licensed under this article

 

would possess.

 

     (13) A written consent form meeting the requirements set forth

 

in this section and signed by the patient is presumed valid. The

 

presumption created by this subsection may be rebutted by evidence

 

that establishes, by a preponderance of the evidence, that consent

 

was obtained through fraud, negligence, deception,

 

misrepresentation, coercion, or duress.

 

     (14) A completed certification form described in subsection

 

(11)(f) that is signed by a local health department representative

 

is presumed valid. The presumption created by this subsection may

 

be rebutted by evidence that establishes, by a preponderance of the

 

evidence, that the physician who relied upon the certification had

 

actual knowledge that the certificate contained a false or

 

misleading statement or signature.

 

     (15) This section does not create a right to abortion.

 

     (16) Notwithstanding any other provision of this section, a

 

person shall not perform an abortion that is prohibited by law.

 

     (17) If any portion of this act or the application of this act

 

to any person or circumstances is found invalid by a court, that

 

invalidity does not affect the remaining portions or applications

 

of the act that can be given effect without the invalid portion or

 

application, if those remaining portions are not determined by the

 

court to be inoperable.

 

     (18) Upon a patient's request, each local health department

 

shall:

 

     (a) Provide a pregnancy test for that patient to confirm the

 

pregnancy as required under subsection (3)(a) and determine the

 

probable gestational stage of the fetus. The local health

 

department need not comply with this subdivision if the

 

requirements of subsection (3)(a) have already been met.

 

     (b) If a pregnancy is confirmed, ensure that the patient is

 

provided with a completed pregnancy certification form described in

 

subsection (11)(f) at the time the information is provided.

 

     (19) The identity and address of a patient who is provided

 

information or who consents to an abortion pursuant to this section

 

is confidential and is subject to disclosure only with the consent

 

of the patient or by judicial process.

 

     (20) A local health department with a file containing the

 

identity and address of a patient described in subsection (19) who

 

has been assisted by the local health department under this section

 

shall do both of the following:

 

     (a) Only release the identity and address of the patient to a

 

physician or qualified person assisting the physician in order to

 

verify the receipt of the information required under this section.

 

     (b) Destroy the information containing the identity and

 

address of the patient within 30 days after assisting the patient

 

under this section.

 

     Sec. 17015b. (1) Except when a medical emergency exists that

 

prevents compliance with this section, a physician shall not

 

perform an abortion on a pregnant woman before determining, in

 

accordance with standard medical practice, whether a fetal

 

heartbeat is detectable in the fetus the pregnant woman is

 

carrying. An individual who performs an abortion in a medical

 

emergency without determining whether the fetus has a detectable

 

heartbeat shall note in the pregnant woman's medical record the

 

specific nature of the medical emergency that existed. Compliance

 

with this section does not require the use of an intravaginal

 

diagnostic procedure.

 

     (2) If during the examination required under subsection (1) a

 

fetal heartbeat is detected, the physician or a qualified person

 

assisting the physician shall offer to the pregnant woman the

 

option of hearing or seeing evidence of the fetal heartbeat.

 

     (3) If the examination required under subsection (1) does not

 

detect a fetal heartbeat, the physician or a qualified person

 

assisting the physician shall do all of the following that apply:

 

     (a) Advise the pregnant woman of the physician's

 

recommendation either to immediately perform an additional

 

diagnostic procedure or procedures that may detect a fetal

 

heartbeat or to delay until a later date performing a diagnostic

 

procedure to determine if the fetus is physically developing.

 

     (b) Inform the pregnant woman of the probability of

 

maintaining the pregnancy versus experiencing a miscarriage, given

 

the absence of a detectable fetal heartbeat, the state of

 

pregnancy, and other factors known to affect the possibility of a

 

miscarriage.

 

     (c) If the fetus has been visibly identified but is not

 

exhibiting a heartbeat or other signs of physical activity, advise

 

the pregnant woman that a procedure to remove a fetus that has died

 

is not considered an abortion under law and inform the pregnant

 

woman of the relative risks and benefits of different means of

 

terminating the pregnancy, including medical inducement, a surgical

 

procedure, or allowing a miscarriage to occur spontaneously.

 

     Sec. 17515. A physician, before performing an abortion on a

 

patient, shall comply with sections 17015 and 17015a.to 17015b.

 

     Enacting section 1. This amendatory act takes effect 90 days

 

after the date it is enacted into law.