Text of LA HB 570 (2022)

HLS 22RS-397 ORIGINAL 2022 Regular Session HOUSE BILL NO. 570 BY REPRESENTATIVE FIRMENT HEALTH/CHILDREN: Prohibits certain procedures to alter the sex of a minor child 1 AN ACT 2 To enact Part VIII of Chapter 5-A of Title 40 of the Louisiana Revised Statutes of 1950, to 3 be comprised of R.S. 40:1091.1 through 1091.8, relative to gender reassignment 4 procedures; to provide for a short title; to provide for the prohibition of certain 5 procedures to alter a minor child's sex and to designate this act as the Save 6 Adolescents from Experimentation (SAFE) Act; and to provide for related matters. 7 Be it enacted by the Legislature of Louisiana: 8 Section 1. Part VIII of Chapter 5-A of Title 40 of the Louisiana Revised Statutes of 9 1950, comprised of R.S. 40:1091.1 through 1091.8, is hereby enacted to read as follows: 10 PART VIII. THE SAVE ADOLESCENTS FROM EXPERIMENTATION ACT 11 §1091.1. Short title; purpose 12 A. This Part shall be known and cited as the "SAFE Act". 13 B. This state has a compelling governmental interest in protecting the health 14 and safety of its citizens, especially vulnerable children. 15 C. Only a tiny percent of the American population experiences distress at 16 identifying with their biological sex. According to the American Psychiatric 17 Association, prevalence ranges from five thousandths of a percent to fourteen 18 thousandths of a percent for natal adult males and from two thousandths of a percent 19 to four thousandths of a percent for natal females. Page 1 of 10 CODING: Words in struck through type are deletions from existing law; words underscored are additions. HLS 22RS-397 ORIGINAL HB NO. 570 1 D. Studies consistently demonstrate that the vast majority of children who 2 are gender non-conforming or experience distress at identifying with their biological 3 sex come to identify with their biological sex in adolescence or adulthood, thereby 4 rendering most medical healthcare interventions unnecessary. 5 E. Scientific studies show that individuals struggling with distress at 6 identifying with their biological sex often have already experienced 7 psychopathology, which indicates these individuals should be encouraged to seek 8 mental healthcare services before undertaking any hormonal or surgical intervention. 9 F. Suicide rates, psychiatric morbidities, and mortality rates remain markedly 10 elevated above the background population after inpatient gender reassignment 11 procedures have been performed. 12 G. Some healthcare providers are prescribing puberty-blocking drugs in 13 order to delay the onset or progression of normally-timed puberty in children who 14 experience distress at identifying with their biological sex. This is being done 15 despite the lack of any long-term longitudinal studies evaluating the risks and 16 benefits of using these drugs for the treatment of such distress or gender transition. 17 H. Healthcare providers are also prescribing cross-sex hormones for children 18 who experience distress at identifying with their biological sex, despite the fact that 19 no randomized clinical trials have been conducted on the efficacy or safety of the use 20 of cross-sex hormones in adults or children for the purpose of treating such distress 21 or gender transition. 22 I. The use of cross-sex hormones comes with the following serious known 23 risks: 24 (1) For biological females, erythrocytosis, severe liver dysfunction, coronary 25 artery disease, cerebrovascular disease, hypertension, increased risk of breast and 26 uterine cancers, and irreversible infertility. 27 (2) For biological males, thromboembolic disease, cholelithiasis, 28 macroprolactinoma, coronary artery disease, cerebrovascular disease, 29 hypertriglyceridemia, breast cancer, and irreversible infertility. Page 2 of 10 CODING: Words in struck through type are deletions from existing law; words underscored are additions. HLS 22RS-397 ORIGINAL HB NO. 570 1 J. Genital and non-genital reassignment surgeries are generally not 2 recommended for children, although evidence indicates referrals for children to have 3 such surgeries are becoming more frequent. 4 K. Genital gender reassignment surgery includes several irreversible invasive 5 procedures for males and females and involves the following alterations of 6 biologically normal and functional body parts: 7 (1) For biological males, surgery may involve genital reconstruction 8 including penectomy, orchiectomy, vaginoplasty, clitoroplasty, and vulvoplasty. 9 (2) For biological females, surgery may involve a hysterectomy or 10 oophorectomy, reconstruction of the urethra, genital reconstruction including 11 metoidioplasty or phalloplasty, vaginectomy, scrotoplasty, and implantation of 12 erection or testicular prostheses. 13 L. The complications, risks, and long-term care concerns associated with 14 genital gender reassignment surgery for both males and females are numerous and 15 complex. 16 M. Non-genital gender reassignment surgery includes various invasive 17 procedures for males and females, including the following procedures, and also 18 involves the alteration or removal of biologically normal and functional body parts: 19 (1) For biological males, procedures may include augmentation 20 mommoplasty, facial feminization surgery, liposuction, lipofilling voice surgery, 21 thyroid cartilage reduction, gluteal augmentation, hair reconstruction, and other 22 aesthetic procedures. 23 (2) For biological females, procedures may include subcutaneous 24 mastectomy, voice surgery, thyroid cartilage reduction, gluteal augmentation, hair 25 reconstruction, and other aesthetic procedures. 26 N. It is an accepted principle of economics and public policy that when a 27 service or product is subsidized or paid for, demand for that service or product 28 increases. Between 2015 and 2016, gender reassignment surgeries increased by 29 twenty percent. Page 3 of 10 CODING: Words in struck through type are deletions from existing law; words underscored are additions. HLS 22RS-397 ORIGINAL HB NO. 570 1 O. It is a grave concern to the Legislature of Louisiana that the medical 2 community is allowing individuals who experience distress at identifying with their 3 biological sex to be subjects of irreversible, and drastic non-genital gender 4 reassignment surgery and irreversible, permanently sterilizing genital gender 5 reassignment surgery, despite the lack of studies showing that the benefits of such 6 extreme interventions outweigh the risks. 7 P. The risks of gender transition procedures far outweigh any benefit at this 8 stage of clinical study on these procedures. 9 §1091.2. Definitions 10 For the purposes of this Part, the following terms have the meaning ascribed 11 to them unless the context clearly indicates otherwise: 12 (1) "Biological sex", "birth sex", and "sex" mean the biological indication 13 of male and female, including sex chromosomes, naturally occurring sex hormones, 14 gonads, and nonambiguous internal and external genitalia present at birth, without 15 regard to an individual's psychological, chosen, or subjective experience of gender. 16 (2) "Cross-sex hormone" means testosterone or other androgens given to 17 biological females at doses that are profoundly larger or more potent than would 18 normally occur naturally in healthy biological females, or estrogen given to 19 biological males at does that are larger or more potent than would normally occur 20 naturally in healthy biological males. 21 (3) "Gender" means the psychological, behavioral, social, and cultural 22 aspects of being male or female. 23 (4) "Gender reassignment surgery" means any medical or surgical service 24 that seeks to surgically alter or remove healthy physical or anatomical characteristics 25 or features that are typical for the individual's biological sex, in order to instill or 26 create physiological or anatomical characteristics that resemble a sex different from 27 the individual's birth sex including, without limitation, genital or non-genital 28 reassignment surgery performed for the purpose of assisting an individual with a 29 gender transition. 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HLS 22RS-397 ORIGINAL HB NO. 570 1 (5) "Gender transition" means the process in which a person goes from 2 identifying with and living as a gender that corresponds with his biological sex to 3 identifying with and living as a gender different from his biological sex, including 4 social, legal, or physical changes. 5 (6) "Gender transition procedures" means any medical or surgical service, 6 including physician services, inpatient and outpatient hospital services, or 7 prescription drugs related to gender transition, that seeks to alter or remove physical 8 or anatomical characteristics or features that are typical for the individual's biological 9 sex, or to instill or create physiological or anatomical characteristics that resemble 10 a sex different from the individual's birth sex including medical services that provide 11 puberty-blocking drugs, cross-sex hormones, or other mechanisms to promote the 12 development of feminizing or masculinizing features in the opposite sex, or genital 13 or non-genital gender reassignment surgery performed for the purpose of assisting 14 an individual with a gender transition. 15 (7) "Genital gender reassignment surgery" means surgical procedures such 16 as penectomy, orchiectomy, vaginoplasty, clitoroplasty, or vulvoplasty for 17 biologically male patients or hysterectomy, ovariectomy, reconstruction of the fixed 18 part of the urethra with or without a metoidiplasty or a phalloplasty, vaginectomy, 19 scrotoplasty, or implantation of erection and testicular prostheses for biologically 20 female patients when performed for the purpose of assisting an individual with a 21 gender transition. 22 (8) "Medical healthcare professional" means any of the following: 23 (a) A nurse licensed under Chapter 11 of Title 37 of the Louisiana Revised 24 Statutes of 1950. 25 (b) A physician assistant licensed under Chapter 11 of Title 37 of the 26 Louisiana Revised Statutes of 1950. 27 (c) A psychiatrist or psychologist licensed under Chapter 11 of Title 22 of 28 the Louisiana Revised Statutes of 1950. 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HLS 22RS-397 ORIGINAL HB NO. 570 1 (d) A pharmacist licensed under Chapter 11 of Title 37 of the Louisiana 2 Revised Statutes of 1950. 3 (e) Any other professional licensed to provide medical healthcare services. 4 (9) "Non-genital gender reassignment surgery" means surgical procedures 5 such as augmentation mammoplasty, facial feminization surgery, liposuction, 6 lipofilling, voice surgery, thyroid cartilage reduction, gluteal augmentation, hair 7 reconstruction, or other aesthetic procedures for biologically male patients or 8 subcutaneous mastectomy, voice surgery, liposuction, lipofilling, pectoral implants, 9 or other aesthetic procedures for biologically female patients when performed for the 10 purpose of assisting an individual with a gender transition. 11 (10) "Physician" means a person who is authorized and licensed in 12 accordance with the provisions of Chapter 15 of Title 37 of the Louisiana Revised 13 Statutes of 1950 to practice medicine and surgery or osteopathic medicine and 14 surgery. 15 (11) "Puberty-blocking drugs" means Gonadotropin-releasing hormone 16 analogs or other synthetic drugs used in biological male patients to stop luteinizing 17 hormone secretion and therefore, testosterone secretion, or synthetic drugs used in 18 biological females that stop the production of estrogen and progesterone, when used 19 to delay or suppress pubertal development in children for the purpose of assisting an 20 individual with a gender transition. 21 (12) "Public funds" means any state, county, or local government monies, 22 in addition to any department, agency, or instrumentality authorized or appropriated 23 pursuant to state law or derived from any fund in which such monies are deposited. 24 §1091.3. Procedure prohibitions 25 A. Gender transition procedures, as defined in R.S. 40:1091.2, do not include 26 any of the following: 27 (1) Services provided to individuals born with a medically verifiable disorder 28 of sex development, including a person with external biological sex characteristics 29 that are irresolvably ambiguous, such as an individual born with forty-six XX Page 6 of 10 CODING: Words in struck through type are deletions from existing law; words underscored are additions. HLS 22RS-397 ORIGINAL HB NO. 570 1 chromosomes with virilization, forty-six XY chromosomes with undervirilization, 2 or having both ovarian and testicular tissue. 3 (2) Services provided to an individual when a physician has otherwise 4 diagnosed a disorder of sexual development, in which the physician has determined 5 through genetic or biochemical testing that the individual does not have normal sex 6 chromosome structure, sex steroid hormone production, or sex steroid hormone 7 action for a biological male or biological female. 8 (3) Notwithstanding any other provision of this Part, the treatment of any 9 infection, injury, disease, or disorder that has been caused or exacerbated by the 10 performance of gender transition procedures, whether or not the procedures were 11 performed in accordance with state and federal law. 12 B. Gender reassignment surgery, as defined in R.S. 40:1091.2, does not 13 include any procedure undertaken because an individual suffers from a physical 14 disorder, physical injury, or physical illness that is certified by a physician and that 15 would place the individual in imminent danger of death or impairment of major 16 bodily function unless surgery is performed. 17 §1091.4. Gender transition procedures; prohibition 18 A. No physician or other medical healthcare professional shall provide 19 gender transition procedures to any person under eighteen years of age. 20 B. No physician, mental health provider, or other medical healthcare 21 professional shall refer any person under eighteen years of age to any medical doctor 22 for gender transition procedures. 23 §1091.5. School personnel 24 No nurse, counselor, teacher, principal, or other official or staff at a public 25 or private school shall do any of the following: 26 (1) Encourage or coerce a minor to withhold from the minor's parent or legal 27 guardian the fact that the minor's perception of his gender is inconsistent with his 28 sex. Page 7 of 10 CODING: Words in struck through type are deletions from existing law; words underscored are additions. HLS 22RS-397 ORIGINAL HB NO. 570 1 (2) Withhold from a minor's parent or legal guardian information related to 2 the minor's perception that his gender is inconsistent with his sex. 3 §1091.6. Allocation of funds 4 A. No public funds shall be directly or indirectly used, granted, paid, or 5 distributed to any entity, organization, or individual that provides gender transition 6 procedures to any minor. 7 B. Healthcare services furnished by or in a healthcare facility owned or 8 operated by the state or a parish or local government entity, or by a physician or 9 other individual employed by the state or a parish or local government entity, shall 10 not include gender transition procedures for minors. 11 §1091.7. Healthcare provisions; insurance 12 The benefit package for eligible children under any health insurance policy 13 or other plan providing healthcare coverage in this state shall not include 14 reimbursement for gender transition procedures for any person under eighteen years 15 of age. 16 §1091.8. Penalties 17 A. Any provision of gender transition procedures to a person under eighteen 18 years of age shall be considered unprofessional conduct and shall be subject to 19 discipline by the licensing entity with jurisdiction over the physician, mental health 20 provider, or other medical healthcare professional. 21 B. A person may assert an actual or threatened violation of this Part as a 22 claim or defense in a judicial or administrative proceeding and obtain compensatory 23 damages, injunctive relief, declaratory relief, or any other appropriate relief. 24 C. A person shall be required to bring a claim for a violation of this Part not 25 later than two years after the day the cause of action accrues. A minor may bring an 26 action before reaching eighteen years of age through a parent or guardian, and may 27 bring an action in the minor's own name upon reaching eighteen years of age at any 28 time from that point until twenty years after. Page 8 of 10 CODING: Words in struck through type are deletions from existing law; words underscored are additions. HLS 22RS-397 ORIGINAL HB NO. 570 1 D. Notwithstanding any other provision of law, an action under this Section 2 may be commenced, and relief may be granted, in a judicial proceeding without 3 regard to whether the person commencing the action has sought or exhausted 4 available administrative remedies. 5 E. In any action or proceeding to enforce a provision of this Part, a 6 prevailing party who establishes a violation of this Part shall be entitled to recover 7 reasonable attorneys' fees. 8 F. The attorney general may bring an action to enforce compliance with this 9 Part. Nothing in this Part shall be construed to deny, impair, or otherwise affect any 10 right or authority of the attorney general, the state, or any agency, officer, or 11 employee of the state, acting under any provision of the Louisiana Revised Statutes 12 of 1950, to institute or intervene in any proceeding. DIGEST The digest printed below was prepared by House Legislative Services. It constitutes no part of the legislative instrument. The keyword, one-liner, abstract, and digest do not constitute part of the law or proof or indicia of legislative intent. [R.S. 1:13(B) and 24:177(E)] HB 570 Original 2022 Regular Session Firment Abstract: Establishes the "SAFE Act" in Louisiana and prohibits procedures that alter the gender of minors. Proposed law states that the risks associated with the allowance of irreversible, permanently sterilizing genital gender reassignment surgery outweigh the scientific benefits. Proposed law defines "biological sex", "birth sex","sex""cross-sex hormone", "gender", "gender reassignment surgery", "gender transition", "gender transition procedures", "genital gender reassignment surgery", "medical healthcare professional", "non-genital gender reassignment surgery", "physician""puberty-blocking drugs", and "public funds". Proposed law prohibits certain medical services for medically diagnosed individuals. Proposed law prohibits any physician or other medical healthcare professional from performing any gender transition procedures on any person under 18 years of age or referring any person under 18 years of age to any medical doctor for gender transition procedures. Proposed law prohibits school personnel from encouraging or coercing a minor to withhold from the minor's parent or legal guardian the fact that the minor's perception of his gender is inconsistent with his sex. Proposed law prohibits the use of any public funds or funds allocated to hospitals for the purpose of financing a gender reassignment procedure. Page 9 of 10 CODING: Words in struck through type are deletions from existing law; words underscored are additions. HLS 22RS-397 ORIGINAL HB NO. 570 Proposed law excludes gender transition procedures for any person under 18 years of age from healthcare coverage reimbursement. Proposed law provides that any provision of gender transition procedures to a person under 18 years of age shall be considered unprofessional conduct and shall be subject to discipline by the licensing entity with jurisdiction over the physician, mental health provider, or other medical healthcare professional. (Adds R.S. 40:1091.1-1091.8) Page 10 of 10 CODING: Words in struck through type are deletions from existing law; words underscored are additions.