Text of MO SB 164 (2023)

EXPLANATION-Matter enclosed in bold-faced brackets [thus] in this bill is not enacted and is intended to be omitted in the law. FIRST REGULAR SESSION SENATE BILL NO. 164 102ND GENERAL ASSEMBLY INTRODUCED BY SENATOR CARTER. 1196S.01I KRISTINA MARTIN, Secretary AN ACT To repeal section 568.060, RSMo, and to enact in lieu thereof two new sections relating to gender transition procedures, with existing penalty provisions. Be it enacted by the General Assembly of the State of Missouri, as follows: Section A. Section 568.060, RSMo, is repealed and two new 1 sections enacted in lieu thereof, to be known as sections 2 191.1720 and 568.060, to read as follows: 3 191.1720. 1. This section shall be known and may be 1 cited as the "Missouri Save Adolescents from Experimentation 2 (SAFE) Act". 3 2. For purposes of this section, the following terms 4 mean: 5 (1) "Biological sex", the biological indication of the 6 physical condition of being male or female, which is 7 determined by a person's chromosomes, identified at birth by 8 a person's anatomy, and indicated on their birth 9 certificate, without regard to an individual's 10 psychological, chosen, or subjective experience of gender; 11 (2) "Cross-sex hormones": 12 (a) Testosterone or other androgens given to 13 biological sex females in amounts that are larger or more 14 potent than would normally occur naturally in healthy 15 biological sex females; and 16 SB 164 2 (b) Estrogen given to biological sex males in amounts 17 that are larger or more potent than would normally occur 18 naturally in healthy biological sex males; 19 (3) "Gender", the psychological, behavioral, social, 20 and cultural aspects of being male or female; 21 (4) "Gender reassignment surgery", any medical or 22 surgical service that alters or removes physical or 23 anatomical characteristics of an individual's biological sex 24 for the purpose of gender transition; 25 (5) "Gender transition", the process in which an 26 individual transitions from his or her biological sex to a 27 gender different from his or her biological sex, which may 28 involve social, legal, or physical changes; 29 (6) "Gender transition procedures": 30 (a) Any medical or surgical service, including, but 31 not limited to, physician's services, inpatient and 32 outpatient hospital services, or prescribed drugs, related 33 to gender transition that seeks to: 34 a. Alter or remove physical or anatomical 35 characteristics or features that are typical for the 36 individual's biological sex; or 37 b. Instill or create physiological or anatomical 38 characteristics that resemble a sex different from the 39 individual's biological sex, including, but not limited to: 40 (i) Medical services that provide puberty-blocking 41 drugs, cross-sex hormones, or other mechanisms to promote 42 the development of feminizing or masculinizing features in 43 the opposite biological sex; or 44 (ii) Genital or nongenital gender reassignment surgery 45 performed for the purpose of assisting an individual with a 46 gender transition; 47 SB 164 3 (b) The term "gender transition procedures" shall not 48 include: 49 a. Services to individuals born with medically- 50 verifiable disorders of sex development, including 51 individuals with external biological sex characteristics 52 that are irresolvably ambiguous, such as those born with 53 forty-six XX chromosomes with virilization or forty-six XY 54 chromosomes with undervirilization; 55 b. Services provided when a physician has otherwise 56 diagnosed an individual with a disorder of sexual 57 development and determined through genetic or biochemical 58 testing that the individual does not have normal sex 59 chromosome structure, sex steroid hormone production, or sex 60 steroid hormone action; or 61 c. The treatment of any infection, injury, disease, or 62 disorder that has been caused by or exacerbated by the 63 performance of gender transition procedures regardless of 64 whether the gender transition procedure was performed in 65 accordance with state and federal law; 66 (7) "Genital gender reassignment surgery", a medical 67 procedure performed for the purpose of assisting an 68 individual with a gender transition, including, but not 69 limited to: 70 (a) Surgical procedures such as penectomy, 71 orchiectomy, vaginoplasty, clitoroplasty, or vulvoplasty for 72 biologically male patients or hysterectomy or ovariectomy 73 for biologically female patients; 74 (b) Reconstruction of the fixed part of the urethra 75 with or without a metoidioplasty; or 76 (c) Phalloplasty, vaginectomy, scrotoplasty, or 77 implantation of erection or testicular prostheses for 78 biologically female patients; 79 SB 164 4 (8) "Health care provider", an individual who is 80 licensed, certified, or otherwise authorized by the laws of 81 this state to administer health care in the ordinary course 82 of the practice of his or her profession; 83 (9) "Nongenital gender reassignment surgery", medical 84 procedures performed for the purpose of assisting an 85 individual with a gender transition, including, but not 86 limited to: 87 (a) Surgical procedures for biologically male 88 patients, such as augmentation mammoplasty, facial 89 feminization surgery, liposuction, lipofilling, voice 90 surgery, thyroid cartilage reduction, gluteal augmentation, 91 hair reconstruction, or various aesthetic procedures; or 92 (b) Surgical procedures for biologically female 93 patients, such as subcutaneous mastectomy, voice surgery, 94 liposuction, lipofilling, pectoral implants, or various 95 aesthetic procedures; 96 (10) "Physician", an individual who is licensed under 97 chapter 334; 98 (11) "Puberty-blocking drugs", gonadotropin-releasing 99 hormone analogues or other synthetic drugs used in 100 biological sex males to stop luteinizing hormone secretion 101 and therefore testosterone secretion, or synthetic drugs 102 used in biological sex females that stop the production of 103 estrogens and progesterone, when used to delay or suppress 104 pubertal development in children for the purpose of 105 assisting an individual with a gender transition. 106 3. A physician or other health care provider shall not 107 provide gender transition procedures to any individual under 108 eighteen years of age and shall not refer any individual 109 under eighteen years of age to any health care provider for 110 gender transition procedures. 111 SB 164 5 4. Any physician or health care provider who willfully 112 and knowingly does or assists any prohibited action under 113 subsection 3 of this section shall have his or her license, 114 application for license, or authority to practice his or her 115 profession as a physician, surgeon, nurse, or other health 116 care provider in the state of Missouri rejected or revoked 117 by his or her respective licensing board. 118 5. The provision of gender transition procedures to an 119 individual under eighteen years of age in violation of the 120 provisions of this section shall be considered grounds for a 121 cause of action against the health care provider for 122 personal injury or death under chapter 538 and such cause of 123 action shall be governed by the provisions of such chapter. 124 An individual under eighteen years of age upon whom gender 125 transition procedures were performed in violation of this 126 section may bring the cause of action either through a next 127 friend or his or her own name, subject to the provisions of 128 section 516.105. 129 568.060. 1. As used in this section, the following 1 terms shall mean: 2 (1) "Abuse", the infliction of physical, sexual, or 3 mental injury against a child by any person eighteen years 4 of age or older. For purposes of this section, abuse shall 5 not include injury inflicted on a child by accidental means 6 by a person with care, custody, or control of the child, or 7 discipline of a child by a person with care, custody, or 8 control of the child, including spanking, in a reasonable 9 manner; 10 (2) "Abusive head trauma", a serious physical injury 11 to the head or brain caused by any means, including but not 12 limited to shaking, jerking, pushing, pulling, slamming, 13 hitting, or kicking; 14 SB 164 6 (3) "Mental injury", an injury to the intellectual or 15 psychological capacity or the emotional condition of a child 16 as evidenced by an observable and substantial impairment of 17 the ability of the child to function within his or her 18 normal range of performance or behavior; 19 (4) "Neglect", the failure to provide, by those 20 responsible for the care, custody, and control of a child 21 under the age of eighteen years, the care reasonable and 22 necessary to maintain the physical and mental health of the 23 child, when such failure presents a substantial probability 24 that death or physical injury or sexual injury would result; 25 (5) "Physical injury", physical pain, illness, or any 26 impairment of physical condition, including but not limited 27 to bruising, lacerations, hematomas, welts, or permanent or 28 temporary disfigurement and impairment of any bodily 29 function or organ; 30 (6) "Serious emotional injury", an injury that creates 31 a substantial risk of temporary or permanent medical or 32 psychological damage, manifested by impairment of a 33 behavioral, cognitive, or physical condition. Serious 34 emotional injury shall be established by testimony of 35 qualified experts upon the reasonable expectation of 36 probable harm to a reasonable degree of medical or 37 psychological certainty; 38 (7) "Serious physical injury", a physical injury that 39 creates a substantial risk of death or that causes serious 40 disfigurement or protracted loss or impairment of the 41 function of any part of the body. 42 2. A person commits the offense of abuse or neglect of 43 a child if such person knowingly causes a child who is less 44 than eighteen years of age: 45 SB 164 7 (1) To suffer physical or mental injury as a result of 46 abuse or neglect; or 47 (2) To be placed in a situation in which the child may 48 suffer physical or mental injury as the result of abuse or 49 neglect. 50 3. A person commits the offense of abuse or neglect of 51 a child if such person recklessly causes a child who is less 52 than eighteen years of age to suffer from abusive head 53 trauma. 54 4. A person commits the offense of abuse or neglect of 55 a child if such person coerces a child who is less than 56 eighteen years of age to undergo any surgical or hormonal 57 treatment for the purpose of gender reassignment, as such 58 term is defined in section 191.1720. 59 5. A person does not commit the offense of abuse or 60 neglect of a child by virtue of the sole fact that the 61 person delivers or allows the delivery of a child to a 62 provider of emergency services. 63 [5.]6. The offense of abuse or neglect of a child is: 64 (1) A class D felony, without eligibility for 65 probation, parole, or conditional release until the 66 defendant has served no less than one year of such sentence, 67 unless the person has previously been found guilty of a 68 violation of this section or of a violation of the law of 69 any other jurisdiction that prohibits the same or similar 70 conduct or the injury inflicted on the child is a serious 71 emotional injury or a serious physical injury, in which case 72 abuse or neglect of a child is a class B felony, without 73 eligibility for probation or parole until the defendant has 74 served not less than five years of such sentence; or 75 SB 164 8 (2) A class A felony if the child dies as a result of 76 injuries sustained from conduct chargeable under the 77 provisions of this section. 78 [6.]7. Notwithstanding subsection [5]6 of this section 79 to the contrary, the offense of abuse or neglect of a child 80 is a class A felony, without eligibility for probation, 81 parole, or conditional release until the defendant has 82 served not less than fifteen years of such sentence, if: 83 (1) The injury is a serious emotional injury or a 84 serious physical injury; 85 (2) The child is less than fourteen years of age; and 86 (3) The injury is the result of sexual abuse or sexual 87 abuse in the first degree as defined under section 566.100 88 or sexual exploitation of a minor as defined under section 89 573.023. 90 [7.]8. The circuit or prosecuting attorney may refer a 91 person who is suspected of abuse or neglect of a child to an 92 appropriate public or private agency for treatment or 93 counseling so long as the agency has consented to taking 94 such referrals. Nothing in this subsection shall limit the 95 discretion of the circuit or prosecuting attorney to 96 prosecute a person who has been referred for treatment or 97 counseling pursuant to this subsection. 98 [8.]9. Nothing in this section shall be construed to 99 alter the requirement that every element of any crime 100 referred to herein must be proven beyond a reasonable doubt. 101 [9.]10. Discipline, including spanking administered in 102 a reasonable manner, shall not be construed to be abuse 103 under this section. 104 