Text of MO SB 236 (2023)

FIRST REGULAR SESSION SENATE BILL NO. 236 102ND GENERAL ASSEMBLY INTRODUCED BY SENATOR HOSKINS. 0356S.01I KRISTINA MARTIN, Secretary AN ACT To amend chapter 191, RSMo, by adding thereto one new section relating to gender transition procedures. Be it enacted by the General Assembly of the State of Missouri, as follows: Section A. Chapter 191, RSMo, is amended by adding thereto 1 one new section, to be known as section 191.1720, to read as 2 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 6 male or female in the context of reproductive potential or 7 capacity, such as sex chromosomes, naturally occurring sex 8 hormones, gonads, and nonambiguous internal and external 9 genitalia present at birth, without regard to an 10 individual's psychological, chosen, or subjective experience 11 of gender; 12 (2) "Cross-sex hormones": 13 (a) Testosterone or other androgens given to 14 biological sex females in amounts that are larger or more 15 potent than would normally occur naturally in healthy 16 biological sex females; and 17 (b) Estrogen given to biological sex males in amounts 18 that are larger or more potent than would normally occur 19 naturally in healthy biological sex males; 20 SB 236 2 (3) "Gender", the psychological, behavioral, social, 21 and cultural aspects of being male or female; 22 (4) "Gender reassignment surgery", any medical or 23 surgical service that seeks to surgically alter or remove 24 healthy physical or anatomical characteristics or features 25 that are typical for the individual's biological sex in 26 order to instill or create physiological or anatomical 27 characteristics that resemble a sex different from the 28 individual's biological sex, including, but not limited to, 29 genital or nongenital gender reassignment surgery performed 30 for the purpose of assisting an individual with a gender 31 transition; 32 (5) "Gender transition", the process in which an 33 individual transitions from identifying with and living as a 34 gender that corresponds to his or her biological sex to 35 identifying and living as a gender different from his or her 36 biological sex, and may involve social, legal, or physical 37 changes; 38 (6) "Gender transition procedures": 39 (a) Any medical or surgical service, including, but 40 not limited to, physician's services, inpatient and 41 outpatient hospital services, or prescribed drugs, related 42 to gender transition that seeks to: 43 a. Alter or remove physical or anatomical 44 characteristics or features that are typical for the 45 individual's biological sex; or 46 b. Instill or create physiological or anatomical 47 characteristics that resemble a sex different from the 48 individual's biological sex, including, but not limited to: 49 (i) Medical services that provide puberty-blocking 50 drugs, cross-sex hormones, or other mechanisms to promote 51 SB 236 3 the development of feminizing or masculinizing features in 52 the opposite biological sex; or 53 (ii) Genital or nongenital gender reassignment surgery 54 performed for the purpose of assisting an individual with a 55 gender transition; 56 (b) The term "gender transition procedures" shall not 57 include: 58 a. Services to individuals born with a medically- 59 verifiable disorder of sex development, including, but not 60 limited to, an individual with external biological sex 61 characteristics that are irresolvably ambiguous, such as 62 those born with forty-six XX chromosomes with virilization, 63 forty-six XY chromosomes with undervirilization, or having 64 both ovarian and testicular tissue; 65 b. Services provided when a physician has otherwise 66 diagnosed an individual with a disorder of sexual 67 development and determined through genetic or biochemical 68 testing that the individual does not have normal sex 69 chromosome structure, sex steroid hormone production, or sex 70 steroid hormone action; 71 c. The treatment of any infection, injury, disease, or 72 disorder that has been caused by or exacerbated by the 73 performance of gender transition procedures regardless of 74 whether the gender transition procedure was performed in 75 accordance with state and federal law; or 76 d. Any procedure undertaken because the individual 77 suffers from a physical disorder, physical injury, or 78 physical illness that would, as certified by a physician, 79 place the individual in imminent danger of death or 80 impairment of a major bodily function unless surgery is 81 performed; 82 SB 236 4 (7) "Genital gender reassignment surgery", a medical 83 procedure performed for the purpose of assisting an 84 individual with a gender transition, including, but not 85 limited to: 86 (a) Surgical procedures such as penectomy, 87 orchiectomy, vaginoplasty, clitoroplasty, or vulvoplasty for 88 biologically male patients or hysterectomy or ovariectomy 89 for biologically female patients; 90 (b) Reconstruction of the fixed part of the urethra 91 with or without a metoidioplasty; or 92 (c) Phalloplasty, vaginectomy, scrotoplasty, or 93 implantation of erection or testicular prostheses for 94 biologically female patients; 95 (8) "Health care provider", an individual who is 96 licensed, certified, or otherwise authorized by the laws of 97 this state to administer health care in the ordinary course 98 of the practice of his or her profession; 99 (9) "Nongenital gender reassignment surgery", medical 100 procedures performed for the purpose of assisting an 101 individual with a gender transition, including, but not 102 limited to: 103 (a) Surgical procedures for biologically male 104 patients, such as augmentation mammoplasty, facial 105 feminization surgery, liposuction, lipofilling, voice 106 surgery, thyroid cartilage reduction, gluteal augmentation, 107 hair reconstruction, or various aesthetic procedures; or 108 (b) Surgical procedures for biologically female 109 patients, such as subcutaneous mastectomy, voice surgery, 110 liposuction, lipofilling, pectoral implants, or various 111 aesthetic procedures; 112 (10) "Physician", an individual who is licensed under 113 chapter 334; 114 SB 236 5 (11) "Puberty-blocking drugs", gonadotropin-releasing 115 hormone analogues or other synthetic drugs used in 116 biological sex males to stop luteinizing hormone secretion 117 and therefore testosterone secretion, or synthetic drugs 118 used in biological sex females that stop the production of 119 estrogens and progesterone, when used to delay or suppress 120 pubertal development in children for the purpose of 121 assisting an individual with a gender transition. 122 3. A physician or other health care provider shall not 123 provide gender transition procedures to any individual under 124 eighteen years of age and shall not refer any individual 125 under eighteen years of age to any health care provider for 126 gender transition procedures. 127 4. Any referral for or provision of gender transition 128 procedures to an individual under eighteen years of age 129 shall be considered unprofessional conduct and any health 130 care provider doing so may be subject to discipline by the 131 appropriate licensing entity or disciplinary review board 132 with competent jurisdiction in this state. 133 5. The provision of gender transition procedures to an 134 individual under eighteen years of age in violation of the 135 provisions of this section shall be considered grounds for a 136 cause of action against the health care provider for 137 personal injury or death under chapter 538 and such cause of 138 action shall be governed by the provisions of such chapter. 139 An individual under eighteen years of age upon whom gender 140 transition procedures were performed in violation of this 141 section may bring the cause of action either through a next 142 friend or his or her own name, subject to the provisions of 143 section 516.105. 144 