Text of MO SB 699 (2022)

EXPLANATION-Matter enclosed in bold-faced brackets [thus] in this bill is not enacted and is intended to be omitted in the law. SECOND REGULAR SESSION SENATE BILL NO. 699 101ST GENERAL ASSEMBLY INTRODUCED BY SENATOR MOON. 3753S.02I ADRIANE D. CROUSE, Secretary AN ACT To repeal sections 1.205, 170.015, 188.010, 188.015, 188.017, 188.018, 188.020, 188.021, 188.023, 188.025, 188.026, 188.027, 188.028, 188.030, 188.031, 188.033, 188.035, 188.036, 188.038, 188.039, 188.043, 188.044, 188.047, 188.052, 188.055, 188.056, 188.057, 188.058, 188.060, 188.065, 188.070, 188.075, 188.080, 188.100, 188.105, 188.110, 188.115, 188.120, 188.125, 188.160, 188.200, 188.205, 188.210, 188.215, 188.220, 188.230, 188.250, 188.325, 188.335, 188.375, 191.211, 191.320, 191.724, 191.831, 191.923, 191.975, 192.665, 192.667, 194.390, 196.1127, 197.150, 197.152, 197.158, 197.160, 197.162, 197.165, 197.200, 197.205, 197.215, 197.220, 197.225, 197.230, 197.235, 197.240, 197.285, 197.287, 197.289, 197.293, 197.295, 197.315, 208.655, 334.100, 334.245, 376.805, 376.1199, 491.060, 556.061, 562.031, 562.071, 563.026, 565.300, 574.200, 595.027, and 595.120, RSMo, and to enact in lieu thereof forty-six new sections relating to abortion, with penalty provisions and an emergency clause. Be it enacted by the General Assembly of the State of Missouri, as follows: Section A. Sections 1.205, 170.015, 188.010, 188.015, 1 188.017, 188.018, 188.020, 188.021, 188.023, 188.025, 188.026, 2 188.027, 188.028, 188.030, 188.031, 188.033, 188.035, 188.036, 3 188.038, 188.039, 188.043, 188.044, 188.047, 188.052, 188.055, 4 188.056, 188.057, 188.058, 188.060, 188.065, 188.070, 188.075, 5 188.080, 188.100, 188.105, 188.110, 188.115, 188.120, 188.125, 6 188.160, 188.200, 188.205, 188.210, 188.215, 188.220, 188.230, 7 188.250, 188.325, 188.335, 188.375, 191.211, 191.320, 191.724, 8 191.831, 191.923, 191.975, 192.665, 192.667, 194.390, 196.1127, 9 SB 699 2 197.150, 197.152, 197.158, 197.160, 197.162, 197.165, 197.200, 10 197.205, 197.215, 197.220, 197.225, 197.230, 197.235, 197.240, 11 197.285, 197.287, 197.289, 197.293, 197.295, 197.315, 208.655, 12 334.100, 334.245, 376.805, 376.1199, 491.060, 556.061, 562.031, 13 562.071, 563.026, 565.300, 574.200, 595.027, and 595.120, RSMo, 14 are repealed and forty-six new sections enacted in lieu thereof, 15 to be known as sections 1.205, 170.015, 188.010, 188.015, 16 188.020, 188.023, 188.125, 191.211, 191.320, 191.724, 191.831, 17 191.923, 191.975, 192.665, 192.667, 196.1127, 197.150, 197.152, 18 197.158, 197.160, 197.162, 197.165, 197.200, 197.205, 197.215, 19 197.220, 197.225, 197.230, 197.235, 197.240, 197.285, 197.287, 20 197.289, 197.293, 197.295, 197.315, 334.100, 376.1199, 491.060, 21 556.061, 562.031, 562.071, 563.026, 565.015, 595.027, and 22 595.120, to read as follows: 23 1.205. 1. The general assembly of this state finds 1 that: 2 (1) The life of each human being begins at conception; 3 (2) Unborn children have protectable interests in 4 life, health, and well-being; 5 (3) The natural parents of unborn children have 6 protectable interests in the life, health, and well-being of 7 their unborn child. 8 2. [Effective January 1, 1988,] The laws of this state 9 shall be interpreted and construed to acknowledge on behalf 10 of the unborn child at every stage of development, all the 11 rights, privileges, and immunities available to other 12 persons, citizens, and residents of this state[, subject 13 only to] in accordance with the Constitution of the United 14 States[, and decisional interpretations thereof by the 15 United States Supreme Court and specific provisions to the 16 contrary in the statutes and constitution of this state]. 17 SB 699 3 3. As used in this section, the term "unborn children" 18 or "unborn child" shall include all unborn child or children 19 or the offspring of human beings from the moment of 20 conception, as defined in section 188.015, until birth at 21 every stage of biological development. 22 4. Nothing in this section shall be interpreted as 23 creating a cause of action against a woman for indirectly 24 harming her unborn child by failing to properly care for 25 herself or by failing to follow any particular program of 26 prenatal care. 27 170.015. 1. Any course materials and instruction 1 relating to human sexuality and sexually transmitted 2 diseases shall be medically and factually accurate and shall: 3 (1) Present abstinence from sexual activity as the 4 preferred choice of behavior in relation to all sexual 5 activity for unmarried pupils because it is the only method 6 that is one hundred percent effective in preventing 7 pregnancy, sexually transmitted diseases and the emotional 8 trauma associated with adolescent sexual activity, and 9 advise students that teenage sexual activity places them at 10 a higher risk of dropping out of school because of the 11 consequences of sexually transmitted diseases and unplanned 12 pregnancy; 13 (2) Stress that sexually transmitted diseases are 14 serious, possible, health hazards of sexual activity. 15 Pupils shall be provided with the latest medical information 16 regarding exposure to human immunodeficiency virus, acquired 17 immune deficiency syndrome (AIDS), human papilloma virus, 18 hepatitis and other sexually transmitted diseases; 19 (3) Present students with the latest medically factual 20 information regarding both the possible side effects and 21 health benefits of all forms of contraception, including the 22 SB 699 4 success and failure rates for the prevention of pregnancy 23 and sexually transmitted diseases; or shall present students 24 with information on contraceptives and pregnancy in a manner 25 consistent with the provisions of the federal abstinence 26 education law, 42 U.S.C. Section 710; 27 (4) Include a discussion of the possible emotional and 28 psychological consequences of preadolescent and adolescent 29 sexual activity and the consequences of adolescent 30 pregnancy, as well as the advantages of adoption, including 31 the adoption of special needs children, and the processes 32 involved in making an adoption plan; 33 (5) Teach skills of conflict management, personal 34 responsibility and positive self-esteem through discussion 35 and role-playing at appropriate grade levels to emphasize 36 that the pupil has the power to control personal behavior. 37 Pupils shall be encouraged to base their actions on 38 reasoning, self-discipline, sense of responsibility, self- 39 control, and ethical considerations, such as respect for 40 one's self and others. Pupils shall be taught not to make 41 unwanted physical and verbal sexual advances or otherwise 42 exploit another person. Pupils shall be taught to resist 43 unwanted sexual advances and other negative peer pressure; 44 (6) Advise pupils of the laws pertaining to their 45 financial responsibility to children born in and out of 46 wedlock and advise pupils of the provisions of chapter 566 47 pertaining to statutory rape; 48 (7) Teach pupils about the dangers of sexual 49 predators, including online predators when using electronic 50 communication methods such as the internet, cell phones, 51 text messages, chat rooms, email, and instant messaging 52 programs. Pupils shall be taught how to behave responsibly 53 and remain safe on the internet and the importance of having 54 SB 699 5 open communication with responsible adults and reporting any 55 inappropriate situation, activity, or abuse to a responsible 56 adult, and depending on intent and content, to local law 57 enforcement, the Federal Bureau of Investigation, or the 58 National Center for Missing & Exploited Children's 59 CyberTipline; 60 (8) Teach pupils about the consequences, both personal 61 and legal, of inappropriate text messaging, even among 62 friends; and 63 (9) Teach pupils about sexual harassment, sexual 64 violence, and consent: 65 (a) For the purposes of this subdivision, the term 66 "consent" shall mean a freely given agreement to the conduct 67 at issue by a competent person. An expression of lack of 68 consent through words or conduct means there is no consent. 69 Lack of verbal or physical resistance or submission 70 resulting from the use of force, threat of force, or placing 71 another person in fear does not constitute consent. A 72 current or previous dating or social or sexual relationship 73 by itself or the manner of dress of the person involved with 74 the accused in the conduct at issue shall not constitute 75 consent; 76 (b) For the purposes of this subdivision, the term 77 "sexual harassment" shall mean uninvited and unwelcome 78 verbal or physical behavior of a sexual nature especially by 79 a person in authority toward a subordinate; 80 (c) For the purposes of this subdivision, the term 81 "sexual violence" shall mean causing or attempting to cause 82 another to engage involuntarily in any sexual act by force, 83 threat of force, duress, or without that person's consent. 84 2. Policies concerning referrals and parental 85 notification regarding contraception shall be determined by 86 SB 699 6 local school boards or charter schools, consistent with the 87 provisions of section 167.611. 88 3. A school district or charter school which provides 89 human sexuality instruction may separate students according 90 to gender for instructional purposes. 91 4. The board of a school district or charter school 92 shall determine the specific content of the district's or 93 school's instruction in human sexuality, in accordance with 94 subsections 1 to 3 of this section, and shall ensure that 95 all instruction in human sexuality is appropriate to the age 96 of the students receiving such instruction. 97 5. Before providing any course materials and 98 instruction relating to human sexuality and sexually 99 transmitted diseases to any student, regardless of the 100 course title or description, a school district or charter 101 school shall notify the parent or legal guardian of each 102 student enrolled in the district or school of[: 103 (1)] the basic content of the district's or school's 104 human sexuality and sexually transmitted diseases course 105 materials and instruction to be provided to the student[; and 106 (2) The parent's right to remove]. After receipt of 107 such basic content, the parent or legal guardian of each 108 student shall indicate in writing whether the parent or 109 legal guardian desires to allow the district or school to 110 include the student [from] in any part of the district's or 111 school's human sexuality and sexually transmitted diseases 112 course materials and instruction. No school shall provide 113 any course materials and instruction relating to human 114 sexuality and sexually transmitted diseases to a student 115 until the district or school has received such written 116 indication from the student's parent or legal guardian that 117 SB 699 7 the student may receive such course materials and 118 instruction. 119 6. A school district or charter school shall make all 120 curriculum materials used in the district's or school's 121 human sexuality instruction available for public inspection 122 pursuant to chapter 610 prior to the use of such materials 123 in actual instruction. 124 [7. No school district or charter school, or its 125 personnel or agents, shall provide abortion services, or 126 permit a person or entity to offer, sponsor, or furnish in 127 any manner any course materials or instruction relating to 128 human sexuality or sexually transmitted diseases to its 129 students if such person or entity is a provider of abortion 130 services. 131 8. As used in this section, the following terms mean: 132 (1) "Abortion", the same meaning as such term is 133 defined in section 188.015; 134 (2) "Abortion services": 135 (a) Performing, inducing, or assisting in the 136 performance or inducing of an abortion which is not 137 necessary to save the life of the mother; 138 (b) Encouraging a patient to have an abortion or 139 referring a patient for an abortion, which is not necessary 140 to save the life of the mother; or 141 (c) Developing or dispensing drugs, chemicals, or 142 devices intended to be used to induce an abortion which is 143 not necessary to save the life of the mother.] 144 7. (1) Violation of this section is a class C 145 misdemeanor. 146 (2) In any legal proceeding related to a violation of 147 this section, no entity directly or indirectly receiving any 148 taxpayer funds shall provide any legal advice, counsel, or 149 SB 699 8 representation to any person or entity that violates this 150 section. 151 188.010. In recognition that Almighty God is the 1 author of life, that all men and women are "endowed by their 2 Creator with certain unalienable Rights, that among these 3 are Life", and that Article I, Section 2 of the Constitution 4 of Missouri provides that all persons have a natural right 5 to life, it is the intention of the general assembly of the 6 state of Missouri to: 7 (1) Defend the right to life of all humans, born and 8 unborn; 9 (2) Declare that the state and all of its political 10 subdivisions are a "sanctuary of life" that protects 11 pregnant women and their unborn children; and 12 (3) [Regulate] Abolish abortion [to the full extent 13 permitted by the Constitution of the United States, 14 decisions of the United States Supreme Court, and federal 15 statutes] in this state. 16 188.015. As used in this chapter, the following terms 1 mean: 2 (1) "Abortion": 3 (a) The act of using or prescribing any instrument, 4 device, medicine, drug, or any other means or substance with 5 the intent to destroy the life of an embryo or fetus in his 6 or her mother's womb; or 7 (b) The intentional termination of the pregnancy of a 8 mother by using or prescribing any instrument, device, 9 medicine, drug, or other means or substance with an 10 intention other than to increase the probability of a live 11 birth or to remove a dead unborn child; 12 SB 699 9 (2) ["Abortion facility", a clinic, physician's 13 office, or any other place or facility in which abortions 14 are performed or induced other than a hospital; 15 (3)] "Conception", the fertilization of the ovum of a 16 female by a sperm of a male; 17 [(4) "Department", the department of health and senior 18 services; 19 (5) "Down Syndrome", the same meaning as defined in 20 section 191.923; 21 (6) "Gestational age", length of pregnancy as measured 22 from the first day of the woman's last menstrual period; 23 (7)] (3) "Medical emergency", a condition which, based 24 on reasonable medical judgment, so complicates the medical 25 condition of a pregnant woman as to necessitate the 26 immediate abortion of her pregnancy to avert the death of 27 the pregnant woman or for which a delay will create a 28 serious risk of substantial and irreversible physical 29 impairment of a major bodily function of the pregnant woman; 30 [(8) "Physician", any person licensed to practice 31 medicine in this state by the state board of registration 32 for the healing arts; 33 (9) "Reasonable medical judgment", a medical judgment 34 that would be made by a reasonably prudent physician, 35 knowledgeable about the case and the treatment possibilities 36 with respect to the medical conditions involved; 37 (10)] (4) "Unborn child", the offspring of human 38 beings from the moment of conception until birth and at 39 every stage of its biological development, including the 40 human conceptus, zygote, morula, blastocyst, embryo, and 41 fetus[; 42 (11) "Viability" or "viable", that stage of fetal 43 development when the life of the unborn child may be 44 SB 699 10 continued indefinitely outside the womb by natural or 45 artificial life-supportive systems; 46 (12) "Viable pregnancy" or "viable intrauterine 47 pregnancy", in the first trimester of pregnancy, an 48 intrauterine pregnancy that can potentially result in a 49 liveborn baby]. 50 188.020. No person shall perform or induce an abortion 1 [except a physician]. 2 188.023. Any licensed health care professional who 1 delivers a baby [or performs an abortion], who has prima 2 facie evidence that a patient has been the victim of 3 statutory rape in the first degree or statutory rape in the 4 second degree, or if the patient is under the age of 5 eighteen, that [he or she] the patient has been a victim of 6 sexual abuse, including rape in the first or second degree, 7 or incest, shall be required to report such offenses in the 8 same manner as provided for by section 210.115. 9 188.125. 1. It is the intent of the general assembly 1 to acknowledge the right of an alternatives to abortion 2 agency to operate freely and engage in speech without 3 governmental interference as protected by the Constitution 4 of the United States and the Constitution and laws of 5 Missouri, the right of a person not to be compelled by the 6 government to participate in abortion contrary to his, her, 7 or its religious beliefs or moral convictions, and that the 8 Constitution of the United States and the Constitution and 9 laws of Missouri shall be interpreted, construed, applied, 10 and enforced to fully protect such rights. 11 2. A political subdivision of this state is preempted 12 from enacting, adopting, maintaining, or enforcing any 13 order, ordinance, rule, regulation, policy, or other similar 14 measure that prohibits, restricts, limits, controls, 15 SB 699 11 directs, interferes with, or otherwise adversely affects an 16 alternatives to abortion agency or its officers', agents', 17 employees', or volunteers' operations or speech including, 18 but not limited to, counseling, referrals, or education of, 19 advertising or information to, or other communications with, 20 clients, patients, other persons, or the public. 21 3. Nothing in subsection 2 of this section shall 22 preclude or preempt a political subdivision of this state 23 from exercising its lawful authority to regulate zoning or 24 land use or to enforce a building or fire code regulation; 25 provided that, such political subdivision treats an 26 alternatives to abortion agency in the same manner as a 27 similarly situated agency and that such authority is not 28 used to circumvent the intent of subsection 2 of this 29 section. 30 4. [A political subdivision of this state is preempted 31 from enacting, adopting, maintaining, or enforcing any 32 order, ordinance, rule, regulation, policy, or other similar 33 measure that has the purpose or effect of requiring a person 34 to directly or indirectly participate in abortion if such 35 participation is contrary to the religious beliefs or moral 36 convictions of such person. 37 5. A political subdivision of this state is preempted 38 from enacting, adopting, maintaining, or enforcing any 39 order, ordinance, rule, regulation, policy, or other similar 40 measure requiring a real estate broker, real estate 41 salesperson, real estate broker-salesperson, appraisal firm, 42 appraiser, as such terms are defined in chapter 339, a 43 property owner, or any other person to buy, sell, exchange, 44 purchase, rent, lease, advertise for, or otherwise conduct 45 real estate transactions for, to, or with an abortion 46 facility or for, to, or with a person for the purpose of 47 SB 699 12 performing or inducing an abortion not necessary to save the 48 life of the mother, if such requirement is contrary to the 49 religious beliefs or moral convictions of such real estate 50 broker, real estate salesperson, real estate broker- 51 salesperson, appraisal firm, appraiser, property owner, or 52 other person. 53 6. A political subdivision of this state is preempted 54 from enacting, adopting, maintaining, or enforcing any 55 order, ordinance, rule, regulation, policy, or other similar 56 measure requiring an employer, employee, health plan 57 provider, health plan sponsor, health care provider, or any 58 other person to provide coverage for or to participate in a 59 health plan that includes benefits that are not otherwise 60 required by state law. 61 7. In any action to enforce the provisions of this 62 section, a court of competent jurisdiction may order 63 injunctive or other equitable relief, recovery of damages or 64 other legal remedies, or both, as well as payment of 65 reasonable attorney's fees, costs, and expenses. The relief 66 and remedies set forth shall not be deemed exclusive and 67 shall be in addition to any other relief or remedies 68 permitted by law. 69 8.] In addition to a private cause of action by a 70 person whose rights are violated contrary to the provisions 71 of this section, the attorney general is also authorized to 72 bring a cause of action to defend the rights guaranteed 73 under this section. 74 [9.] 5. Nothing in this section shall be construed to 75 prohibit a political subdivision from enacting, adopting, 76 maintaining, or enforcing any order, ordinance, rule, 77 regulation, policy, or other similar measure to assist 78 pregnant women to carry their unborn children to term or to 79 SB 699 13 assist women in caring for their dependent children or 80 placing their children for adoption including, but not 81 limited to, by funding or otherwise assisting an 82 alternatives to abortion agency to provide services to such 83 women and children. 84 6. An employee of an alternatives to abortion agency 85 shall not voluntarily disclose information communicated to 86 the employee relating to and in connection with an 87 individual who has presented themselves to the agency for 88 the purpose of seeking an alternative to an abortion, except 89 by permission of the individual. The information shall be 90 considered privileged and confidential; provided, that such 91 information may be shared with other employees of the agency 92 for purposes of providing services to that individual. 93 [10.] 7. As used in this section, [the following terms 94 mean: 95 (1)] "alternatives to abortion agency" shall mean: 96 (a) A maternity home as defined in section 135.600; 97 (b) A pregnancy resource center as defined in section 98 135.630; or 99 (c) An agency or entity that has the primary purpose 100 of providing services or counseling to pregnant women to 101 assist such women in carrying their unborn children to term 102 instead of having abortions and to assist such women in 103 caring for their dependent children or placing their 104 children for adoption, as described in section 188.325, 105 regardless of whether such agency or entity is receiving 106 funding or reimbursement from the state for such purposes[; 107 (2) "Participate in abortion": 108 (a) To undergo an abortion; or 109 (b) To perform or induce, assist in, refer or counsel 110 for, advocate for, promote, procure, reimburse for, or 111 SB 699 14 provide health plan coverage for an abortion not necessary 112 to save the life of the mother]. 113 191.211. State expenditures for new programs and 1 initiatives enacted by sections 103.178, 143.999, [188.230,] 2 191.231, 191.825 to 191.839, 208.177, 208.178, 208.179 and 3 208.181, 211.490, 285.240, 337.093, 374.126, 376.891 to 4 376.894, 431.064, 660.016, 660.017 and 660.018, and the 5 state expenditures for the new initiatives and expansion of 6 programs enacted by revising sections 105.711 and 105.721, 7 191.520, 191.600, 198.090, 208.151, 208.152 and 208.215, as 8 provided by H.B. 564, 1993, shall be funded exclusively by 9 federal funds and the funding sources established in 10 sections 149.011, 149.015, 149.035, 149.061, 149.065, 11 149.160, 149.170, 149.180, 149.190 and 149.192, and no 12 future general revenue shall be appropriated to fund such 13 new programs or expansions. 14 191.320. The department may contract with tertiary 1 genetic centers to provide genetic diagnostic and counseling 2 services, to initiate and conduct investigations of the 3 causes, mortality, methods of treatment, prevention and cure 4 of genetic disorders and related birth defects, and to 5 develop and administer programs and activities which aid in 6 the prevention or treatment of a particular genetic 7 disorder. It may establish outreach clinics to be located 8 throughout the state. The department may divide the state 9 into regions for this purpose. The boundaries of such 10 regions, to the extent practicable, shall be contiguous with 11 relevant boundaries of political subdivisions and health 12 service areas. These centers and clinics may provide 13 genetic diagnostic evaluations, treatment, counseling and 14 follow-up for families with or at high risk for a genetic 15 disease, such as sickle cell anemia, cystic fibrosis, 16 SB 699 15 inherited cardiovascular disease, inherited forms of mental 17 retardations, or hemophilia, provided that such evaluations, 18 treatment, and counseling shall not include referral for 19 abortions [unless such abortions are certified in writing by 20 a physician that, in his professional judgment, the life of 21 the mother would be endangered if the fetus were carried to 22 term]. 23 191.724. 1. The rights guaranteed under this section 1 are in addition to the rights guaranteed under section 2 376.805, relating to health plan coverage of abortion, and 3 section 376.1199, relating to health plan coverage of 4 certain obstetrical and gynecological benefits and 5 pharmaceutical coverage. 6 2. No employee, self-employed person, or any other 7 person shall be compelled to obtain coverage for, or be 8 discriminated against or penalized for declining or refusing 9 coverage for, [abortion,] contraception[,] or sterilization 10 in a health plan if such items or procedures are contrary to 11 the religious beliefs or moral convictions of such employee 12 or person. 13 3. No employer, health plan provider, health plan 14 sponsor, health care provider, or any other person or entity 15 shall be compelled to provide coverage for, or be 16 discriminated against or penalized for declining or refusing 17 coverage for, [abortion,] contraception[,] or sterilization 18 in a health plan if such items or procedures are contrary to 19 the religious beliefs or moral convictions of such employer, 20 health plan provider, health plan sponsor, health care 21 provider, person, or entity. 22 4. No governmental entity, public official, or entity 23 acting in a governmental capacity shall discriminate against 24 or penalize an employee, self-employed person, employer, 25 SB 699 16 health plan provider, health plan sponsor, health care 26 provider, or any other person or entity because of such 27 employee's, self-employed person's, employer's, health plan 28 provider's, health plan sponsor's, health care provider's, 29 or other person's or entity's unwillingness, based on 30 religious beliefs or moral convictions, to obtain or provide 31 coverage for, pay for, participate in, or refer for, 32 [abortion,] contraception[,] or sterilization in a health 33 plan. 34 5. Whenever the attorney general has a reasonable 35 cause to believe that any person or entity or group of 36 persons or entities is being, has been, or is threatened to 37 be denied any of the rights granted by this section or other 38 law that protects the religious beliefs or moral convictions 39 of such persons or entities, and such denial raises an issue 40 of general public importance, the attorney general may bring 41 a civil action in any appropriate state or federal court. 42 Such complaint shall set forth the facts and request such 43 appropriate relief, including but not limited to an 44 application for a permanent or temporary injunction, 45 restraining order, mandamus, an order under the federal 46 Administrative Procedure Act, Religious Freedom Restoration 47 Act, or other federal law, an order under section 1.302 48 relating to free exercise of religion, or other order 49 against the governmental entity, public official, or entity 50 acting in a governmental capacity responsible for such 51 denial or threatened denial of rights, as the attorney 52 general deems necessary to ensure the full enjoyment of the 53 rights granted by law. Nothing contained herein shall 54 preclude a private cause of action against a governmental 55 entity, public official, or entity acting in a governmental 56 capacity by any person or entity or group of persons or 57 SB 699 17 entities aggrieved by a violation of this section or other 58 law that protects the religious beliefs or moral convictions 59 of such persons or entities, or be considered a limitation 60 on any other remedy permitted by law. A court may order any 61 appropriate relief, including recovery of damages, payment 62 of reasonable attorney's fees, costs, and expenses. 63 6. For purposes of this section, "sterilization" shall 64 mean any elective medical procedure for which the sole 65 purpose is to make an individual incapable of reproduction. 66 191.831. 1. There is hereby established in the state 1 treasury a "Health Initiatives Fund", to which shall be 2 deposited all revenues designated for the fund under 3 subsection 8 of section 149.015, and subsection 3 of section 4 149.160, and section 167.609, and all other funds donated to 5 the fund or otherwise deposited pursuant to law. The state 6 treasurer shall administer the fund. Money in the fund 7 shall be appropriated to provide funding for implementing 8 the new programs and initiatives established by sections 9 105.711 and 105.721. The moneys in the fund may further be 10 used to fund those programs established by sections 191.411, 11 191.520 and 191.600, sections 208.151 and 208.152, and 12 sections 103.178, 143.999, 167.600 to 167.621, [188.230,] 13 191.211, 191.231, 191.825 to 191.839, 192.013, 208.177, 14 208.178, 208.179 and 208.181, 211.490, 285.240, 337.093, 15 374.126, 376.891 to 376.894, 431.064, 660.016, 660.017 and 16 660.018; in addition, not less than fifteen percent of the 17 proceeds deposited to the health initiative fund pursuant to 18 sections 149.015 and 149.160 shall be appropriated annually 19 to provide funding for the C-STAR substance abuse 20 rehabilitation program of the department of mental health, 21 or its successor program, and a C-STAR pilot project 22 developed by the director of the division of alcohol and 23 SB 699 18 drug abuse and the director of the department of corrections 24 as an alternative to incarceration, as provided in 25 subsections 2, 3, and 4 of this section. Such pilot project 26 shall be known as the "Alt-care" program. In addition, some 27 of the proceeds deposited to the health initiatives fund 28 pursuant to sections 149.015 and 149.160 shall be 29 appropriated annually to the division of alcohol and drug 30 abuse of the department of mental health to be used for the 31 administration and oversight of the substance abuse traffic 32 offenders program defined in section 302.010 and section 33 577.001. The provisions of section 33.080 to the contrary 34 notwithstanding, money in the health initiatives fund shall 35 not be transferred at the close of the biennium to the 36 general revenue fund. 37 2. The director of the division of alcohol and drug 38 abuse and the director of the department of corrections 39 shall develop and administer a pilot project to provide a 40 comprehensive substance abuse treatment and rehabilitation 41 program as an alternative to incarceration, hereinafter 42 referred to as "Alt-care". Alt-care shall be funded using 43 money provided under subsection 1 of this section through 44 the Missouri Medicaid program, the C-STAR program of the 45 department of mental health, and the division of alcohol and 46 drug abuse's purchase-of-service system. Alt-care shall 47 offer a flexible combination of clinical services and living 48 arrangements individually adapted to each client and her 49 children. Alt-care shall consist of the following 50 components: 51 (1) Assessment and treatment planning; 52 (2) Community support to provide continuity, 53 monitoring of progress and access to services and resources; 54 (3) Counseling from individual to family therapy; 55 SB 699 19 (4) Day treatment services which include accessibility 56 seven days per week, transportation to and from the Alt-care 57 program, weekly drug testing, leisure activities, weekly 58 events for families and companions, job and education 59 preparedness training, peer support and self-help and daily 60 living skills; and 61 (5) Living arrangement options which are permanent, 62 substance-free and conducive to treatment and recovery. 63 3. Any female who is pregnant or is the custodial 64 parent of a child or children under the age of twelve years, 65 and who has pleaded guilty to or found guilty of violating 66 the provisions of chapter 195, and whose controlled 67 substance abuse was a precipitating or contributing factor 68 in the commission of the offense, and who is placed on 69 probation may be required, as a condition of probation, to 70 participate in Alt-care, if space is available in the pilot 71 project area. Determinations of eligibility for the 72 program, placement, and continued participation shall be 73 made by the division of alcohol and drug abuse, in 74 consultation with the department of corrections. 75 4. The availability of space in Alt-care shall be 76 determined by the director of the division of alcohol and 77 drug abuse in conjunction with the director of the 78 department of corrections. If the sentencing court is 79 advised that there is no space available, the court shall 80 consider other authorized dispositions. 81 191.923. 1. The general assembly of the state of 1 Missouri hereby finds and declares that pregnant women who 2 choose to undergo prenatal screening should have access to 3 timely and informative counseling about the conditions being 4 tested for, the accuracy of such tests, and resources for 5 obtaining support services for such conditions. Informed 6 SB 699 20 consent is a critical component of all genetic testing and 7 prenatal screening[, particularly as the results of such 8 testing or screening and the counseling that follows may 9 lead to the unnecessary abortion of unborn humans with Down 10 Syndrome or other prenatally diagnosed conditions]. 11 2. As used in this section, the following terms shall 12 mean: 13 (1) "Down Syndrome", a chromosomal disorder caused by 14 an error in cell division that results in the presence of an 15 extra whole or partial copy of chromosome 21; 16 (2) "Health care provider", any person or entity 17 licensed, accredited, or certified by the state of Missouri 18 to perform specified health services; 19 (3) "Prenatally diagnosed condition", any adverse 20 fetal health condition identified by prenatal genetic 21 testing or indicated by prenatal screening procedures; 22 (4) "Prenatal test", a diagnostic procedure or 23 screening procedure performed upon a pregnant woman or her 24 unborn offspring to obtain information about her offspring's 25 health or development. 26 3. When a prenatally diagnosed condition, including 27 but not limited to Down Syndrome, becomes known as a result 28 of one or more prenatal tests, the physician or other health 29 care professional who requested or ordered prenatal tests, 30 or his or her designee, shall provide the patient with 31 current information about the conditions that were tested 32 for, the accuracy of such tests, and resources for obtaining 33 support services for such conditions, including information 34 hotlines specific to Down Syndrome or other prenatally 35 diagnosed conditions, resource centers, and clearinghouses 36 for such conditions, support programs for parents and 37 SB 699 21 families, and the alternatives to abortion services program 38 under section 188.325. 39 4. The department of health and senior services shall 40 establish a clearinghouse of information concerning 41 supportive services providers, information hotlines specific 42 to Down Syndrome or other prenatally diagnosed conditions, 43 resource centers, education, other support programs for 44 parents and families, and the alternatives to abortion 45 services program under section 188.325. 46 191.975. 1. This section shall be known and may be 1 cited as the "Adoption Awareness Law". 2 2. To raise public awareness and to educate the 3 public, the department of social services, with the 4 assistance of the department of health and senior services, 5 shall be responsible for: 6 (1) Collecting and distributing resource materials to 7 educate the public about foster care and adoption; 8 (2) Developing and distributing educational materials, 9 including but not limited to videos, brochures and other 10 media as part of a comprehensive public relations campaign 11 about the positive option of adoption and foster care. The 12 materials shall include, but not be limited to, information 13 about: 14 (a) The benefits of adoption and foster care; 15 (b) Adoption and foster care procedures; 16 (c) Means of financing the cost of adoption and foster 17 care including, but not limited to, adoption subsidies, 18 foster care payments, and adoption tax credits; 19 (d) Options for birth parents in choosing adoptive 20 parents; 21 (e) Protection for and rights of birth parents and 22 adoptive parents prior to and following the adoption; 23 SB 699 22 (f) Location of adoption and foster care agencies; 24 (g) Information regarding various state health and 25 social service programs for pregnant women and children, 26 including but not limited to medical assistance programs and 27 temporary assistance for needy families (TANF); and 28 (h) Referrals to appropriate counseling services, 29 including but not be limited to counseling services for 30 parents who are considering retaining custody of their 31 children, placing their children for adoption, or becoming 32 foster or adoptive parents[; but excluding any referrals for 33 abortion or to abortion facilities]; 34 (3) Making such educational materials available 35 through state and local public health clinics, public 36 hospitals, family planning clinics, [abortion facilities as 37 defined in section 188.015,] maternity homes as defined in 38 section 135.600, child-placing agencies licensed pursuant to 39 sections 210.481 to 210.536, attorneys whose practice 40 involves private adoptions, in vitro fertilization clinics 41 and private physicians for distribution to their patients 42 who request such educational materials. Such materials 43 shall also be available to the public through the department 44 of social services' internet website; 45 (4) Establishing a toll-free telephone number for 46 information on adoption and foster care, and to answer 47 questions and assist persons inquiring about becoming 48 adoptive or foster parents. 49 3. In addition, the department may establish and 50 implement an ongoing advertising campaign for the 51 recruitment of adoptive and foster care families, with a 52 special emphasis on the recruitment of qualified adoptive 53 and foster care families for special needs children. Such 54 advertising campaign may utilize, but shall not be limited 55 SB 699 23 to, the following media: television, radio, outdoor 56 advertising, newspaper, magazines and other print media, 57 websites, and the internet. The department may contract 58 with professional advertising agencies or other professional 59 entities to conduct such advertising campaign on behalf of 60 the department. 61 4. The provisions of this section shall be subject to 62 appropriations. 63 5. The department of social services shall promulgate 64 rules for the implementation of this section in accordance 65 with chapter 536. 66 192.665. As used in this section, section 192.667, and 1 sections 197.150 to 197.165, the following terms mean: 2 (1) "Charge data", information submitted by health 3 care providers on current charges for leading procedures and 4 diagnoses; 5 (2) "Charges by payer", information submitted by 6 hospitals on amount billed to Medicare, Medicaid, other 7 government sources and all nongovernment sources combined as 8 one data element; 9 (3) "Department", the department of health and senior 10 services; 11 (4) "Financial data", information submitted by 12 hospitals drawn from financial statements which includes the 13 balance sheet, income statement, charity care and bad debt 14 and charges by payer, prepared in accordance with generally 15 accepted accounting principles; 16 (5) "Health care provider", hospitals as defined in 17 section 197.020 and ambulatory surgical centers [and 18 abortion facilities] as defined in section 197.200; 19 (6) "Nosocomial infection", as defined by the federal 20 Centers for Disease Control and Prevention and applied to 21 SB 699 24 infections within hospitals, ambulatory surgical centers, 22 abortion facilities, and other facilities; 23 (7) "Nosocomial infection incidence rate", a risk- 24 adjusted measurement of new cases of nosocomial infections 25 by procedure or device within a population over a given 26 period of time, with such measurements defined by rule of 27 the department pursuant to subsection 3 of section 192.667 28 for use by all hospitals, ambulatory surgical centers, 29 [abortion facilities,] and other facilities in complying 30 with the requirements of the Missouri nosocomial infection 31 control act of 2004; 32 (8) "Other facility", a type of facility determined to 33 be a source of infections and designated by rule of the 34 department pursuant to subsection 11 of section 192.667; 35 (9) "Patient abstract data", data submitted by 36 hospitals which includes but is not limited to date of 37 birth, sex, race, zip code, county of residence, admission 38 date, discharge date, principal and other diagnoses, 39 including external causes, principal and other procedures, 40 procedure dates, total billed charges, disposition of the 41 patient and expected source of payment with sources 42 categorized according to Medicare, Medicaid, other 43 government, workers' compensation, all commercial payors 44 coded with a common code, self-pay, no charge and other. 45 192.667. 1. All health care providers shall at least 1 annually provide to the department charge data as required 2 by the department. All hospitals shall at least annually 3 provide patient abstract data and financial data as required 4 by the department. Hospitals as defined in section 197.020 5 shall report patient abstract data for outpatients and 6 inpatients. Ambulatory surgical centers [and abortion 7 facilities] as defined in section 197.200 shall provide 8 SB 699 25 patient abstract data to the department. The department 9 shall specify by rule the types of information which shall 10 be submitted and the method of submission. 11 2. The department shall collect data on the incidence 12 of health care-associated infections from hospitals, 13 ambulatory surgical centers, [abortion facilities,] and 14 other facilities as necessary to generate the reports 15 required by this section. Hospitals, ambulatory surgical 16 centers, [abortion facilities,] and other facilities shall 17 provide such data in compliance with this section. In order 18 to streamline government and to eliminate duplicative 19 reporting requirements, if the Centers for Medicare and 20 Medicaid Services, or its successor entity, requires 21 hospitals to submit health care-associated infection data, 22 then hospitals and the department shall not be required to 23 comply with the health care-associated infection data 24 reporting requirements of subsections 2 to 17 of this 25 section applicable to hospitals, except that the department 26 shall post a link on its website to publicly reported data 27 by hospitals on the Centers for Medicare and Medicaid 28 Services' Hospital Compare website, or its successor. 29 3. The department shall promulgate rules specifying 30 the standards and procedures for the collection, analysis, 31 risk adjustment, and reporting of the incidence of health 32 care-associated infections and the types of infections and 33 procedures to be monitored pursuant to subsection 13 of this 34 section. In promulgating such rules, the department shall: 35 (1) Use methodologies and systems for data collection 36 established by the federal Centers for Disease Control and 37 Prevention's National Healthcare Safety Network, or its 38 successor; and 39 SB 699 26 (2) Consider the findings and recommendations of the 40 infection control advisory panel established pursuant to 41 section 197.165. 42 4. By January 1, 2017, the infection control advisory 43 panel created by section 197.165 shall make recommendations 44 to the department regarding the Centers for Medicare and 45 Medicaid Services' health care-associated infection data 46 collection, analysis, and public reporting requirements for 47 hospitals, ambulatory surgical centers, and other facilities 48 in the federal Centers for Disease Control and Prevention's 49 National Healthcare Safety Network, or its successor, in 50 lieu of all or part of the data collection, analysis, and 51 public reporting requirements of this section. The advisory 52 panel recommendations shall address which hospitals shall be 53 required as a condition of licensure to use the National 54 Healthcare Safety Network for data collection; the use of 55 the National Healthcare Safety Network for risk adjustment 56 and analysis of hospital submitted data; and the use of the 57 Centers for Medicare and Medicaid Services' Hospital Compare 58 website, or its successor, for public reporting of the 59 incidence of health care-associated infection metrics. The 60 advisory panel shall consider the following factors in 61 developing its recommendation: 62 (1) Whether the public is afforded the same or greater 63 access to facility-specific infection control indicators and 64 metrics; 65 (2) Whether the data provided to the public is subject 66 to the same or greater accuracy of risk adjustment; 67 (3) Whether the public is provided with the same or 68 greater specificity of reporting of infections by type of 69 facility infections and procedures; 70 SB 699 27 (4) Whether the data is subject to the same or greater 71 level of confidentiality of the identity of an individual 72 patient; 73 (5) Whether the National Healthcare Safety Network, or 74 its successor, has the capacity to receive, analyze, and 75 report the required data for all facilities; 76 (6) Whether the cost to implement the National 77 Healthcare Safety Network infection data collection and 78 reporting system is the same or less. 79 5. After considering the recommendations of the 80 infection control advisory panel, and provided that the 81 requirements of subsection 13 of this section can be met, 82 the department shall implement guidelines from the federal 83 Centers for Disease Control and Prevention's National 84 Healthcare Safety Network, or its successor. It shall be a 85 condition of licensure for hospitals that meet the minimum 86 public reporting requirements of the National Healthcare 87 Safety Network and the Centers for Medicare and Medicaid 88 Services to participate in the National Healthcare Safety 89 Network, or its successor. Such hospitals shall permit the 90 National Healthcare Safety Network, or its successor, to 91 disclose facility-specific infection data to the department 92 as required under this section, and as necessary to provide 93 the public reports required by the department. It shall be 94 a condition of licensure for any ambulatory surgical center 95 [or abortion facility] which does not voluntarily 96 participate in the National Healthcare Safety Network, or 97 its successor, to submit facility-specific data to the 98 department as required under this section, and as necessary 99 to provide the public reports required by the department. 100 6. The department shall not require the resubmission 101 of data which has been submitted to the department of health 102 SB 699 28 and senior services or the department of social services 103 under any other provision of law. The department of health 104 and senior services shall accept data submitted by 105 associations or related organizations on behalf of health 106 care providers by entering into binding agreements 107 negotiated with such associations or related organizations 108 to obtain data required pursuant to section 192.665 and this 109 section. A health care provider shall submit the required 110 information to the department of health and senior services: 111 (1) If the provider does not submit the required data 112 through such associations or related organizations; 113 (2) If no binding agreement has been reached within 114 ninety days of August 28, 1992, between the department of 115 health and senior services and such associations or related 116 organizations; or 117 (3) If a binding agreement has expired for more than 118 ninety days. 119 7. Information obtained by the department under the 120 provisions of section 192.665 and this section shall not be 121 public information. Reports and studies prepared by the 122 department based upon such information shall be public 123 information and may identify individual health care 124 providers. The department of health and senior services may 125 authorize the use of the data by other research 126 organizations pursuant to the provisions of section 127 192.067. The department shall not use or release any 128 information provided under section 192.665 and this section 129 which would enable any person to determine any health care 130 provider's negotiated discounts with specific preferred 131 provider organizations or other managed care organizations. 132 The department shall not release data in a form which could 133 SB 699 29 be used to identify a patient. Any violation of this 134 subsection is a class A misdemeanor. 135 8. The department shall undertake a reasonable number 136 of studies and publish information, including at least an 137 annual consumer guide, in collaboration with health care 138 providers, business coalitions and consumers based upon the 139 information obtained pursuant to the provisions of section 140 192.665 and this section. The department shall allow all 141 health care providers and associations and related 142 organizations who have submitted data which will be used in 143 any publication to review and comment on the publication 144 prior to its publication or release for general use. The 145 publication shall be made available to the public for a 146 reasonable charge. 147 9. Any health care provider which continually and 148 substantially, as these terms are defined by rule, fails to 149 comply with the provisions of this section shall not be 150 allowed to participate in any program administered by the 151 state or to receive any moneys from the state. 152 10. A hospital, as defined in section 197.020, 153 aggrieved by the department's determination of ineligibility 154 for state moneys pursuant to subsection 9 of this section 155 may appeal as provided in section 197.071. An ambulatory 156 surgical center [or abortion facility] as defined in section 157 197.200 aggrieved by the department's determination of 158 ineligibility for state moneys pursuant to subsection 9 of 159 this section may appeal as provided in section 197.221. 160 11. The department of health may promulgate rules 161 providing for collection of data and publication of the 162 incidence of health care-associated infections for other 163 types of health facilities determined to be sources of 164 SB 699 30 infections; except that, physicians' offices shall be exempt 165 from reporting and disclosure of such infections. 166 12. By January 1, 2017, the advisory panel shall 167 recommend and the department shall adopt in regulation with 168 an effective date of no later than January 1, 2018, the 169 requirements for the reporting of the following types of 170 infections as specified in this subsection: 171 (1) Infections associated with a minimum of four 172 surgical procedures for hospitals and a minimum of two 173 surgical procedures for ambulatory surgical centers that 174 meet the following criteria: 175 (a) Are usually associated with an elective surgical 176 procedure. An "elective surgical procedure" is a planned, 177 nonemergency surgical procedure that may be either medically 178 required such as a hip replacement or optional such as 179 breast augmentation; 180 (b) Demonstrate a high priority aspect such as 181 affecting a large number of patients, having a substantial 182 impact for a smaller population, or being associated with 183 substantial cost, morbidity, or mortality; or 184 (c) Are infections for which reports are collected by 185 the National Healthcare Safety Network or its successor; 186 (2) Central line-related bloodstream infections; 187 (3) Health care-associated infections specified for 188 reporting by hospitals, ambulatory surgical centers, and 189 other health care facilities by the rules of the Centers for 190 Medicare and Medicaid Services to the federal Centers for 191 Disease Control and Prevention's National Healthcare Safety 192 Network, or its successor; and 193 (4) Other categories of infections that may be 194 established by rule by the department. 195 SB 699 31 The department, in consultation with the advisory panel, 196 shall be authorized to collect and report data on subsets of 197 each type of infection described in this subsection. 198 13. In consultation with the infection control 199 advisory panel established pursuant to section 197.165, the 200 department shall develop and disseminate to the public 201 reports based on data compiled for a period of twelve 202 months. Such reports shall be updated quarterly and shall 203 show for each hospital, ambulatory surgical center, 204 [abortion facility,] and other facility metrics on risk- 205 adjusted health care-associated infections under this 206 section. 207 14. The types of infections under subsection 12 of 208 this section to be publicly reported shall be determined by 209 the department by rule and shall be consistent with the 210 infections tracked by the National Healthcare Safety 211 Network, or its successor. 212 15. Reports published pursuant to subsection 13 of 213 this section shall be published and readily accessible on 214 the department's internet website. The reports shall be 215 distributed at least annually to the governor and members of 216 the general assembly. The department shall make such 217 reports available to the public for a period of at least two 218 years. 219 16. The Hospital Industry Data Institute shall publish 220 a report of Missouri hospitals'[,] and ambulatory surgical 221 centers'[, and abortion facilities'] compliance with 222 standardized quality of care measures established by the 223 federal Centers for Medicare and Medicaid Services for 224 prevention of infections related to surgical procedures. If 225 the Hospital Industry Data Institute fails to do so by July 226 31, 2008, and annually thereafter, the department shall be 227 SB 699 32 authorized to collect information from the Centers for 228 Medicare and Medicaid Services or from hospitals, ambulatory 229 surgical centers, and abortion facilities and publish such 230 information in accordance with this section. 231 17. The data collected or published pursuant to this 232 section shall be available to the department for purposes of 233 licensing hospitals[,] and ambulatory surgical centers[, and 234 abortion facilities] pursuant to chapter 197. 235 18. The department shall promulgate rules to implement 236 the provisions of section 192.131 and sections 197.150 to 237 197.160. Any rule or portion of a rule, as that term is 238 defined in section 536.010, that is created under the 239 authority delegated in this section shall become effective 240 only if it complies with and is subject to all of the 241 provisions of chapter 536 and, if applicable, section 242 536.028. This section and chapter 536 are nonseverable and 243 if any of the powers vested with the general assembly 244 pursuant to chapter 536 to review, to delay the effective 245 date, or to disapprove and annul a rule are subsequently 246 held unconstitutional, then the grant of rulemaking 247 authority and any rule proposed or adopted after August 28, 248 2004, shall be invalid and void. 249 19. No later than August 28, 2017, each hospital, 250 excluding mental health facilities as defined in section 251 632.005, and each ambulatory surgical center [and abortion 252 facility] as defined in section 197.200, shall in 253 consultation with its medical staff establish an 254 antimicrobial stewardship program for evaluating the 255 judicious use of antimicrobials, especially antibiotics that 256 are the last line of defense against resistant infections. 257 The hospital's stewardship program and the results of the 258 program shall be monitored and evaluated by hospital quality 259 SB 699 33 improvement departments and shall be available upon 260 inspection to the department. At a minimum, the 261 antimicrobial stewardship program shall be designed to 262 evaluate that hospitalized patients receive, in accordance 263 with accepted medical standards of practice, the appropriate 264 antimicrobial, at the appropriate dose, at the appropriate 265 time, and for the appropriate duration. 266 20. Hospitals described in subsection 19 of this 267 section shall meet the National Healthcare Safety Network 268 requirements for reporting antimicrobial usage or resistance 269 by using the Centers for Disease Control and Prevention's 270 Antimicrobial Use and Resistance (AUR) Module when 271 conditions of participation promulgated by the Centers for 272 Medicare and Medicaid Services requiring the electronic 273 reporting of antibiotic use or antibiotic resistance by 274 hospitals become effective. When such antimicrobial usage 275 or resistance reporting takes effect, hospitals shall 276 authorize the National Healthcare Safety Network, or its 277 successor, to disclose to the department facility-specific 278 information reported to the AUR Module. Facility-specific 279 data on antibiotic usage and resistance collected under this 280 subsection shall not be disclosed to the public, but the 281 department may release case-specific information to other 282 facilities, physicians, and the public if the department 283 determines on a case-by-case basis that the release of such 284 information is necessary to protect persons in a public 285 health emergency. Nothing in this section shall prohibit a 286 hospital from voluntarily reporting antibiotic use or 287 antibiotic resistance data through the National Healthcare 288 Safety Network, or its successor, prior to the effective 289 date of the conditions of participation requiring the 290 reporting. 291 SB 699 34 21. The department shall make a report to the general 292 assembly beginning January 1, 2018, and on every January 293 first thereafter on the incidence, type, and distribution of 294 antimicrobial-resistant infections identified in the state 295 and within regions of the state. 296 196.1127. 1. The moneys appropriated to the life 1 sciences research board pursuant to sections 196.1100 to 2 196.1124 shall be subject to the provisions of this section. 3 2. As used in this section, the following terms shall 4 mean: 5 (1) ["Abortion services" include performing, inducing, 6 or assisting with abortions, as defined in section 188.015, 7 or encouraging patients to have abortions, referring 8 patients for abortions not necessary to save the life of the 9 mother, or development of drugs, chemicals, or devices 10 intended to be used to induce an abortion; 11 (2)] "Child", a human being recognized as a minor 12 pursuant to the laws of this state, including if in vivo, an 13 unborn child as defined in section 188.015 and if in vitro, 14 a human being at any of the stages of biological development 15 of an unborn child from conception or inception onward; 16 [(3)] (2) "Conception", the same meaning as such term 17 is defined in section 188.015; 18 [(4)] (3) "Facilities and administrative costs", those 19 costs that are incurred for common or joint objectives and 20 therefore cannot be identified readily and specifically with 21 a particular research project or any other institutional 22 activity; 23 [(5)] (4) "Human cloning", the creation of a human 24 being by any means other than by the fertilization of an 25 oocyte of a human female by a sperm of a human male; 26 SB 699 35 [(6)] (5) "Prohibited human research", research in a 27 research project in which there is the taking or utilization 28 of the organs, tissues, or cellular material of: 29 (a) A deceased child, unless consent is given by the 30 parents in a manner provided in sections 194.210 to 194.290 31 relating to anatomical gifts, and neither parent caused the 32 death of such child or consented to another person causing 33 the death of such child; 34 (b) A living child, when the intended or likely result 35 of such taking or utilization is to kill or cause harm to 36 the health, safety, or welfare of such child, or when the 37 purpose is to target such child for possible destruction in 38 the future; 39 [(7)] (6) "Public funds", include: 40 (a) Any moneys received or controlled by the state of 41 Missouri or any official, department, division, agency, or 42 political subdivision thereof, including but not limited to 43 moneys derived from federal, state, or local taxes, gifts, 44 or grants from any source, settlements of any claims or 45 causes of action, public or private, bond proceeds, federal 46 grants or payments, or intergovernmental transfers; 47 (b) Any moneys received or controlled by an official, 48 department, division, or agency of state government or any 49 political subdivision thereof, or to any person or entity 50 pursuant to appropriation by the general assembly or 51 governing body of any political subdivision of this state; 52 [(8)] (7) "Research project", research proposed to be 53 funded by an award of public funds conducted under the 54 auspices of the entity or entities that applied for and 55 received such award, regardless of whether the research is 56 funded in whole or in part by such award. Such research 57 shall include basic research, including the discovery of new 58 SB 699 36 knowledge; translational research, including translational 59 knowledge in a usable form; and clinical research, including 60 but not limited to health research in human development and 61 aging, cancer, endocrine, cardiovascular, neurological, 62 pulmonary, and infectious disease. 63 3. Public funds shall not be expended, paid, or 64 granted to or on behalf of an existing or proposed research 65 project that involves [abortion services,] human cloning[,] 66 or prohibited human research. A research project that 67 receives an award of public funds shall not share costs with 68 another research project, person, or entity not eligible to 69 receive public funds pursuant to this subsection; provided 70 that a research project that receives an award of public 71 funds may pay a pro rata share of facilities and 72 administrative costs determined in the award of public funds 73 according to standards that ensure that public funds do not 74 in any way subsidize facilities and administrative costs of 75 other research projects, persons, or entities not eligible 76 to receive public funds pursuant to this subsection. The 77 application for an award of public funds shall set forth the 78 proposed rates of pro rata cost reimbursement and shall 79 provide supporting data and rationale for such rates. All 80 applicants for and recipients of awards of public funds 81 shall comply with the cost accounting principles set forth 82 in Part 9905 of Title 48 of the Code of Federal Regulations, 83 or successor regulations, in connection with the application 84 for and administration of the research project. All moneys 85 derived from an award of public funds shall be expended only 86 by checks, drafts, or electronic transfers using a separate 87 accounting process maintained for each research project. No 88 moneys derived from an award of public funds shall be used 89 to cover costs for any other research project or to any 90 SB 699 37 other person or entity. No moneys derived from an award of 91 public funds shall be passed through to any other research 92 project, person, or entity unless included in the original 93 application for the award of public funds or in subsequent 94 amendments or requests to use separate contractors. A 95 research project that receives an award of public funds 96 shall maintain financial records that demonstrate strict 97 compliance with this subsection. Any audit conducted 98 pursuant to any grant or contract awarding public funds 99 shall also certify whether there is compliance with this 100 subsection and shall note any noncompliance as a material 101 audit finding. 102 4. The provisions of this section shall inure to the 103 benefit of all residents of this state. Any taxpayer of 104 this state or any political subdivision of this state shall 105 have standing to bring suit against the state of Missouri or 106 any official, department, division, agency, or political 107 subdivision of this state, and any recipient of public funds 108 who or which is in violation of this subsection in any 109 circuit court with jurisdiction to enforce the provisions of 110 this section. 111 5. This section shall not be construed to permit or 112 make lawful any conduct that is otherwise unlawful pursuant 113 to the laws of this state. 114 6. Any provision of this section is not severable from 115 any appropriation subject to this section or any application 116 declared by any court to be subject to this section. If any 117 provision of this section is found to be invalid or 118 unconstitutional, any appropriation subject to this section 119 or any appropriation declared by any court to be subject to 120 this section shall be void, invalid, and unenforceable. 121 SB 699 38 197.150. The department shall require that each 1 hospital, ambulatory surgical center, [abortion facility,] 2 and other facility have in place procedures for monitoring 3 and enforcing compliance with infection control regulations 4 and standards. Such procedures shall be coordinated with 5 administrative staff, personnel staff, and the quality 6 improvement program. Such procedures shall include, at a 7 minimum, requirements for the facility's infection control 8 program to conduct surveillance of personnel with a portion 9 of the surveillance to be done in such manner that employees 10 and medical staff are observed without their knowledge of 11 such observation, provided that this unobserved surveillance 12 requirement shall not be considered to be grounds for 13 licensure enforcement action by the department until the 14 department establishes clear and verifiable criteria for 15 determining compliance. Such surveillance also may include 16 monitoring of the rate of use of hand hygiene products. 17 197.152. 1. Infection control officers as defined in 1 federal regulation and other hospital[,] and ambulatory 2 surgical center[, and abortion facility] employees shall be 3 protected against retaliation by the hospital[,] or 4 ambulatory surgical center[, or abortion facility] for 5 reporting infection control concerns pursuant to section 6 197.285 and shall be entitled to the full benefits of that 7 section. Such infection control officers shall report any 8 interference in the performance of their duties by their 9 supervisors to the hospital[,] or ambulatory surgical 10 center[, or abortion facility] compliance officer 11 established by and empowered to act pursuant to section 12 197.285. 13 2. Infection control officers as defined in federal 14 regulation shall also have the authority to order the 15 SB 699 39 cessation of a practice that falls outside accepted 16 practices as defined by appropriate state and federal 17 regulatory agencies, accreditation organizations, or the 18 standards adopted by the Centers for Disease Control and 19 Prevention or the Association of Professionals in Infection 20 Control and Epidemiology. The hospital[,] or ambulatory 21 surgical center[, or abortion facility] may require that 22 such a cessation order of an infection control officer be 23 endorsed by the hospital[,] or ambulatory surgical center[, 24 or abortion facility] chief executive officer or his or her 25 designee before taking effect. The hospital[,] or 26 ambulatory surgical center[, or abortion facility] infection 27 control committee shall convene as soon as possible to 28 review such cessation order and may overrule or sustain the 29 directive of the infection control officer. The department 30 shall promulgate rules governing documentation of such 31 events. 32 3. Members of the medical staff who report in good 33 faith infection control concerns to the hospital[,] or 34 ambulatory surgical center[, or abortion facility] 35 administration or medical staff leadership shall not be 36 subject to retaliation or discrimination for doing so. 37 Nothing in this section shall prevent or shield medical 38 staff members from being subject to professional review 39 actions for substandard care or breach of standards 40 established in hospital policy, rules, or medical staff 41 bylaws. 42 197.158. Every hospital[,] and ambulatory surgery 1 center[, and abortion facility] shall, beginning June 1, 2 2006, provide each patient an opportunity to submit to the 3 hospital[,] or ambulatory surgical center[, or abortion 4 facility] administration complaints, comments, and 5 SB 699 40 suggestions related to the care they received or their 6 personal observations related to the quality of care 7 provided. The department shall promulgate rules to 8 implement this section. 9 197.160. The department of health and senior services 1 shall have access to all data and information held by 2 hospitals, ambulatory surgical centers, [abortion 3 facilities,] and other facilities related to their infection 4 control practices, rates, or treatments of infections. 5 Failure to provide such access shall be grounds for full or 6 partial licensure suspension or revocation pursuant to 7 section 197.293, sections 197.010 to 197.100, or sections 8 197.200 to 197.240. If the department determines that the 9 hospital, ambulatory surgical center, [abortion facility,] 10 or other facility is willfully impeding access to such 11 information, the department shall be authorized to direct 12 all state agencies to suspend all or a portion of state 13 payments to such entity until such time as the desired 14 information is obtained by the department. 15 197.162. The department shall in its licensure of 1 hospitals[,] and ambulatory surgical centers[, and abortion 2 facilities] give special attention to infection control 3 practices and shall direct hospitals[,] and ambulatory 4 surgical centers[, and abortion facilities] to set 5 quantifiable measures of performance for reducing the 6 incidence of nosocomial infections in Missouri. The 7 department shall prepare an annual report on infection 8 control standards and compliance, which shall be shared with 9 the governor and the general assembly. 10 197.165. 1. The department shall appoint an 1 "Infection Control Advisory Panel" for the purposes of 2 implementing sections 192.131 and 192.667. 3 SB 699 41 2. Members of the infection control advisory panel 4 shall include: 5 (1) Two public members; 6 (2) Three board-certified or board-eligible physicians 7 licensed pursuant to chapter 334 who are affiliated with a 8 Missouri hospital or medical school, active members of the 9 Society for Health Care Epidemiology of America, and have 10 demonstrated interest and expertise in health facility 11 infection control; 12 (3) One physician licensed pursuant to chapter 334 who 13 is active in the practice of medicine in Missouri and who 14 holds medical staff privileges at a Missouri hospital; 15 (4) Four infection control practitioners certified by 16 the certification board of infection control and 17 epidemiology, at least two of whom shall be practicing in a 18 rural hospital or setting and at least two of whom shall be 19 registered professional nurses licensed under chapter 335; 20 (5) A medical statistician with an advanced degree in 21 such specialty; 22 (6) A clinical microbiologist with an advanced degree 23 in such specialty; 24 (7) Three employees of the department, representing 25 the functions of hospital[,] and ambulatory surgical 26 center[, and abortion facility] licensure, epidemiology and 27 health data analysis, who shall serve as ex officio 28 nonvoting members of the panel. 29 3. Reasonable expenses of the panel shall be paid from 30 private donations made specifically for that purpose to the 31 "Infection Control Advisory Panel Fund", which is hereby 32 created in the state treasury. If such donations are not 33 received from private sources, then the provisions of this 34 act shall be implemented without the advisory panel. 35 SB 699 42 197.200. As used in sections 197.200 to 197.240, 1 unless the context clearly indicates otherwise, the 2 following terms mean: 3 (1) ["Abortion facility", as such term is defined in 4 section 188.015; 5 (2)] "Ambulatory surgical center", any public or 6 private establishment operated primarily for the purpose of 7 performing surgical procedures or primarily for the purpose 8 of performing childbirths, and which does not provide 9 services or other accommodations for patients to stay more 10 than twenty-three hours within the establishment, provided, 11 however, that nothing in this definition shall be construed 12 to include the offices of dentists currently licensed 13 pursuant to chapter 332; 14 [(3)] (2) "Dentist", any person currently licensed to 15 practice dentistry pursuant to chapter 332; 16 [(4)] (3) "Department", the department of health and 17 senior services; 18 [(5)] (4) "Governmental unit", any city, county or 19 other political subdivision of this state, or any 20 department, division, board or other agency of any political 21 subdivision of this state; 22 [(6)] (5) "Person", any individual, firm, partnership, 23 corporation, company, or association and the legal 24 successors thereof; 25 [(7)] (6) "Physician", any person currently licensed 26 to practice medicine pursuant to chapter 334; 27 [(8)] (7) "Podiatrist", any person currently licensed 28 to practice podiatry pursuant to chapter 330. 29 197.205. 1. No person or governmental unit acting 1 severally or jointly with any other person or governmental 2 unit shall establish, conduct or maintain an ambulatory 3 SB 699 43 surgical center [or abortion facility] in this state without 4 a license under sections 197.200 to 197.240 issued by the 5 department of health and senior services. 6 2. Nothing in sections 197.200 to 197.240 shall be 7 construed to impair or abridge the authority of a 8 governmental unit to license ambulatory surgical centers [or 9 abortion facilities], provided that any ordinance of a 10 governmental unit shall require compliance with all rules, 11 regulations, and standards adopted by the department to 12 implement the provisions of sections 197.200 to 197.240. 13 197.215. 1. Upon receipt of an application for a 1 license, the department of health and senior services shall 2 issue a license if the applicant and ambulatory surgical 3 center facilities [or abortion facilities] meet the 4 requirements established under sections 197.200 to 197.240, 5 and have provided affirmative evidence that: 6 (1) Each member of the surgical staff is a physician, 7 dentist or podiatrist currently licensed to practice in 8 Missouri[, and each person authorized to perform or induce 9 abortions is a physician currently licensed to practice in 10 Missouri]; 11 (2) Surgical procedures in ambulatory surgical centers 12 shall be performed only by physicians, dentists or 13 podiatrists, who at the time are privileged to perform 14 surgical procedures in at least one licensed hospital in the 15 community in which the ambulatory surgical center is 16 located, thus providing assurance to the public that 17 patients treated in the center shall receive continuity of 18 care should the services of a hospital be required; 19 alternatively, applicant shall submit a copy of a current 20 working agreement with at least one licensed hospital in the 21 community in which the ambulatory surgical center is 22 SB 699 44 located, guaranteeing the transfer and admittance of 23 patients for emergency treatment whenever necessary; 24 (3) Continuous physician services or registered 25 professional nursing services are provided whenever a 26 patient is in the facility; 27 (4) Adequate medical records for each patient are to 28 be maintained. 29 2. Upon receipt of an application for a license, or 30 the renewal thereof, the department shall issue or renew the 31 license if the applicant and program meet the requirements 32 established under sections 197.200 to 197.240. Each license 33 shall be issued only for the persons and premises named in 34 the application. A license, unless sooner suspended or 35 revoked, shall be issued for a period of one year. 36 3. Each license shall be issued only for the premises 37 and persons or governmental units named in the application, 38 and shall not be transferable or assignable except with the 39 written consent of the department. Licenses shall be posted 40 in a conspicuous place on the licensed premises. 41 4. If, during the period in which an ambulatory 42 surgical center [license or an abortion facility] license is 43 in effect, the license holder or operator legally transfers 44 operational responsibilities by any process to another 45 person as defined in section 197.200, an application shall 46 be made for the issuance of a new license to become 47 effective on the transfer date. 48 197.220. The department of health and senior services 1 may deny, suspend or revoke a license in any case in which 2 the department finds that there has been a substantial 3 failure to comply with the requirements of sections 197.200 4 to 197.240, or in any case in which the director of the 5 department makes a finding that: 6 SB 699 45 (1) The applicant, or if the applicant is a firm, 7 partnership or association, any of its members, or if a 8 corporation, any of its officers or directors, or the person 9 designated to manage or supervise the facility, has been 10 finally adjudicated and found guilty, or entered a plea of 11 guilty or nolo contendere, in a criminal prosecution under 12 the laws of any state or of the United States, for any 13 offense reasonably related to the qualifications, functions, 14 or duties of an ambulatory surgical center [or of an 15 abortion facility], or for any offense an essential element 16 of which is fraud, dishonesty, or an act of violence, or for 17 any offense involving moral turpitude, whether or not 18 sentence is imposed; 19 (2) The licensure status or record of the applicant, 20 or if the applicant is a firm, partnership or association, 21 of any of its members, or if a corporation, of any of its 22 officers or directors, or of the person designated to manage 23 or supervise the facility, from any other state, federal 24 district or land, territory or commonwealth of the United 25 States, or of any foreign country where the applicant has 26 done business in a similar capacity indicates that granting 27 a license to the applicant would be detrimental to the 28 interests of the public. 29 197.225. [1.] The department of health and senior 1 services may adopt such reasonable rules, regulations, and 2 standards for the types of services provided as are 3 necessary to carry out the provisions of sections 197.200 to 4 197.240, and to assure quality patient care and patient 5 safety, which shall include, but not be limited to: 6 (1) Construction of the facility including, but not 7 limited to, plumbing, heating, lighting, and ventilation 8 SB 699 46 which should insure the health, safety, comfort, and privacy 9 of patients and protection from fire hazard; 10 (2) Number, qualifications, and organization of all 11 personnel, having responsibility for any part of the care 12 provided to the patients; 13 (3) Equipment essential to the health, welfare, and 14 safety of the patients; 15 (4) Facilities, programs, and services to be provided 16 in connection with the care of patients in ambulatory 17 surgical centers; and 18 (5) Procedures for peer review and for receiving and 19 investigating complaints regarding any ambulatory surgical 20 center or any physician, dentist, podiatrist, nurse, 21 assistant, manager, supervisor, or employee practicing or 22 working in any such facility. 23 [2. The department of health and senior services may 24 adopt separate rules, regulations, or standards to apply to 25 ambulatory surgical centers and to apply to abortion 26 facilities. 27 3. Abortion facilities shall be required to maintain a 28 written protocol for managing medical emergencies and the 29 transfer of patients requiring further emergency care to a 30 hospital within a reasonable distance from the abortion 31 facility.] 32 197.230. 1. The department of health and senior 1 services shall make, or cause to be made, such inspections 2 and investigations as it deems necessary. The department 3 may delegate its powers and duties to investigate and 4 inspect ambulatory surgical centers [or abortion facilities] 5 to an official of a political subdivision having a 6 population of at least four hundred fifty thousand if such 7 political subdivision is deemed qualified by the department 8 SB 699 47 to inspect and investigate ambulatory surgical centers. The 9 official so designated shall submit a written report of his 10 or her findings to the department and the department may 11 accept the recommendations of such official if it determines 12 that the facility inspected meets minimum standards 13 established pursuant to sections 197.200 to 197.240. 14 2. [In the case of any abortion facility, the 15 department shall make or cause to be made an unannounced on- 16 site inspection and investigation at least annually. Such 17 on-site inspection and investigation shall include, but not 18 be limited to, the following areas: 19 (1) Compliance with all statutory and regulatory 20 requirements for an abortion facility, including 21 requirements that the facility maintain adequate staffing 22 and equipment to respond to medical emergencies; 23 (2) Compliance with the provisions of chapter 188; and 24 (3) Compliance with the requirement in section 197.215 25 that continuous physician services or registered 26 professional nursing services be provided whenever a patient 27 is in the facility. 28 3.] Inspection, investigation, and quality assurance 29 reports shall be made available to the public. Any portion 30 of a report may be redacted when made publicly available if 31 such portion would disclose information that is not subject 32 to disclosure under the law. 33 197.235. 1. Any person operating, conducting, 1 managing, or establishing an ambulatory surgical center [or 2 abortion facility] without a license required by sections 3 197.200 to 197.240 is guilty of a class A misdemeanor and, 4 upon conviction, shall be subject to a fine of not more than 5 five hundred dollars. Each day of continuing violation 6 shall constitute a separate offense. 7 SB 699 48 2. The attorney general shall represent the department 8 of health and senior services and shall institute an action 9 in the name of the state for injunctive or other relief 10 against any person or governmental unit to restrain or 11 prevent the establishment, conduct, management, or operation 12 of an ambulatory surgical center [or abortion facility] 13 without a license issued pursuant to the provisions of 14 sections 197.200 to 197.240. 15 3. Any person operating, conducting, managing, or 16 establishing an ambulatory surgical center [or abortion 17 facility] who, in the course of advertising, promoting, or 18 otherwise publicizing the activities, business, location, or 19 any other matter concerning the operations of said 20 ambulatory surgical center [or abortion facility], uses or 21 employs in any manner the words "State, Missouri, State of 22 Missouri, Department of Health and Senior Services, the 23 initials 'Mo.'," or any emblem of the state of Missouri or 24 the department of health and senior services, for the 25 purpose of conveying or in any manner reasonably calculated 26 to convey the false impression that the state of Missouri or 27 any department, agency, bureau, or instrumentality thereof 28 is involved in the business of said ambulatory surgical 29 center [or abortion facility], or took part in said 30 advertisement, promotion, publicity, or other statement, 31 shall be subject to a fine of one hundred dollars per day 32 for each day during the period beginning with the day said 33 advertisement, promotion, publication, or statement first 34 appears and ending on the day on which it is withdrawn. 35 197.240. After September 28, 1975, no individual or 1 group health insurance policy of insurance providing 2 coverage on an expense incurred basis, nor individual or 3 group service or indemnity type contract issued by a 4 SB 699 49 nonprofit corporation, nor any self-insured group health 5 benefit plan or trust, of any kind or description, shall be 6 issued or payment accepted therefor in renewal or 7 continuation thereof unless coverage for any service 8 performed in an ambulatory surgical center [or abortion 9 facility] is provided for therein if such service would have 10 been covered under the terms of the policy or contract as an 11 eligible inpatient service, except as provided in section 12 376.805. Nothing in this section shall apply to a group 13 contract, plan or trust which provides health care and 14 surgical care directly to its members and their dependents. 15 Nothing in this section shall be construed to mandate 16 coverage under an individual or group health insurance 17 policy of insurance providing coverage on an expense- 18 incurred basis, or an individual or group service or 19 indemnity type contract issued by a nonprofit corporation, 20 or any self-insured group health benefit plan or trust, of 21 any kind or description, to provide health insurance for 22 services which are usually performed in a physician's office. 23 197.285. 1. Hospitals[,] and ambulatory surgical 1 centers[, and abortion facilities] shall establish and 2 implement a written policy adopted by each hospital[,] and 3 ambulatory surgical center[, and abortion facility] relating 4 to the protections for employees who disclose information 5 pursuant to subsection 2 of this section. This policy shall 6 include a time frame for completion of investigations 7 related to complaints, not to exceed thirty days, and a 8 method for notifying the complainant of the disposition of 9 the investigation. This policy shall be submitted to the 10 department of health and senior services to verify 11 implementation. At a minimum, such policy shall include the 12 following provisions: 13 SB 699 50 (1) No supervisor or individual with authority to hire 14 or fire in a hospital[,] or ambulatory surgical center[, or 15 abortion facility] shall prohibit employees from disclosing 16 information pursuant to subsection 2 of this section; 17 (2) No supervisor or individual with authority to hire 18 or fire in a hospital[,] or ambulatory surgical center[, or 19 abortion facility] shall use or threaten to use his or her 20 supervisory authority to knowingly discriminate against, 21 dismiss, penalize or in any way retaliate against or harass 22 an employee because the employee in good faith reported or 23 disclosed any information pursuant to subsection 2 of this 24 section, or in any way attempt to dissuade, prevent or 25 interfere with an employee who wishes to report or disclose 26 such information; 27 (3) Establish a program to identify a compliance 28 officer who is a designated person responsible for 29 administering the reporting and investigation process and an 30 alternate person should the primary designee be implicated 31 in the report. 32 2. This section shall apply to information disclosed 33 or reported in good faith by an employee concerning: 34 (1) Alleged facility mismanagement or fraudulent 35 activity; 36 (2) Alleged violations of applicable federal or state 37 laws or administrative rules concerning patient care, 38 patient safety or facility safety; or 39 (3) The ability of employees to successfully perform 40 their assigned duties. 41 All information disclosed, collected and maintained pursuant 42 to this subsection and pursuant to the written policy 43 requirements of this section shall be accessible to the 44 SB 699 51 department of health and senior services at all times and 45 shall be reviewed by the department of health and senior 46 services at least annually. Complainants shall be notified 47 of the department of health and senior services' access to 48 such information and of the complainant's right to notify 49 the department of health and senior services of any 50 information concerning alleged violations of applicable 51 federal or state laws or administrative rules concerning 52 patient care, patient safety or facility safety. 53 3. Prior to any disclosure to individuals or agencies 54 other than the department of health and senior services, 55 employees wishing to make a disclosure pursuant to the 56 provisions of this section shall first report to the 57 individual or individuals designated by the hospital[,] or 58 ambulatory surgical center[, or abortion facility] pursuant 59 to subsection 1 of this section. 60 4. If the compliance officer, compliance committee or 61 management official discovers credible evidence of 62 misconduct from any source and, after a reasonable inquiry, 63 has reason to believe that the misconduct may violate 64 criminal, civil or administrative law, then the hospital[,] 65 or ambulatory surgical center[, or abortion facility] shall 66 report the existence of misconduct to the appropriate 67 governmental authority within a reasonable period, but not 68 more than seven days after determining that there is 69 credible evidence of a violation. 70 5. Reports made to the department of health and senior 71 services shall be subject to the provisions of section 72 197.477, provided that the restrictions of section 197.477 73 shall not be construed to limit the employee's ability to 74 subpoena from the original source the information reported 75 to the department pursuant to this section. 76 SB 699 52 6. Each written policy shall allow employees making a 77 report who wish to remain anonymous to do so, and shall 78 include safeguards to protect the confidentiality of the 79 employee making the report, the confidentiality of patients 80 and the integrity of data, information and medical records. 81 7. Each hospital[,] and ambulatory surgical center[, 82 and abortion facility] shall, within forty-eight hours of 83 the receipt of a report, notify the employee that his or her 84 report has been received and is being reviewed. 85 197.287. [By July 1, 2001,] All hospitals and 1 ambulatory surgical centers[, and by July 1, 2018, all 2 abortion facilities] shall provide training programs, with 3 measurable minimal training outcomes relating to quality of 4 patient care and patient safety, to all unlicensed staff 5 providing patient care in their facility within ninety days 6 of the beginning date of employment. Standards for such 7 training shall be established by the department of health 8 and senior services by rule. It shall be a requirement of 9 hospital[,] and ambulatory surgical center[, and abortion 10 facility] licensure pursuant to this chapter that all 11 hospitals[,] and ambulatory surgical centers[, and abortion 12 facilities] submit documentation to the department of health 13 and senior services on the training program used. 14 197.289. 1. All hospitals[,] and ambulatory surgical 1 centers[, and abortion facilities] shall develop and 2 implement a methodology which ensures adequate nurse 3 staffing that will meet the needs of patients. At a 4 minimum, there shall be on duty at all times a sufficient 5 number of licensed registered nurses to provide patient care 6 requiring the judgment and skills of a licensed registered 7 nurse and to oversee the activities of all nursing personnel. 8 SB 699 53 2. There shall be sufficient licensed and ancillary 9 nursing personnel on duty on each nursing unit to meet the 10 needs of each patient in accordance with accepted standards 11 of quality patient care. 12 197.293. 1. In addition to the powers established in 1 sections 197.070 and 197.220, the department of health and 2 senior services shall use the following standards for 3 enforcing hospital[,] and ambulatory surgical center[, and 4 abortion facility] licensure regulations promulgated to 5 enforce the provisions of sections 197.010 to 197.120, 6 sections 197.150 to 197.165, and sections 197.200 to 197.240: 7 (1) Upon notification of a deficiency in meeting 8 regulatory standards, the hospital[,] or ambulatory surgical 9 center[, or abortion facility] shall develop and implement a 10 plan of correction approved by the department which 11 includes, but is not limited to, the specific type of 12 corrective action to be taken and an estimated time to 13 complete such action; 14 (2) If the plan as implemented does not correct the 15 deficiency, the department may either: 16 (a) Direct the hospital[,] or ambulatory surgical 17 center[, or abortion facility] to develop and implement a 18 plan of correction pursuant to subdivision (1) of this 19 subsection; or 20 (b) Require the hospital[,] or ambulatory surgical 21 center[, or abortion facility] to implement a plan of 22 correction developed by the department; 23 (3) If there is a continuing deficiency after 24 implementation of the plan of correction pursuant to 25 subdivision (2) of this subsection and the hospital[,] or 26 ambulatory surgical center[, or abortion facility] has had 27 an opportunity to correct such deficiency, the department 28 SB 699 54 may restrict new inpatient admissions or outpatient entrants 29 to the service or services affected by such deficiency; 30 (4) If there is a continuing deficiency after the 31 department restricts new inpatient admissions or outpatient 32 entrants to the service or services pursuant to subdivision 33 (3) of this subsection and the hospital[,] or ambulatory 34 surgical center[, or abortion facility] has had an 35 opportunity to correct such deficiency, the department may 36 suspend operations in all or part of the service or services 37 affected by such deficiency; 38 (5) If there is a continuing deficiency after 39 suspension of operations pursuant to subdivision (4) of this 40 subsection, the department may deny, suspend or revoke the 41 hospital's[,] or ambulatory surgical center's[, or abortion 42 facility's] license pursuant to section 197.070 or section 43 197.220. 44 2. Notwithstanding the provisions of subsection 1 of 45 this section to the contrary, if a deficiency in meeting 46 licensure standards presents an immediate and serious threat 47 to the patients' health and safety, the department may, 48 based on the scope and severity of the deficiency, restrict 49 access to the service or services affected by the deficiency 50 until the hospital[,] or ambulatory surgical center[, or 51 abortion facility] has developed and implemented an approved 52 plan of correction. Decisions as to whether a deficiency 53 constitutes an immediate and serious threat to the patients' 54 health and safety shall be made in accordance with 55 guidelines established pursuant to regulation of the 56 department of health and senior services and such decisions 57 shall be approved by the bureau of health facility licensing 58 in the department of health and senior services, or its 59 successor agency, or by a person authorized by the 60 SB 699 55 regulations to approve such decisions in the absence of the 61 director. 62 197.295. 1. A hospital[,] or ambulatory surgical 1 center[, or abortion facility] aggrieved by a decision of 2 the department pursuant to the provisions of paragraph (b) 3 of subdivision (2) and subdivisions (3), (4) and (5) of 4 subsection 1 of section 197.293 may appeal such decision to 5 the administrative hearing commission pursuant to section 6 197.071 or section 197.221, and seek judicial review 7 pursuant to section 621.145. An appeal of an action to 8 restrict new inpatient admissions or outpatient entrants, 9 suspend operations or revoke a license shall be heard on an 10 expedited basis by the administrative hearing commission. 11 The hospital[,] or ambulatory surgical center[, or abortion 12 facility] may apply to the administrative hearing commission 13 for an order to stay or suspend any such departmental action 14 pending the commission's findings and ruling as authorized 15 by section 621.035. 16 2. If both the department and the hospital[,] or 17 ambulatory surgical center[, or abortion facility] agree to 18 do so, prior to an appeal to the administrative hearing 19 commission pursuant to section 197.071 or section 197.221, 20 an official action of the department made pursuant to 21 sections 197.010 to 197.120 or sections 197.200 to 197.240 22 may be appealed to a departmental hearing officer. The 23 department of health and senior services shall promulgate 24 rules specifying the qualifications of such a hearing 25 officer, establish procedures to ensure impartial decisions 26 and provide for comparable appeal remedies when a 27 departmental hearing officer is unavailable. 28 197.315. 1. Any person who proposes to develop or 1 offer a new institutional health service within the state 2 SB 699 56 must obtain a certificate of need from the committee prior 3 to the time such services are offered. 4 2. Only those new institutional health services which 5 are found by the committee to be needed shall be granted a 6 certificate of need. Only those new institutional health 7 services which are granted certificates of need shall be 8 offered or developed within the state. No expenditures for 9 new institutional health services in excess of the 10 applicable expenditure minimum shall be made by any person 11 unless a certificate of need has been granted. 12 3. After October 1, 1980, no state agency charged by 13 statute to license or certify health care facilities shall 14 issue a license to or certify any such facility, or distinct 15 part of such facility, that is developed without obtaining a 16 certificate of need. 17 4. If any person proposes to develop any new 18 institutional health care service without a certificate of 19 need as required by sections 197.300 to 197.366, the 20 committee shall notify the attorney general, and he shall 21 apply for an injunction or other appropriate legal action in 22 any court of this state against that person. 23 5. After October 1, 1980, no agency of state 24 government may appropriate or grant funds to or make payment 25 of any funds to any person or health care facility which has 26 not first obtained every certificate of need required 27 pursuant to sections 197.300 to 197.366. 28 6. A certificate of need shall be issued only for the 29 premises and persons named in the application and is not 30 transferable except by consent of the committee. 31 7. Project cost increases, due to changes in the 32 project application as approved or due to project change 33 orders, exceeding the initial estimate by more than ten 34 SB 699 57 percent shall not be incurred without consent of the 35 committee. 36 8. Periodic reports to the committee shall be required 37 of any applicant who has been granted a certificate of need 38 until the project has been completed. The committee may 39 order the forfeiture of the certificate of need upon failure 40 of the applicant to file any such report. 41 9. A certificate of need shall be subject to 42 forfeiture for failure to incur a capital expenditure on any 43 approved project within six months after the date of the 44 order. The applicant may request an extension from the 45 committee of not more than six additional months based upon 46 substantial expenditure made. 47 10. Each application for a certificate of need must be 48 accompanied by an application fee. The time of filing 49 commences with the receipt of the application and the 50 application fee. The application fee is one thousand 51 dollars, or one-tenth of one percent of the total cost of 52 the proposed project, whichever is greater. All application 53 fees shall be deposited in the state treasury. Because of 54 the loss of federal funds, the general assembly will 55 appropriate funds to the Missouri health facilities review 56 committee. 57 11. In determining whether a certificate of need 58 should be granted, no consideration shall be given to the 59 facilities or equipment of any other health care facility 60 located more than a fifteen-mile radius from the applying 61 facility. 62 12. When a nursing facility shifts from a skilled to 63 an intermediate level of nursing care, it may return to the 64 higher level of care if it meets the licensure requirements, 65 without obtaining a certificate of need. 66 SB 699 58 13. [In no event shall a certificate of need be denied 67 because the applicant refuses to provide abortion services 68 or information. 69 14.] A certificate of need shall not be required for 70 the transfer of ownership of an existing and operational 71 health facility in its entirety. 72 [15.] 14. A certificate of need may be granted to a 73 facility for an expansion, an addition of services, a new 74 institutional service, or for a new hospital facility which 75 provides for something less than that which was sought in 76 the application. 77 [16.] 15. The provisions of this section shall not 78 apply to facilities operated by the state, and appropriation 79 of funds to such facilities by the general assembly shall be 80 deemed in compliance with this section, and such facilities 81 shall be deemed to have received an appropriate certificate 82 of need without payment of any fee or charge. The 83 provisions of this subsection shall not apply to hospitals 84 operated by the state and licensed under this chapter, 85 except for department of mental health state-operated 86 psychiatric hospitals. 87 [17.] 16. Notwithstanding other provisions of this 88 section, a certificate of need may be issued after July 1, 89 1983, for an intermediate care facility operated exclusively 90 for the intellectually disabled. 91 [18.] 17. To assure the safe, appropriate, and cost- 92 effective transfer of new medical technology throughout the 93 state, a certificate of need shall not be required for the 94 purchase and operation of: 95 (1) Research equipment that is to be used in a 96 clinical trial that has received written approval from a 97 duly constituted institutional review board of an accredited 98 SB 699 59 school of medicine or osteopathy located in Missouri to 99 establish its safety and efficacy and does not increase the 100 bed complement of the institution in which the equipment is 101 to be located. After the clinical trial has been completed, 102 a certificate of need must be obtained for continued use in 103 such facility; or 104 (2) Equipment that is to be used by an academic health 105 center operated by the state in furtherance of its research 106 or teaching missions. 107 334.100. 1. The board may refuse to issue or renew 1 any certificate of registration or authority, permit or 2 license required pursuant to this chapter for one or any 3 combination of causes stated in subsection 2 of this 4 section. The board shall notify the applicant in writing of 5 the reasons for the refusal and shall advise the applicant 6 of the applicant's right to file a complaint with the 7 administrative hearing commission as provided by chapter 8 621. As an alternative to a refusal to issue or renew any 9 certificate, registration or authority, the board may, at 10 its discretion, issue a license which is subject to 11 probation, restriction or limitation to an applicant for 12 licensure for any one or any combination of causes stated in 13 subsection 2 of this section. The board's order of 14 probation, limitation or restriction shall contain a 15 statement of the discipline imposed, the basis therefor, the 16 date such action shall become effective, and a statement 17 that the applicant has thirty days to request in writing a 18 hearing before the administrative hearing commission. If 19 the board issues a probationary, limited or restricted 20 license to an applicant for licensure, either party may file 21 a written petition with the administrative hearing 22 commission within thirty days of the effective date of the 23 SB 699 60 probationary, limited or restricted license seeking review 24 of the board's determination. If no written request for a 25 hearing is received by the administrative hearing commission 26 within the thirty-day period, the right to seek review of 27 the board's decision shall be considered as waived. 28 2. The board may cause a complaint to be filed with 29 the administrative hearing commission as provided by chapter 30 621 against any holder of any certificate of registration or 31 authority, permit or license required by this chapter or any 32 person who has failed to renew or has surrendered the 33 person's certificate of registration or authority, permit or 34 license for any one or any combination of the following 35 causes: 36 (1) Use of any controlled substance, as defined in 37 chapter 195, or alcoholic beverage to an extent that such 38 use impairs a person's ability to perform the work of any 39 profession licensed or regulated by this chapter; 40 (2) The person has been finally adjudicated and found 41 guilty, or entered a plea of guilty or nolo contendere, in a 42 criminal prosecution under the laws of any state or of the 43 United States, for any offense reasonably related to the 44 qualifications, functions or duties of any profession 45 licensed or regulated pursuant to this chapter, for any 46 offense involving fraud, dishonesty or an act of violence, 47 or for any offense involving moral turpitude, whether or not 48 sentence is imposed; 49 (3) Use of fraud, deception, misrepresentation or 50 bribery in securing any certificate of registration or 51 authority, permit or license issued pursuant to this chapter 52 or in obtaining permission to take any examination given or 53 required pursuant to this chapter; 54 SB 699 61 (4) Misconduct, fraud, misrepresentation, dishonesty, 55 unethical conduct or unprofessional conduct in the 56 performance of the functions or duties of any profession 57 licensed or regulated by this chapter, including, but not 58 limited to, the following: 59 (a) Obtaining or attempting to obtain any fee, charge, 60 tuition or other compensation by fraud, deception or 61 misrepresentation; willfully and continually overcharging or 62 overtreating patients; or charging for visits to the 63 physician's office which did not occur unless the services 64 were contracted for in advance, or for services which were 65 not rendered or documented in the patient's records; 66 (b) Attempting, directly or indirectly, by way of 67 intimidation, coercion or deception, to obtain or retain a 68 patient or discourage the use of a second opinion or 69 consultation; 70 (c) Willfully and continually performing inappropriate 71 or unnecessary treatment, diagnostic tests or medical or 72 surgical services; 73 (d) Delegating professional responsibilities to a 74 person who is not qualified by training, skill, competency, 75 age, experience or licensure to perform such 76 responsibilities; 77 (e) Misrepresenting that any disease, ailment or 78 infirmity can be cured by a method, procedure, treatment, 79 medicine or device; 80 (f) Performing or prescribing medical services which 81 have been declared by board rule to be of no medical or 82 osteopathic value; 83 (g) Final disciplinary action by any professional 84 medical or osteopathic association or society or licensed 85 hospital or medical staff of such hospital in this or any 86 SB 699 62 other state or territory, whether agreed to voluntarily or 87 not, and including, but not limited to, any removal, 88 suspension, limitation, or restriction of the person's 89 license or staff or hospital privileges, failure to renew 90 such privileges or license for cause, or other final 91 disciplinary action, if the action was in any way related to 92 unprofessional conduct, professional incompetence, 93 malpractice or any other violation of any provision of this 94 chapter; 95 (h) Signing a blank prescription form; or dispensing, 96 prescribing, administering or otherwise distributing any 97 drug, controlled substance or other treatment without 98 sufficient examination including failing to establish a 99 valid physician-patient relationship pursuant to section 100 334.108, or for other than medically accepted therapeutic or 101 experimental or investigative purposes duly authorized by a 102 state or federal agency, or not in the course of 103 professional practice, or not in good faith to relieve pain 104 and suffering, or not to cure an ailment, physical infirmity 105 or disease, except as authorized in section 334.104; 106 (i) Exercising influence within a physician-patient 107 relationship for purposes of engaging a patient in sexual 108 activity; 109 (j) Being listed on any state or federal sexual 110 offender registry; 111 (k) Terminating the medical care of a patient without 112 adequate notice or without making other arrangements for the 113 continued care of the patient; 114 (l) Failing to furnish details of a patient's medical 115 records to other treating physicians or hospitals upon 116 proper request; or failing to comply with any other law 117 relating to medical records; 118 SB 699 63 (m) Failure of any applicant or licensee to cooperate 119 with the board during any investigation; 120 (n) Failure to comply with any subpoena or subpoena 121 duces tecum from the board or an order of the board; 122 (o) Failure to timely pay license renewal fees 123 specified in this chapter; 124 (p) Violating a probation agreement, order, or other 125 settlement agreement with this board or any other licensing 126 agency; 127 (q) Failing to inform the board of the physician's 128 current residence and business address; 129 (r) Advertising by an applicant or licensee which is 130 false or misleading, or which violates any rule of the 131 board, or which claims without substantiation the positive 132 cure of any disease, or professional superiority to or 133 greater skill than that possessed by any other physician. 134 An applicant or licensee shall also be in violation of this 135 provision if the applicant or licensee has a financial 136 interest in any organization, corporation or association 137 which issues or conducts such advertising; 138 (s) Any other conduct that is unethical or 139 unprofessional involving a minor; 140 (5) Any conduct or practice which is or might be 141 harmful or dangerous to the mental or physical health of a 142 patient or the public; or incompetency, gross negligence or 143 repeated negligence in the performance of the functions or 144 duties of any profession licensed or regulated by this 145 chapter. For the purposes of this subdivision, "repeated 146 negligence" means the failure, on more than one occasion, to 147 use that degree of skill and learning ordinarily used under 148 the same or similar circumstances by the member of the 149 applicant's or licensee's profession; 150 SB 699 64 (6) Violation of, or attempting to violate, directly 151 or indirectly, or assisting or enabling any person to 152 violate, any provision of this chapter or chapter 324, or of 153 any lawful rule or regulation adopted pursuant to this 154 chapter or chapter 324; 155 (7) Impersonation of any person holding a certificate 156 of registration or authority, permit or license or allowing 157 any person to use his or her certificate of registration or 158 authority, permit, license or diploma from any school; 159 (8) Revocation, suspension, restriction, modification, 160 limitation, reprimand, warning, censure, probation or other 161 final disciplinary action against the holder of or applicant 162 for a license or other right to practice any profession 163 regulated by this chapter by another state, territory, 164 federal agency or country, whether or not voluntarily agreed 165 to by the licensee or applicant, including, but not limited 166 to, the denial of licensure, surrender of the license, 167 allowing the license to expire or lapse, or discontinuing or 168 limiting the practice of medicine while subject to an 169 investigation or while actually under investigation by any 170 licensing authority, medical facility, branch of the Armed 171 Forces of the United States of America, insurance company, 172 court, agency of the state or federal government, or 173 employer; 174 (9) A person is finally adjudged incapacitated or 175 disabled by a court of competent jurisdiction; 176 (10) Assisting or enabling any person to practice or 177 offer to practice any profession licensed or regulated by 178 this chapter who is not registered and currently eligible to 179 practice pursuant to this chapter; or knowingly performing 180 any act which in any way aids, assists, procures, advises, 181 or encourages any person to practice medicine who is not 182 SB 699 65 registered and currently eligible to practice pursuant to 183 this chapter. A physician who works in accordance with 184 standing orders or protocols or in accordance with the 185 provisions of section 334.104 shall not be in violation of 186 this subdivision; 187 (11) Issuance of a certificate of registration or 188 authority, permit or license based upon a material mistake 189 of fact; 190 (12) Failure to display a valid certificate or license 191 if so required by this chapter or any rule promulgated 192 pursuant to this chapter; 193 (13) Violation of the drug laws or rules and 194 regulations of this state, including but not limited to any 195 provision of chapter 195, any other state, or the federal 196 government; 197 (14) Knowingly making, or causing to be made, or 198 aiding, or abetting in the making of, a false statement in 199 any birth, death or other certificate or document executed 200 in connection with the practice of the person's profession; 201 (15) Knowingly making a false statement, orally or in 202 writing to the board; 203 (16) Soliciting patronage in person or by agents or 204 representatives, or by any other means or manner, under the 205 person's own name or under the name of another person or 206 concern, actual or pretended, in such a manner as to 207 confuse, deceive, or mislead the public as to the need or 208 necessity for or appropriateness of health care services for 209 all patients, or the qualifications of an individual person 210 or persons to diagnose, render, or perform health care 211 services; 212 (17) Using, or permitting the use of, the person's 213 name under the designation of "Doctor", "Dr.", "M.D.", or 214 SB 699 66 "D.O.", or any similar designation with reference to the 215 commercial exploitation of any goods, wares or merchandise; 216 (18) Knowingly making or causing to be made a false 217 statement or misrepresentation of a material fact, with 218 intent to defraud, for payment pursuant to the provisions of 219 chapter 208 or chapter 630 or for payment from Title XVIII 220 or Title XIX of the Social Security Act; 221 (19) Failure or refusal to properly guard against 222 contagious, infectious or communicable diseases or the 223 spread thereof; maintaining an unsanitary office or 224 performing professional services under unsanitary 225 conditions; or failure to report the existence of an 226 unsanitary condition in the office of a physician or in any 227 health care facility to the board, in writing, within thirty 228 days after the discovery thereof; 229 (20) Any candidate for licensure or person licensed to 230 practice as a physical therapist, paying or offering to pay 231 a referral fee or, notwithstanding section 334.010 to the 232 contrary, practicing or offering to practice professional 233 physical therapy independent of the prescription and 234 direction of a person licensed and registered as a physician 235 and surgeon pursuant to this chapter, as a dentist pursuant 236 to chapter 332, as a podiatrist pursuant to chapter 330, as 237 an advanced practice registered nurse under chapter 335, or 238 any licensed and registered physician, dentist, podiatrist, 239 or advanced practice registered nurse practicing in another 240 jurisdiction, whose license is in good standing; 241 (21) Any candidate for licensure or person licensed to 242 practice as a physical therapist, treating or attempting to 243 treat ailments or other health conditions of human beings 244 other than by professional physical therapy and as 245 authorized by sections 334.500 to 334.620; 246 SB 699 67 (22) Any person licensed to practice as a physician or 247 surgeon, requiring, as a condition of the physician-patient 248 relationship, that the patient receive prescribed drugs, 249 devices or other professional services directly from 250 facilities of that physician's office or other entities 251 under that physician's ownership or control. A physician 252 shall provide the patient with a prescription which may be 253 taken to the facility selected by the patient and a 254 physician knowingly failing to disclose to a patient on a 255 form approved by the advisory commission for professional 256 physical therapists as established by section 334.625 which 257 is dated and signed by a patient or guardian acknowledging 258 that the patient or guardian has read and understands that 259 the physician has a pecuniary interest in a physical therapy 260 or rehabilitation service providing prescribed treatment and 261 that the prescribed treatment is available on a competitive 262 basis. This subdivision shall not apply to a referral by 263 one physician to another physician within a group of 264 physicians practicing together; 265 (23) A pattern of personal use or consumption of any 266 controlled substance unless it is prescribed, dispensed or 267 administered by another physician who is authorized by law 268 to do so; 269 (24) Habitual intoxication or dependence on alcohol, 270 evidence of which may include more than one alcohol-related 271 enforcement contact as defined by section 302.525; 272 (25) Failure to comply with a treatment program or an 273 aftercare program entered into as part of a board order, 274 settlement agreement or licensee's professional health 275 program; 276 (26) Revocation, suspension, limitation, probation, or 277 restriction of any kind whatsoever of any controlled 278 SB 699 68 substance authority, whether agreed to voluntarily or not, 279 or voluntary termination of a controlled substance authority 280 while under investigation; 281 (27) For a physician to operate, conduct, manage, or 282 establish an abortion facility, or for a physician to 283 perform an abortion in an abortion facility[, if such 284 facility comes under the definition of an ambulatory 285 surgical center pursuant to sections 197.200 to 197.240, and 286 such facility has failed to obtain or renew a license as an 287 ambulatory surgical center]. 288 3. Collaborative practice arrangements, protocols and 289 standing orders shall be in writing and signed and dated by 290 a physician prior to their implementation. 291 4. After the filing of such complaint before the 292 administrative hearing commission, the proceedings shall be 293 conducted in accordance with the provisions of chapter 621. 294 Upon a finding by the administrative hearing commission that 295 the grounds, provided in subsection 2 of this section, for 296 disciplinary action are met, the board may, singly or in 297 combination, warn, censure or place the person named in the 298 complaint on probation on such terms and conditions as the 299 board deems appropriate for a period not to exceed ten 300 years, or may suspend the person's license, certificate or 301 permit for a period not to exceed three years, or restrict 302 or limit the person's license, certificate or permit for an 303 indefinite period of time, or revoke the person's license, 304 certificate, or permit, or administer a public or private 305 reprimand, or deny the person's application for a license, 306 or permanently withhold issuance of a license or require the 307 person to submit to the care, counseling or treatment of 308 physicians designated by the board at the expense of the 309 individual to be examined, or require the person to attend 310 SB 699 69 such continuing educational courses and pass such 311 examinations as the board may direct. 312 5. In any order of revocation, the board may provide 313 that the person may not apply for reinstatement of the 314 person's license for a period of time ranging from two to 315 seven years following the date of the order of revocation. 316 All stay orders shall toll this time period. 317 6. Before restoring to good standing a license, 318 certificate or permit issued pursuant to this chapter which 319 has been in a revoked, suspended or inactive state for any 320 cause for more than two years, the board may require the 321 applicant to attend such continuing medical education 322 courses and pass such examinations as the board may direct. 323 7. In any investigation, hearing or other proceeding 324 to determine a licensee's or applicant's fitness to 325 practice, any record relating to any patient of the licensee 326 or applicant shall be discoverable by the board and 327 admissible into evidence, regardless of any statutory or 328 common law privilege which such licensee, applicant, record 329 custodian or patient might otherwise invoke. In addition, 330 no such licensee, applicant, or record custodian may 331 withhold records or testimony bearing upon a licensee's or 332 applicant's fitness to practice on the ground of privilege 333 between such licensee, applicant or record custodian and a 334 patient. 335 376.1199. 1. Each health carrier or health benefit 1 plan that offers or issues health benefit plans providing 2 obstetrical/gynecological benefits and pharmaceutical 3 coverage, which are delivered, issued for delivery, 4 continued or renewed in this state on or after January 1, 5 2002, shall: 6 SB 699 70 (1) Notwithstanding the provisions of subsection 4 of 7 section 354.618, provide enrollees with direct access to the 8 services of a participating obstetrician, participating 9 gynecologist or participating obstetrician/gynecologist of 10 her choice within the provider network for covered 11 services. The services covered by this subdivision shall be 12 limited to those services defined by the published 13 recommendations of the accreditation council for graduate 14 medical education for training an obstetrician, gynecologist 15 or obstetrician/gynecologist, including but not limited to 16 diagnosis, treatment and referral for such services. A 17 health carrier shall not impose additional co-payments, 18 coinsurance or deductibles upon any enrollee who seeks or 19 receives health care services pursuant to this subdivision, 20 unless similar additional co-payments, coinsurance or 21 deductibles are imposed for other types of health care 22 services received within the provider network. Nothing in 23 this subsection shall be construed to require a health 24 carrier to perform, induce, pay for, reimburse, guarantee, 25 arrange, provide any resources for or refer a patient for an 26 abortion, as defined in section 188.015, other than a 27 spontaneous abortion or to prevent the death of the female 28 upon whom the abortion is performed, or to supersede or 29 conflict with section 376.805; and 30 (2) Notify enrollees annually of cancer screenings 31 covered by the enrollees' health benefit plan and the 32 current American Cancer Society guidelines for all cancer 33 screenings or notify enrollees at intervals consistent with 34 current American Cancer Society guidelines of cancer 35 screenings which are covered by the enrollees' health 36 benefit plans. The notice shall be delivered by mail unless 37 SB 699 71 the enrollee and health carrier have agreed on another 38 method of notification; and 39 (3) Include coverage for services related to 40 diagnosis, treatment and appropriate management of 41 osteoporosis when such services are provided by a person 42 licensed to practice medicine and surgery in this state, for 43 individuals with a condition or medical history for which 44 bone mass measurement is medically indicated for such 45 individual. In determining whether testing or treatment is 46 medically appropriate, due consideration shall be given to 47 peer-reviewed medical literature. A policy, provision, 48 contract, plan or agreement may apply to such services the 49 same deductibles, coinsurance and other limitations as apply 50 to other covered services; and 51 (4) If the health benefit plan also provides coverage 52 for pharmaceutical benefits, provide coverage for 53 contraceptives either at no charge or at the same level of 54 deductible, coinsurance or co-payment as any other covered 55 drug. 56 No such deductible, coinsurance or co-payment shall be 57 greater than any drug on the health benefit plan's 58 formulary. As used in this section, "contraceptive" shall 59 include all prescription drugs and devices approved by the 60 federal Food and Drug Administration for use as a 61 contraceptive, but shall exclude all drugs and devices that 62 are intended to induce an abortion, as defined in section 63 188.015, which shall be subject to section 376.805. Nothing 64 in this subdivision shall be construed to exclude coverage 65 for prescription contraceptive drugs or devices ordered by a 66 health care provider with prescriptive authority for reasons 67 other than contraceptive or abortion purposes. 68 SB 699 72 2. For the purposes of this section, "health carrier" 69 and "health benefit plan" shall have the same meaning as 70 defined in section 376.1350. 71 3. The provisions of this section shall not apply to a 72 supplemental insurance policy, including a life care 73 contract, accident-only policy, specified disease policy, 74 hospital policy providing a fixed daily benefit only, 75 Medicare supplement policy, long-term care policy, short- 76 term major medical policies of six months or less duration, 77 or any other supplemental policy as determined by the 78 director of the department of commerce and insurance. 79 4. Notwithstanding the provisions of subdivision (4) 80 of subsection 1 of this section to the contrary: 81 (1) Any health carrier shall offer and issue to any 82 person or entity purchasing a health benefit plan, a health 83 benefit plan that excludes coverage for contraceptives if 84 the use or provision of such contraceptives is contrary to 85 the moral, ethical or religious beliefs or tenets of such 86 person or entity; 87 (2) Upon request of an enrollee who is a member of a 88 group health benefit plan and who states that the use or 89 provision of contraceptives is contrary to his or her moral, 90 ethical or religious beliefs, any health carrier shall issue 91 to or on behalf of such enrollee a policy form that excludes 92 coverage for contraceptives. Any administrative costs to a 93 group health benefit plan associated with such exclusion of 94 coverage not offset by the decreased costs of providing 95 coverage shall be borne by the group policyholder or group 96 plan holder; 97 (3) Any health carrier which is owned, operated or 98 controlled in substantial part by an entity that is operated 99 pursuant to moral, ethical or religious tenets that are 100 SB 699 73 contrary to the use or provision of contraceptives shall be 101 exempt from the provisions of subdivision (4) of subsection 102 1 of this section. For purposes of this subsection, if new 103 premiums are charged for a contract, plan or policy, it 104 shall be determined to be a new contract, plan or policy. 105 5. Except for a health carrier that is exempted from 106 providing coverage for contraceptives pursuant to this 107 section, a health carrier shall allow enrollees in a health 108 benefit plan that excludes coverage for contraceptives 109 pursuant to subsection 4 of this section to purchase a 110 health benefit plan that includes coverage for 111 contraceptives. 112 6. Any health benefit plan issued pursuant to 113 subsection 1 of this section shall provide clear and 114 conspicuous written notice on the enrollment form or any 115 accompanying materials to the enrollment form and the group 116 health benefit plan application and contract: 117 (1) Whether coverage for contraceptives is or is not 118 included; 119 (2) That an enrollee who is a member of a group health 120 benefit plan with coverage for contraceptives has the right 121 to exclude coverage for contraceptives if such coverage is 122 contrary to his or her moral, ethical or religious beliefs; 123 and 124 (3) That an enrollee who is a member of a group health 125 benefit plan without coverage for contraceptives has the 126 right to purchase coverage for contraceptives[; 127 (4) Whether an optional rider for elective abortions 128 has been purchased by the group contract holder pursuant to 129 section 376.805; and 130 (5) That an enrollee who is a member of a group health 131 plan with coverage for elective abortions has the right to 132 SB 699 74 exclude and not pay for coverage for elective abortions if 133 such coverage is contrary to his or her moral, ethical, or 134 religious beliefs]. 135 For purposes of this subsection, if new premiums are charged 136 for a contract, plan, or policy, it shall be determined to 137 be a new contract, plan, or policy. 138 7. Health carriers shall not disclose to the person or 139 entity who purchased the health benefit plan the names of 140 enrollees who exclude coverage for contraceptives in the 141 health benefit plan or who purchase a health benefit plan 142 that includes coverage for contraceptives. Health carriers 143 and the person or entity who purchased the health benefit 144 plan shall not discriminate against an enrollee because the 145 enrollee excluded coverage for contraceptives in the health 146 benefit plan or purchased a health benefit plan that 147 includes coverage for contraceptives. 148 8. The departments of health and senior services and 149 commerce and insurance may promulgate rules necessary to 150 implement the provisions of this section. No rule or 151 portion of a rule promulgated pursuant to this section shall 152 become effective unless it has been promulgated pursuant to 153 chapter 536. Any rule or portion of a rule, as that term is 154 defined in section 536.010, that is created under the 155 authority delegated in this section shall become effective 156 only if it complies with and is subject to all of the 157 provisions of chapter 536 and, if applicable, section 158 536.028. This section and chapter 536 are nonseverable and 159 if any of the powers vested with the general assembly 160 pursuant to chapter 536 to review, to delay the effective 161 date or to disapprove and annul a rule are subsequently held 162 unconstitutional, then the grant of rulemaking authority and 163 SB 699 75 any rule proposed or adopted after August 28, 2001, shall be 164 invalid and void. 165 491.060. The following persons shall be incompetent to 1 testify: 2 (1) A person who is mentally incapacitated at the time 3 of his or her production for examination; 4 (2) A child under ten years of age, who appears 5 incapable of receiving just impressions of the facts 6 respecting which the child is examined, or of relating them 7 truly; provided, however, that except as provided in 8 subdivision (1) of this section, a child under the age of 9 ten who is alleged to be a victim of an offense pursuant to 10 chapter 565, 566 or 568 shall be considered a competent 11 witness and shall be allowed to testify without 12 qualification in any judicial proceeding involving such 13 alleged offense. The trier of fact shall be permitted to 14 determine the weight and credibility to be given to the 15 testimony; 16 (3) An attorney, concerning any communication made to 17 the attorney by such attorney's client in that relation, or 18 such attorney's advice thereon, without the consent of such 19 client; 20 (4) Any person practicing as a minister of the gospel, 21 priest, rabbi or other person serving in a similar capacity 22 for any organized religion, concerning a communication made 23 to him or her in his or her professional capacity as a 24 spiritual advisor, confessor, counselor or comforter; 25 (5) A physician licensed pursuant to chapter 334, a 26 chiropractor licensed pursuant to chapter 331, a licensed 27 psychologist or a dentist licensed pursuant to chapter 332, 28 concerning any information which he or she may have acquired 29 from any patient while attending the patient in a 30 SB 699 76 professional character, and which information was necessary 31 to enable him or her to prescribe and provide treatment for 32 such patient as a physician, chiropractor, psychologist or 33 dentist; 34 (6) Any employee of an alternatives to abortion 35 agency, as defined in section 188.125, concerning a 36 communication made to him or her in his or her professional 37 capacity by an individual who presents themselves to the 38 agency for the purpose of seeking an alternative to an 39 abortion, unless such individual consents to the disclosure 40 of the communication. 41 556.061. In this code, unless the context requires a 1 different definition, the following terms shall mean: 2 (1) "Access", to instruct, communicate with, store 3 data in, retrieve or extract data from, or otherwise make 4 any use of any resources of, a computer, computer system, or 5 computer network; 6 (2) "Affirmative defense": 7 (a) The defense referred to is not submitted to the 8 trier of fact unless supported by evidence; and 9 (b) If the defense is submitted to the trier of fact 10 the defendant has the burden of persuasion that the defense 11 is more probably true than not; 12 (3) "Burden of injecting the issue": 13 (a) The issue referred to is not submitted to the 14 trier of fact unless supported by evidence; and 15 (b) If the issue is submitted to the trier of fact any 16 reasonable doubt on the issue requires a finding for the 17 defendant on that issue; 18 (4) "Commercial film and photographic print 19 processor", any person who develops exposed photographic 20 film into negatives, slides or prints, or who makes prints 21 SB 699 77 from negatives or slides, for compensation. The term 22 commercial film and photographic print processor shall 23 include all employees of such persons but shall not include 24 a person who develops film or makes prints for a public 25 agency; 26 (5) "Computer", the box that houses the central 27 processing unit (CPU), along with any internal storage 28 devices, such as internal hard drives, and internal 29 communication devices, such as internal modems capable of 30 sending or receiving electronic mail or fax cards, along 31 with any other hardware stored or housed internally. Thus, 32 computer refers to hardware, software and data contained in 33 the main unit. Printers, external modems attached by cable 34 to the main unit, monitors, and other external attachments 35 will be referred to collectively as peripherals and 36 discussed individually when appropriate. When the computer 37 and all peripherals are referred to as a package, the term 38 "computer system" is used. Information refers to all the 39 information on a computer system including both software 40 applications and data; 41 (6) "Computer equipment", computers, terminals, data 42 storage devices, and all other computer hardware associated 43 with a computer system or network; 44 (7) "Computer hardware", all equipment which can 45 collect, analyze, create, display, convert, store, conceal 46 or transmit electronic, magnetic, optical or similar 47 computer impulses or data. Hardware includes, but is not 48 limited to, any data processing devices, such as central 49 processing units, memory typewriters and self-contained 50 laptop or notebook computers; internal and peripheral 51 storage devices, transistor-like binary devices and other 52 memory storage devices, such as floppy disks, removable 53 SB 699 78 disks, compact disks, digital video disks, magnetic tape, 54 hard drive, optical disks and digital memory; local area 55 networks, such as two or more computers connected together 56 to a central computer server via cable or modem; peripheral 57 input or output devices, such as keyboards, printers, 58 scanners, plotters, video display monitors and optical 59 readers; and related communication devices, such as modems, 60 cables and connections, recording equipment, RAM or ROM 61 units, acoustic couplers, automatic dialers, speed dialers, 62 programmable telephone dialing or signaling devices and 63 electronic tone-generating devices; as well as any devices, 64 mechanisms or parts that can be used to restrict access to 65 computer hardware, such as physical keys and locks; 66 (8) "Computer network", two or more interconnected 67 computers or computer systems; 68 (9) "Computer program", a set of instructions, 69 statements, or related data that directs or is intended to 70 direct a computer to perform certain functions; 71 (10) "Computer software", digital information which 72 can be interpreted by a computer and any of its related 73 components to direct the way they work. Software is stored 74 in electronic, magnetic, optical or other digital form. The 75 term commonly includes programs to run operating systems and 76 applications, such as word processing, graphic, or 77 spreadsheet programs, utilities, compilers, interpreters and 78 communications programs; 79 (11) "Computer-related documentation", written, 80 recorded, printed or electronically stored material which 81 explains or illustrates how to configure or use computer 82 hardware, software or other related items; 83 (12) "Computer system", a set of related, connected or 84 unconnected, computer equipment, data, or software; 85 SB 699 79 (13) "Confinement": 86 (a) A person is in confinement when such person is 87 held in a place of confinement pursuant to arrest or order 88 of a court, and remains in confinement until: 89 a. A court orders the person's release; or 90 b. The person is released on bail, bond, or 91 recognizance, personal or otherwise; or 92 c. A public servant having the legal power and duty to 93 confine the person authorizes his release without guard and 94 without condition that he return to confinement; 95 (b) A person is not in confinement if: 96 a. The person is on probation or parole, temporary or 97 otherwise; or 98 b. The person is under sentence to serve a term of 99 confinement which is not continuous, or is serving a 100 sentence under a work-release program, and in either such 101 case is not being held in a place of confinement or is not 102 being held under guard by a person having the legal power 103 and duty to transport the person to or from a place of 104 confinement; 105 (14) "Consent": consent or lack of consent may be 106 expressed or implied. Assent does not constitute consent if: 107 (a) It is given by a person who lacks the mental 108 capacity to authorize the conduct charged to constitute the 109 offense and such mental incapacity is manifest or known to 110 the actor; or 111 (b) It is given by a person who by reason of youth, 112 mental disease or defect, intoxication, a drug-induced 113 state, or any other reason is manifestly unable or known by 114 the actor to be unable to make a reasonable judgment as to 115 the nature or harmfulness of the conduct charged to 116 constitute the offense; or 117 SB 699 80 (c) It is induced by force, duress or deception; 118 (15) "Controlled substance", a drug, substance, or 119 immediate precursor in schedules I through V as defined in 120 chapter 195; 121 (16) "Criminal negligence", failure to be aware of a 122 substantial and unjustifiable risk that circumstances exist 123 or a result will follow, and such failure constitutes a 124 gross deviation from the standard of care which a reasonable 125 person would exercise in the situation; 126 (17) "Custody", a person is in custody when he or she 127 has been arrested but has not been delivered to a place of 128 confinement; 129 (18) "Damage", when used in relation to a computer 130 system or network, means any alteration, deletion, or 131 destruction of any part of the computer system or network; 132 (19) "Dangerous felony", the felonies of arson in the 133 first degree, assault in the first degree, attempted rape in 134 the first degree if physical injury results, attempted 135 forcible rape if physical injury results, attempted sodomy 136 in the first degree if physical injury results, attempted 137 forcible sodomy if physical injury results, rape in the 138 first degree, forcible rape, sodomy in the first degree, 139 forcible sodomy, assault in the second degree if the victim 140 of such assault is a special victim as defined in 141 subdivision (14) of section 565.002, kidnapping in the first 142 degree, kidnapping, murder in the second degree, assault of 143 a law enforcement officer in the first degree, domestic 144 assault in the first degree, elder abuse in the first 145 degree, robbery in the first degree, armed criminal action, 146 conspiracy to commit an offense when the offense is a 147 dangerous felony, vehicle hijacking when punished as a class 148 A felony, statutory rape in the first degree when the victim 149 SB 699 81 is a child less than twelve years of age at the time of the 150 commission of the act giving rise to the offense, statutory 151 sodomy in the first degree when the victim is a child less 152 than twelve years of age at the time of the commission of 153 the act giving rise to the offense, child molestation in the 154 first or second degree, abuse of a child if the child dies 155 as a result of injuries sustained from conduct chargeable 156 under section 568.060, child kidnapping, parental kidnapping 157 committed by detaining or concealing the whereabouts of the 158 child for not less than one hundred twenty days under 159 section 565.153, and an "intoxication-related traffic 160 offense" or "intoxication-related boating offense" if the 161 person is found to be a "habitual offender" or "habitual 162 boating offender" as such terms are defined in section 163 577.001; 164 (20) "Dangerous instrument", any instrument, article 165 or substance, which, under the circumstances in which it is 166 used, is readily capable of causing death or other serious 167 physical injury; 168 (21) "Data", a representation of information, facts, 169 knowledge, concepts, or instructions prepared in a 170 formalized or other manner and intended for use in a 171 computer or computer network. Data may be in any form 172 including, but not limited to, printouts, microfiche, 173 magnetic storage media, punched cards and as may be stored 174 in the memory of a computer; 175 (22) "Deadly weapon", any firearm, loaded or unloaded, 176 or any weapon from which a shot, readily capable of 177 producing death or serious physical injury, may be 178 discharged, or a switchblade knife, dagger, billy club, 179 blackjack or metal knuckles; 180 SB 699 82 (23) "Digital camera", a camera that records images in 181 a format which enables the images to be downloaded into a 182 computer; 183 (24) "Disability", a mental, physical, or 184 developmental impairment that substantially limits one or 185 more major life activities or the ability to provide 186 adequately for one's care or protection, whether the 187 impairment is congenital or acquired by accident, injury or 188 disease, where such impairment is verified by medical 189 findings; 190 (25) "Elderly person", a person sixty years of age or 191 older; 192 (26) "Felony", an offense so designated or an offense 193 for which persons found guilty thereof may be sentenced to 194 death or imprisonment for a term of more than one year; 195 (27) "Forcible compulsion" either: 196 (a) Physical force that overcomes reasonable 197 resistance; or 198 (b) A threat, express or implied, that places a person 199 in reasonable fear of death, serious physical injury or 200 kidnapping of such person or another person; 201 (28) "Incapacitated", a temporary or permanent 202 physical or mental condition in which a person is 203 unconscious, unable to appraise the nature of his or her 204 conduct, or unable to communicate unwillingness to an act; 205 (29) "Infraction", a violation defined by this code or 206 by any other statute of this state if it is so designated or 207 if no sentence other than a fine, or fine and forfeiture or 208 other civil penalty, is authorized upon conviction; 209 (30) "Inhabitable structure", a vehicle, vessel or 210 structure: 211 SB 699 83 (a) Where any person lives or carries on business or 212 other calling; or 213 (b) Where people assemble for purposes of business, 214 government, education, religion, entertainment, or public 215 transportation; or 216 (c) Which is used for overnight accommodation of 217 persons. 218 Any such vehicle, vessel, or structure is inhabitable 219 regardless of whether a person is actually present. If a 220 building or structure is divided into separately occupied 221 units, any unit not occupied by the actor is an inhabitable 222 structure of another; 223 (31) "Knowingly", when used with respect to: 224 (a) Conduct or attendant circumstances, means a person 225 is aware of the nature of his or her conduct or that those 226 circumstances exist; or 227 (b) A result of conduct, means a person is aware that 228 his or her conduct is practically certain to cause that 229 result; 230 (32) "Law enforcement officer", any public servant 231 having both the power and duty to make arrests for 232 violations of the laws of this state, and federal law 233 enforcement officers authorized to carry firearms and to 234 make arrests for violations of the laws of the United States; 235 (33) "Misdemeanor", an offense so designated or an 236 offense for which persons found guilty thereof may be 237 sentenced to imprisonment for a term of which the maximum is 238 one year or less; 239 (34) "Of another", property that any entity, including 240 but not limited to any natural person, corporation, limited 241 liability company, partnership, association, governmental 242 SB 699 84 subdivision or instrumentality, other than the actor, has a 243 possessory or proprietary interest therein, except that 244 property shall not be deemed property of another who has 245 only a security interest therein, even if legal title is in 246 the creditor pursuant to a conditional sales contract or 247 other security arrangement; 248 (35) "Offense", any felony or misdemeanor; 249 (36) "Person", includes a human being from the moment 250 of conception as defined in section 188.015; 251 (37) "Physical injury", slight impairment of any 252 function of the body or temporary loss of use of any part of 253 the body; 254 [(37)] (38) "Place of confinement", any building or 255 facility and the grounds thereof wherein a court is legally 256 authorized to order that a person charged with or convicted 257 of a crime be held; 258 [(38)] (39) "Possess" or "possessed", having actual or 259 constructive possession of an object with knowledge of its 260 presence. A person has actual possession if such person has 261 the object on his or her person or within easy reach and 262 convenient control. A person has constructive possession if 263 such person has the power and the intention at a given time 264 to exercise dominion or control over the object either 265 directly or through another person or persons. Possession 266 may also be sole or joint. If one person alone has 267 possession of an object, possession is sole. If two or more 268 persons share possession of an object, possession is joint; 269 [(39)] (40) "Property", anything of value, whether 270 real or personal, tangible or intangible, in possession or 271 in action; 272 [(40)] (41) "Public servant", any person employed in 273 any way by a government of this state who is compensated by 274 SB 699 85 the government by reason of such person's employment, any 275 person appointed to a position with any government of this 276 state, or any person elected to a position with any 277 government of this state. It includes, but is not limited 278 to, legislators, jurors, members of the judiciary and law 279 enforcement officers. It does not include witnesses; 280 [(41)] (42) "Purposely", when used with respect to a 281 person's conduct or to a result thereof, means when it is 282 his or her conscious object to engage in that conduct or to 283 cause that result; 284 [(42)] (43) "Recklessly", consciously disregarding a 285 substantial and unjustifiable risk that circumstances exist 286 or that a result will follow, and such disregard constitutes 287 a gross deviation from the standard of care which a 288 reasonable person would exercise in the situation; 289 [(43)] (44) "Serious emotional injury", an injury that 290 creates a substantial risk of temporary or permanent medical 291 or psychological damage, manifested by impairment of a 292 behavioral, cognitive or physical condition. Serious 293 emotional injury shall be established by testimony of 294 qualified experts upon the reasonable expectation of 295 probable harm to a reasonable degree of medical or 296 psychological certainty; 297 [(44)] (45) "Serious physical injury", physical injury 298 that creates a substantial risk of death or that causes 299 serious disfigurement or protracted loss or impairment of 300 the function of any part of the body; 301 [(45)] (46) "Services", when used in relation to a 302 computer system or network, means use of a computer, 303 computer system, or computer network and includes, but is 304 not limited to, computer time, data processing, and storage 305 or retrieval functions; 306 SB 699 86 [(46)] (47) "Sexual orientation", male or female 307 heterosexuality, homosexuality or bisexuality by 308 inclination, practice, identity or expression, or having a 309 self-image or identity not traditionally associated with 310 one's gender; 311 [(47)] (48) "Vehicle", a self-propelled mechanical 312 device designed to carry a person or persons, excluding 313 vessels or aircraft; 314 [(48)] (49) "Vessel", any boat or craft propelled by a 315 motor or by machinery, whether or not such motor or 316 machinery is a principal source of propulsion used or 317 capable of being used as a means of transportation on water, 318 or any boat or craft more than twelve feet in length which 319 is powered by sail alone or by a combination of sail and 320 machinery, and used or capable of being used as a means of 321 transportation on water, but not any boat or craft having, 322 as the only means of propulsion, a paddle or oars; 323 [(49)] (50) "Voluntary act": 324 (a) A bodily movement performed while conscious as a 325 result of effort or determination. Possession is a 326 voluntary act if the possessor knowingly procures or 327 receives the thing possessed, or having acquired control of 328 it was aware of his or her control for a sufficient time to 329 have enabled him or her to dispose of it or terminate his or 330 her control; or 331 (b) An omission to perform an act of which the actor 332 is physically capable. A person is not guilty of an offense 333 based solely upon an omission to perform an act unless the 334 law defining the offense expressly so provides, or a duty to 335 perform the omitted act is otherwise imposed by law; 336 [(50)] (51) "Vulnerable person", any person in the 337 custody, care, or control of the department of mental health 338 SB 699 87 who is receiving services from an operated, funded, 339 licensed, or certified program. 340 562.031. 1. A person is not relieved of criminal 1 liability for conduct because he or she engages in such 2 conduct under a mistaken belief of fact or law unless such 3 mistake negatives the existence of the mental state required 4 by the offense. 5 2. A person is not relieved of criminal liability for 6 conduct because he or she believes his or her conduct does 7 not constitute an offense unless his or her belief is 8 reasonable and: 9 (1) The offense is defined by an administrative 10 regulation or order which is not known to him or her and has 11 not been published or otherwise made reasonably available to 12 him or her, and he or she could not have acquired such 13 knowledge by the exercise of due diligence pursuant to facts 14 known to him or her; or 15 (2) He or she acts in reasonable reliance upon an 16 official statement of the law, afterward determined to be 17 invalid or erroneous, contained in: 18 (a) A statute; 19 (b) An opinion or order of an appellate court; or 20 (c) An official interpretation of the statute, 21 regulation or order defining the offense made by a public 22 official or agency legally authorized to interpret such 23 statute, regulation or order. 24 3. The burden of injecting the issue of reasonable 25 belief that conduct does not constitute an offense under 26 subdivisions (1) and (2) of subsection 2 of this section is 27 on the defendant. 28 4. For purposes of this section, reliance is 29 unreasonable if based upon an official statement permitting 30 SB 699 88 the unjustified homicide of an unborn child as defined in 31 section 1.205. 32 562.071. 1. It is an affirmative defense that the 1 defendant engaged in the conduct charged to constitute an 2 offense because he or she was coerced to do so, by the use 3 of, or threatened imminent use of, unlawful physical force 4 upon him or her or a third person, which force or threatened 5 force a person of reasonable firmness in his situation would 6 have been unable to resist. 7 2. The defense of "duress" as defined in subsection 1 8 of this section is not available: 9 (1) As to the crime of murder, except murder by 10 abortion as defined in section 188.015; 11 (2) As to any offense when the defendant recklessly 12 places himself or herself in a situation in which it is 13 probable that he or she will be subjected to the force or 14 threatened force described in subsection 1 of this section. 15 563.026. 1. Unless inconsistent with other provisions 1 of this chapter defining justifiable use of physical force, 2 or with some other provision of law, conduct which would 3 otherwise constitute any offense [other than a class A 4 felony or murder] is justifiable and not criminal when it is 5 necessary as an emergency measure to avoid an imminent 6 public or private injury which is about to occur by reason 7 of a situation occasioned or developed through no fault of 8 the actor, and which is of such gravity that, according to 9 ordinary standards of intelligence and morality, the 10 desirability of avoiding the injury outweighs the 11 desirability of avoiding the injury sought to be prevented 12 by the statute defining the offense charged. 13 2. The necessity and justifiability of conduct under 14 subsection 1 of this section may not rest upon 15 SB 699 89 considerations pertaining only to the morality and 16 advisability of the statute, either in its general 17 application or with respect to its application to a 18 particular class of cases arising thereunder. Whenever 19 evidence relating to the defense of justification under this 20 section is offered, the court shall rule as a matter of law 21 whether the claimed facts and circumstances would, if 22 established, constitute a justification. 23 3. The defense of justification under this section is 24 an affirmative defense. 25 565.015. 1. This section shall be known and may be 1 cited as the "Abolition of Abortion in Missouri Act". 2 2. It is the intent of the general assembly to provide 3 to unborn children the equal protection of the laws of this 4 state; to establish that a living human child, from the 5 moment of conception, is entitled to the same rights, 6 powers, privileges, justice, and protections as are secured 7 or granted by the laws of this state to any other human 8 person; and to treat as void and of no effect any and all 9 federal acts, laws, treaties, decisions, orders, rules, or 10 regulations that would deprive an unborn child of the right 11 to life or prohibit the protection of such right. 12 3. The attorney general and prosecuting and circuit 13 attorneys shall ensure the enforcement of this chapter in 14 relation to abortion regardless of any contrary or 15 conflicting federal acts, laws, treaties, decisions, orders, 16 rules, or regulations. The attorney general shall have 17 concurrent original jurisdiction throughout the state, along 18 with each prosecuting and circuit attorney within their 19 respective jurisdictions, to commence actions to ensure the 20 enforcement of this chapter in relation to abortion. 21 SB 699 90 4. This chapter shall be enforced in relation to 22 abortion regardless of any contrary or conflicting federal 23 acts, laws, treaties, decisions, orders, rules, or 24 regulations. Any court decision purporting to enjoin this 25 state from protecting innocent human life from the moment of 26 conception shall be treated as nonauthoritative, void, and 27 of no force. No government agency or official of this 28 state, including any sheriff, deputy sheriff, or other law 29 enforcement officer, shall give force or effect to any court 30 order that conflicts with this section. Cooperative 31 agreements with federal agencies notwithstanding, no law 32 enforcement agency or law enforcement officer in this state 33 shall assist or cooperate in any way with the arrest or 34 imprisonment of any government official or individual who 35 complies with this section and refuses to comply with any 36 contrary court order. Such contrary orders shall include, 37 but not be limited to, any order to levy upon property, 38 seize bank accounts, arrest the person, or serve process for 39 the purpose of causing any person to violate this section, 40 or for the purpose of punishing any person for the failure 41 to comply with an order contrary to this section. A federal 42 officer or agent who arrests any Missouri government 43 official for compliance with this section shall be subject 44 to arrest by Missouri law enforcement. 45 5. In any investigation or proceeding brought to 46 enforce the provisions of this chapter relating to abortion, 47 as in all other criminal cases, a court on motion of the 48 prosecuting or circuit attorney may order that a witness 49 shall not be excused from giving testimony or producing any 50 papers, documents, or things, on the grounds that such 51 testimony may tend to incriminate or subject the witness to 52 a penalty or forfeiture; but such witness shall not be 53 SB 699 91 prosecuted or subjected to criminal penalty or forfeiture 54 for or on account of any transaction, matter, or thing 55 concerning which the witness has been ordered to testify. 56 The prosecuting or circuit attorney shall also have 57 authority to grant such immunity to a witness who 58 voluntarily agrees to give testimony or produce any papers, 59 documents, or things. The witness may nevertheless be 60 prosecuted for failing to comply with the order to answer, 61 perjury, or the giving of false evidence. 62 6. A woman upon whom an abortion is performed or 63 induced or attempted or intended to be performed or induced 64 shall not be held criminally responsible for the death or 65 attempted death of her child if the woman has been coerced, 66 through physical or other means, to undergo the abortion or 67 if, as a result of mental disease or defect, she was 68 incapable of knowing and appreciating the nature, quality, 69 or wrongfulness of her conduct, as described in section 70 562.086. 71 595.027. 1. Upon request by the department for 1 verification of injuries of victims, medical providers shall 2 submit the information requested by the department within 3 twenty working days of the request at no cost to the fund. 4 2. For purposes of this section, "medical providers" 5 means physicians, dentists, clinical psychologists, 6 optometrists, podiatrists, registered nurses, physician's 7 assistants, chiropractors, physical therapists, hospitals, 8 ambulatory surgical centers, [abortion facilities,] and 9 nursing homes. 10 3. Failure to submit the information as required by 11 this section shall be an infraction. 12 595.120. 1. Prior to January 1, 2019, the department 1 of public safety shall create a poster that provides 2 SB 699 92 information regarding the national human trafficking 3 resource center hotline. The poster shall be no smaller 4 than eight and one-half inches by eleven inches in size and 5 shall include a statement in substantially the following 6 form: 7 The statement shall appear on each poster in English, 26 Spanish, and, for each county, any other language required 27 for voting materials in that county under Section 1973 of 28 the Voting Rights Act of 1965, 42 U.S.C. Section 1973, as 29 amended. In addition to the national human trafficking 30 resource center hotline, the statement may contain any 31 additional hotlines regarding human trafficking for access 32 to help and services. 33 8 9 10 11 12 13 14 15 16 17 "If you or someone you know is being forced to engage in any activity and cannot leave – whether it is commercial sex, housework, farm work, or any other activity – call the National Human Trafficking Resource Center Hotline at 1-888-373- 7888 or text 233733 (BEFREE) or visit the following website: www.traffickingresourcecenter.org to access help and services. Victims of human trafficking are protected under U.S. and Missouri law. 18 The toll-free hotline is: 19 - Available 24 hours a day, 7 days a week 20 21 - Operated by a nonprofit, nongovernmental organization 22 - Anonymous and confidential 23 - Accessible in 170 languages 24 25 - Able to provide help, referral to services, training, and general information.". SB 699 93 2. Beginning March 1, 2019, the human trafficking 34 hotline poster designed by the department of public safety 35 shall be displayed in a conspicuous place in or near the 36 bathrooms or near the entrance of each of the following 37 establishments: 38 (1) Hotels, motels, or other establishments that have 39 been cited as a public nuisance for prostitution under 40 section 567.080; 41 (2) Strip clubs or other sexually oriented businesses; 42 (3) Private clubs that have a liquor permit for on- 43 premises consumption, do not hold themselves out to be food 44 service establishments, and are not affiliated with any 45 nonprofit fraternal, athletic, religious, or veteran 46 organizations; 47 (4) Airports; 48 (5) Train stations that serve passengers; 49 (6) Emergency rooms within general acute care 50 hospitals; 51 (7) Urgent care centers; 52 (8) Privately operated job recruitment centers; 53 (9) Businesses or establishments that offer massage or 54 body work services for compensation by individuals who are 55 not licensed under section 324.265; 56 (10) Women's health centers; 57 (11) [Abortion facilities as defined in section 58 188.015; 59 (12)] Family planning clinics; 60 [(13)] (12) Maternity homes as defined in section 61 135.600; 62 [(14)] (13) Pregnancy resource centers as defined in 63 section 135.630; 64 [(15)] (14) Bus stations; 65 SB 699 94 [(16)] (15) Truck stops. For the purposes of this 66 section, "truck stops" shall mean privately owned and 67 operated facilities that provide food, fuel, shower or other 68 sanitary facilities, and lawful overnight parking; and 69 [(17)] (16) Roadside rest areas. 70 3. The department of public safety shall make the 71 poster available for print on its public website. To obtain 72 a copy of the poster, the owners or operators of an 73 establishment required to post the human trafficking hotline 74 notice under subsection 2 of this section may print the 75 online poster using the online link or request that the 76 poster be mailed for the cost of printing and first class 77 postage. 78 4. Any owner or operator of an establishment required 79 to post the human trafficking hotline notice under 80 subsection 2 of this section who fails to comply with the 81 requirement shall receive a written warning for the first 82 violation and may be guilty of an infraction for any 83 subsequent violation. 84 [188.017. 1. This section shall be known 1 and may be cited as the "Right to Life of the 2 Unborn Child Act". 3 2. Notwithstanding any other provision of 4 law to the contrary, no abortion shall be 5 performed or induced upon a woman, except in 6 cases of medical emergency. Any person who 7 knowingly performs or induces an abortion of an 8 unborn child in violation of this subsection 9 shall be guilty of a class B felony, as well as 10 subject to suspension or revocation of his or 11 her professional license by his or her 12 professional licensing board. A woman upon whom 13 an abortion is performed or induced in violation 14 of this subsection shall not be prosecuted for a 15 conspiracy to violate the provisions of this 16 subsection. 17 3. It shall be an affirmative defense for 18 any person alleged to have violated the 19 provisions of subsection 2 of this section that 20 the person performed or induced an abortion 21 because of a medical emergency. The defendant 22 SB 699 95 shall have the burden of persuasion that the 23 defense is more probably true than not. 24 4. The enactment of this section shall 25 only become effective upon notification to the 26 revisor of statutes by an opinion by the 27 attorney general of Missouri, a proclamation by 28 the governor of Missouri, or the adoption of a 29 concurrent resolution by the Missouri general 30 assembly that: 31 (1) The United States Supreme Court has 32 overruled, in whole or in part, Roe v. Wade, 410 33 U.S. 113 (1973), restoring or granting to the 34 state of Missouri the authority to regulate 35 abortion to the extent set forth in this 36 section, and that as a result, it is reasonably 37 probable that this section would be upheld by 38 the court as constitutional; 39 (2) An amendment to the Constitution of 40 the United States has been adopted that has the 41 effect of restoring or granting to the state of 42 Missouri the authority to regulate abortion to 43 the extent set forth in this section; or 44 (3) The United States Congress has enacted 45 a law that has the effect of restoring or 46 granting to the state of Missouri the authority 47 to regulate abortion to the extent set forth in 48 this section.] 49 [188.018. If any one or more provisions, 1 sections, subsections, sentences, clauses, 2 phrases, or words of this chapter or the 3 application thereof to any person, circumstance, 4 or period of gestational age is found to be 5 unenforceable, unconstitutional, or invalid by a 6 court of competent jurisdiction, the same is 7 hereby declared to be severable and the balance 8 of this chapter shall remain effective 9 notwithstanding such unenforceability, 10 unconstitutionality, or invalidity. The general 11 assembly hereby declares that it would have 12 passed each provision, section, subsection, 13 sentence, clause, phrase, or word thereof, 14 irrespective of the fact that any one or more 15 provisions, sections, subsections, sentences, 16 clauses, phrases, or words of this chapter, or 17 the application of this chapter to any person, 18 circumstance, or period of gestational age, 19 would be declared unenforceable, 20 unconstitutional, or invalid.] 21 [188.021. 1. When RU-486 (mifepristone) 1 or any drug or chemical is used for the purpose 2 of inducing an abortion, the initial dose of the 3 drug or chemical shall be administered in the 4 same room and in the physical presence of the 5 physician who prescribed, dispensed, or 6 otherwise provided the drug or chemical to the 7 patient. The physician inducing the abortion, 8 SB 699 96 or a person acting on such physician's behalf, 9 shall make all reasonable efforts to ensure that 10 the patient returns after the administration or 11 use of RU-486 or any drug or chemical for a 12 follow-up visit unless such termination of the 13 pregnancy has already been confirmed and the 14 patient's medical condition has been assessed by 15 a licensed physician prior to discharge. 16 2. When the Food and Drug Administration 17 label of any drug or chemical used for the 18 purpose of inducing an abortion includes any 19 clinical study in which more than one percent of 20 those administered the drug or chemical required 21 surgical intervention after its administration, 22 no physician may prescribe or administer such 23 drug or chemical to any patient without first 24 obtaining approval from the department of health 25 and senior services of a complication plan from 26 the physician for administration of the drug or 27 chemical to any patient. The complication plan 28 shall include any information deemed necessary 29 by the department to ensure the safety of any 30 patient suffering complications as a result of 31 the administration of the drug or chemical in 32 question. No complication plan shall be 33 required where the patient is administered the 34 drug in a medical emergency at a hospital and is 35 then treated as an inpatient at a hospital under 36 medical monitoring by the hospital until the 37 abortion is completed. 38 3. The department may adopt rules, 39 regulations, and standards governing 40 complication plans to ensure that patients 41 undergoing abortions induced by drugs or 42 chemicals have access to safe and reliable 43 care. Any rule or portion of a rule, as that 44 term is defined in section 536.010, that is 45 created under the authority delegated in this 46 section shall become effective only if it 47 complies with and is subject to all of the 48 provisions of chapter 536 and, if applicable, 49 section 536.028. This section and chapter 536 50 are nonseverable and if any of the powers vested 51 with the general assembly pursuant to chapter 52 536 to review, to delay the effective date, or 53 to disapprove and annul a rule are subsequently 54 held unconstitutional, then the grant of 55 rulemaking authority and any rule proposed or 56 adopted after October 24, 2017, shall be invalid 57 and void.] 58 [188.025. Every abortion performed at 1 sixteen weeks gestational age or later shall be 2 performed in a hospital.] 3 [188.026. 1. This section and sections 1 188.056, 188.057, and 188.058 shall be known and 2 SB 699 97 may be cited as the "Missouri Stands for the 3 Unborn Act". 4 2. In Roe v. Wade, 410 U.S. 113 (1973), 5 certain information about the development of the 6 unborn child, human pregnancy, and the effects 7 of abortion was either not part of the record or 8 was not available at the time. Since 1973, 9 advances in medical and scientific technology 10 have greatly expanded our knowledge of prenatal 11 life and the effects of abortion on women. The 12 general assembly of this state finds: 13 (1) At conception, a new genetically 14 distinct human being is formed; 15 (2) The fact that the life of an 16 individual human being begins at conception has 17 long been recognized in Missouri law: "[T]he 18 child is, in truth, alive from the moment of 19 conception". State v. Emerich, 13 Mo. App. 492, 20 495 (1883), affirmed, 87 Mo. 110 (1885). Under 21 section 1.205, the general assembly has 22 recognized that the life of each human being 23 begins at conception and that unborn children 24 have protectable interests in life, health, and 25 well-being; 26 (3) The first prohibition of abortion in 27 Missouri was enacted in 1825. Since then, the 28 repeal and reenactment of prohibitions of 29 abortion have made distinctions with respect to 30 penalties for performing or inducing abortion on 31 the basis of "quickening"; however, the unborn 32 child was still protected from conception onward; 33 (4) In ruling that Missouri's prohibition 34 on abortion was constitutional in 1972, the 35 Missouri supreme court accepted as a stipulation 36 of the parties that "'[i]nfant Doe, Intervenor 37 Defendant in this case, and all other unborn 38 children have all the qualities and attributes 39 of adult human persons differing only in age or 40 maturity. Medically, human life is a continuum 41 from conception to death.'" Rodgers v. Danforth, 42 486 S.W.2d 258, 259 (1972); 43 (5) In Webster v. Reproductive Health 44 Services, 492 U.S. 490 (1989), the Supreme 45 Court, while considering the "preamble" that set 46 forth "findings" in section 1.205, stated: "We 47 think the extent to which the preamble's 48 language might be used to interpret other state 49 statutes or regulations is something that only 50 the courts of Missouri can definitively decide. 51 State law has offered protections to unborn 52 children in tort and probate law". Id. at 506. 53 Since Webster, Missouri courts have construed 54 section 1.205 and have consistently found that 55 an unborn child is a person for purposes of 56 Missouri's homicide and assault laws when the 57 unborn child's mother was killed or assaulted by 58 another person. Section 1.205 has even been 59 SB 699 98 found applicable to the manslaughter of an 60 unborn child who was eight weeks gestational age 61 or earlier. State v. Harrison, 390 S.W.3d 927 62 (Mo. Ct. App. 2013); 63 (6) In medicine, a special emphasis is 64 placed on the heartbeat. The heartbeat is a 65 discernible sign of life at every stage of human 66 existence. During the fifth week of gestational 67 age, an unborn child's heart begins to beat and 68 blood flow begins during the sixth week; 69 (7) Depending on the ultrasound equipment 70 being used, the unborn child's heartbeat can be 71 visually detected as early as six to eight weeks 72 gestational age. By about twelve weeks 73 gestational age, the unborn child's heartbeat 74 can consistently be made audible through the use 75 of a handheld Doppler fetal heart rate device; 76 (8) Confirmation of a pregnancy can be 77 indicated through the detection of the unborn 78 child's heartbeat, while the absence of a 79 heartbeat can be an indicator of the death of 80 the unborn child if the child has reached the 81 point of development when a heartbeat should be 82 detectable; 83 (9) Heart rate monitoring during pregnancy 84 and labor is utilized to measure the heart rate 85 and rhythm of the unborn child, at an average 86 rate between one hundred ten and one hundred 87 sixty beats per minute, and helps determine the 88 health of the unborn child; 89 (10) The Supreme Court in Roe discussed 90 "the difficult question of when life begins" and 91 wrote: "[p]hysicians and their scientific 92 colleagues have regarded [quickening] with less 93 interest and have tended to focus either upon 94 conception, upon live birth, or upon the interim 95 point at which the fetus becomes 'viable', that 96 is, potentially able to live outside the 97 mother's womb, albeit with artificial aid". 98 Roe, 410 U.S. at 160. Today, however, 99 physicians' and scientists' interests on life in 100 the womb also focus on other markers of 101 development in the unborn child, including, but 102 not limited to, presence of a heartbeat, brain 103 development, a viable pregnancy or viable 104 intrauterine pregnancy during the first 105 trimester of pregnancy, and the ability to 106 experience pain; 107 (11) In Planned Parenthood of Central 108 Missouri v. Danforth, 428 U.S. 52 (1976), the 109 Supreme Court noted that "we recognized in Roe 110 that viability was a matter of medical judgment, 111 skill, and technical ability, and we preserved 112 the flexibility of the term". Id. at 64. Due to 113 advances in medical technology and diagnoses, 114 present-day physicians and scientists now 115 describe the viability of an unborn child in an 116 SB 699 99 additional manner, by determining whether there 117 is a viable pregnancy or viable intrauterine 118 pregnancy during the first trimester of 119 pregnancy; 120 (12) While the overall risk of miscarriage 121 after clinical recognition of pregnancy is 122 twelve to fifteen percent, the incidence 123 decreases significantly if cardiac activity in 124 the unborn child has been confirmed. The 125 detection of a heartbeat in an unborn child is a 126 reliable indicator of a viable pregnancy and 127 that the unborn child will likely survive to 128 birth, especially if presenting for a prenatal 129 visit at eight weeks gestational age or later. 130 For asymptomatic women attending a first 131 prenatal visit between six and eleven weeks 132 gestational age where a heartbeat was confirmed 133 through an ultrasound, the subsequent risk of 134 miscarriage is one and six-tenths percent. 135 Although the risk is higher at six weeks 136 gestational age at nine and four-tenths percent, 137 it declines rapidly to one and five-tenths 138 percent at eight weeks gestational age, and less 139 than one percent at nine weeks gestational age 140 or later; 141 (13) The presence of a heartbeat in an 142 unborn child represents a more definable point 143 of ascertaining survivability than the ambiguous 144 concept of viability that has been adopted by 145 the Supreme Court, especially since if a 146 heartbeat is detected at eight weeks gestational 147 age or later in a normal pregnancy, there is 148 likely to be a viable pregnancy and there is a 149 high probability that the unborn child will 150 survive to birth; 151 (14) The placenta begins developing during 152 the early first trimester of pregnancy and 153 performs a respiratory function by making oxygen 154 supply to and carbon dioxide removal from the 155 unborn child possible later in the first 156 trimester and throughout the second and third 157 trimesters of pregnancy; 158 (15) By the fifth week of gestation, the 159 development of the brain of the unborn child is 160 underway. Brain waves have been measured and 161 recorded as early as the eighth week of 162 gestational age in children who were removed 163 during an ectopic pregnancy or hysterectomy. 164 Fetal magnetic resonance imaging (MRI) of an 165 unborn child's brain is used during the second 166 and third trimesters of pregnancy and brain 167 activity has been observed using MRI; 168 (16) Missouri law identifies the presence 169 of circulation, respiration, and brain function 170 as indicia of life under section 194.005, as the 171 presence of circulation, respiration, and brain 172 SB 699 100 function indicates that such person is not 173 legally dead, but is legally alive; 174 (17) Unborn children at eight weeks 175 gestational age show spontaneous movements, such 176 as a twitching of the trunk and developing 177 limbs. It has been reported that unborn 178 children at this stage show reflex responses to 179 touch. The perioral area is the first part of 180 the unborn child's body to respond to touch at 181 about eight weeks gestational age and by 182 fourteen weeks gestational age most of the 183 unborn child's body is responsive to touch; 184 (18) Peripheral cutaneous sensory 185 receptors, the receptors that feel pain, develop 186 early in the unborn child. They appear in the 187 perioral cutaneous area at around seven to eight 188 weeks gestational age, in the palmar regions at 189 ten to ten and a half weeks gestational age, the 190 abdominal wall at fifteen weeks gestational age, 191 and over all of the unborn child's body at 192 sixteen weeks gestational age; 193 (19) Substance P, a peptide that functions 194 as a neurotransmitter, especially in the 195 transmission of pain, is present in the dorsal 196 horn of the spinal cord of the unborn child at 197 eight to ten weeks gestational age. 198 Enkephalins, peptides that play a role in 199 neurotransmission and pain modulation, are 200 present in the dorsal horn at twelve to fourteen 201 weeks gestational age; 202 (20) When intrauterine needling is 203 performed on an unborn child at sixteen weeks 204 gestational age or later, the reaction to this 205 invasive stimulus is blood flow redistribution 206 to the brain. Increased blood flow to the brain 207 is the same type of stress response seen in a 208 born child and an adult; 209 (21) By sixteen weeks gestational age, 210 pain transmission from a peripheral receptor to 211 the cortex is possible in the unborn child; 212 (22) Physicians provide anesthesia during 213 in utero treatment of unborn children as early 214 as sixteen weeks gestational age for certain 215 procedures, including those to correct fetal 216 urinary tract obstruction. Anesthesia is 217 administered by ultrasound-guided injection into 218 the arm or leg of the unborn child; 219 (23) A leading textbook on prenatal 220 development of the human brain states, "It may 221 be concluded that, although nociperception (the 222 actual perception of pain) awaits the appearance 223 of consciousness, nociception (the experience of 224 pain) is present some time before birth. In the 225 absence of disproof, it is merely prudent to 226 assume that pain can be experienced even early 227 in prenatal life (Dr. J. Wisser, Zürich): the 228 fetus should be given the benefit of the 229 SB 699 101 doubt". Ronan O'Rahilly & Fabiola Müller. The 230 Embryonic Human Brain: An Atlas of 231 Developmental Stages (3d ed. 2005); 232 (24) By fourteen or fifteen weeks 233 gestational age or later, the predominant 234 abortion method in Missouri is dilation and 235 evacuation (D&E). The D&E abortion method 236 includes the dismemberment, disarticulation, and 237 exsanguination of the unborn child, causing the 238 unborn child's death; 239 (25) The Supreme Court acknowledged in 240 Gonzales v. Carhart, 550 U.S. 124, 160 (2007), 241 that "the standard D&E is in some respects as 242 brutal, if not more, than the intact D&E" 243 partial birth abortion method banned by Congress 244 and upheld as facially constitutional by the 245 Supreme Court, even though the federal ban was 246 applicable both before and after viability and 247 had no exception for the health of the mother; 248 (26) Missouri's ban on the partial birth 249 abortion method, section 565.300, is in effect 250 because of Gonzales v. Carhart and the Supreme 251 Court's subsequent decision in Nixon v. 252 Reproductive Health Services of Planned 253 Parenthood of the St. Louis Region, Inc., 550 254 U.S. 901 (2007), to vacate and remand to the 255 appellate court the prior invalidation of 256 section 565.300. Since section 565.300, like 257 Congress' ban on partial birth abortion, is 258 applicable both before and after viability, 259 there is ample precedent for the general 260 assembly to constitutionally prohibit the brutal 261 D&E abortion method at fourteen weeks 262 gestational age or later, even before the unborn 263 child is viable, with a medical emergency 264 exception; 265 (27) In Roper v. Simmons, 543 U.S. 551 266 (2005), the Supreme Court determined that 267 "evolving standards of decency" dictated that a 268 Missouri statute allowing the death penalty for 269 a conviction of murder in the first degree for a 270 person under eighteen years of age when the 271 crime was committed was unconstitutional under 272 the Eighth and Fourteenth Amendments to the 273 United States Constitution because it violated 274 the prohibition against "cruel and unusual 275 punishments"; 276 (28) In Bucklew v. Precythe, 139 S. Ct. 277 1112, 1123 (2019), the Supreme Court noted that 278 "'[d]isgusting' practices" like disemboweling 279 and quartering "readily qualified as 'cruel and 280 unusual', as a reader at the time of the Eighth 281 Amendment's adoption would have understood those 282 words"; 283 (29) Evolving standards of decency dictate 284 that Missouri should prohibit the brutal and 285 painful D&E abortion method at fourteen weeks 286 SB 699 102 gestational age or later, with a medical 287 emergency exception, because if a comparable 288 method of killing was used on: 289 (a) A person convicted of murder in the 290 first degree, it would be cruel and unusual 291 punishment; or 292 (b) An animal, it would be unlawful under 293 state law because it would not be a humane 294 method, humane euthanasia, or humane killing of 295 certain animals under chapters 273 and 578; 296 (30) In Roper, the Supreme Court also 297 found that "[i]t is proper that we acknowledge 298 the overwhelming weight of international opinion 299 against the juvenile death penalty.... The 300 opinion of the world community, while not 301 controlling our outcome, does provide respected 302 and significant confirmation for our own 303 conclusions". Roper, 543 U.S. at 578. In its 304 opinion, the Supreme Court was instructed by 305 "international covenants prohibiting the 306 juvenile death penalty", such as the 307 International Covenant on Civil and Political 308 Rights, 999 U.N.T.S. 171. Id. at 577; 309 (31) The opinion of the world community, 310 reflected in the laws of the United Nation's 193- 311 member states and six other entities, is that in 312 most countries, most abortions are prohibited 313 after twelve weeks gestational age or later; 314 (32) The opinion of the world community is 315 also shared by most Americans, who believe that 316 most abortions in the second and third 317 trimesters of pregnancy should be illegal, based 318 on polling that has remained consistent since 319 1996; 320 (33) Abortion procedures performed later 321 in pregnancy have a higher medical risk for 322 women. Compared to an abortion at eight weeks 323 gestational age or earlier, the relative risk 324 increases exponentially at later gestational 325 ages. The relative risk of death for a pregnant 326 woman who had an abortion performed or induced 327 upon her at: 328 (a) Eleven to twelve weeks gestational age 329 is between three and four times higher than an 330 abortion at eight weeks gestational age or 331 earlier; 332 (b) Thirteen to fifteen weeks gestational 333 age is almost fifteen times higher than an 334 abortion at eight weeks gestational age or 335 earlier; 336 (c) Sixteen to twenty weeks gestational 337 age is almost thirty times higher than an 338 abortion at eight weeks gestational age or 339 earlier; and 340 (d) Twenty-one weeks gestational age or 341 later is more than seventy-five times higher 342 SB 699 103 than an abortion at eight weeks gestational age 343 or earlier; 344 (34) In addition to the short-term risks 345 of an abortion, studies have found that the long- 346 term physical and psychological consequences of 347 abortion for women include, but are not limited 348 to, an increased risk of preterm birth, low 349 birthweight babies, and placenta previa in 350 subsequent pregnancies, as well as serious 351 behavioral health issues. These risks increase 352 as abortions are performed or induced at later 353 gestational ages. These consequences of an 354 abortion have a detrimental effect not only on 355 women, their children, and their families, but 356 also on an already burdened health care system, 357 taxpayers, and the workforce; 358 (35) A large percentage of women who have 359 an abortion performed or induced upon them in 360 Missouri each year are at less than eight weeks 361 gestational age, a large majority are at less 362 than fourteen weeks gestational age, a larger 363 majority are at less than eighteen weeks 364 gestational age, and an even larger majority are 365 at less than twenty weeks gestational age. A 366 prohibition on performing or inducing an 367 abortion at eight weeks gestational age or 368 later, with a medical emergency exception, does 369 not amount to a substantial obstacle to a large 370 fraction of women for whom the prohibition is 371 relevant, which is pregnant women in Missouri 372 who are seeking an abortion while not 373 experiencing a medical emergency. The burden 374 that a prohibition on performing or inducing an 375 abortion at eight, fourteen, eighteen, or twenty 376 weeks gestational age or later, with a medical 377 emergency exception, might impose on abortion 378 access, is outweighed by the benefits conferred 379 upon the following: 380 (a) Women more advanced in pregnancy who 381 are at greater risk of harm from abortion; 382 (b) Unborn children at later stages of 383 development; 384 (c) The medical profession, by preserving 385 its integrity and fulfilling its commitment to 386 do no harm; and 387 (d) Society, by fostering respect for 388 human life, born and unborn, at all stages of 389 development, and by lessening societal tolerance 390 of violence against innocent human life; 391 (36) In Webster, the Supreme Court noted, 392 in upholding a Missouri statute, "that there may 393 be a 4-week error in estimating gestational 394 age". Webster, 492 U.S. at 516. Thus, an 395 unborn child thought to be eight weeks 396 gestational age might in fact be twelve weeks 397 gestational age, when an abortion poses a 398 greater risk to the woman and the unborn child 399 SB 699 104 is considerably more developed. An unborn child 400 at fourteen weeks gestational age might be 401 eighteen weeks gestational age and an unborn 402 child at eighteen weeks gestational age might be 403 twenty-two weeks gestational age, when an 404 abortion poses a greater risk to the woman, the 405 unborn child is considerably more developed, the 406 abortion method likely to be employed is more 407 brutal, and the risk of pain experienced by the 408 unborn child is greater. An unborn child at 409 twenty weeks gestational age might be twenty- 410 four weeks gestational age, when an abortion 411 poses a greater risk to the woman, the unborn 412 child is considerably more developed, the 413 abortion method likely to be employed is more 414 brutal, the risk of pain experienced by the 415 unborn child is greater, and the unborn child 416 may be viable. 417 3. The state of Missouri is bound by 418 Article VI, Clause 2 of the Constitution of the 419 United States that "all treaties made, or which 420 shall be made, under the authority of the United 421 States, shall be the supreme law of the land". 422 One such treaty is the International Covenant on 423 Civil and Political Rights, entered into force 424 on March 23, 1976, and adopted by the United 425 States on September 8, 1992. In ratifying the 426 Covenant, the United States declared that while 427 the provisions of Articles 1 through 27 of the 428 Covenant are not self-executing, the United 429 States' understanding is that state governments 430 share responsibility with the federal government 431 in implementing the Covenant. 432 4. Article 6, Paragraph 1, U.N.T.S. at 433 174, of the International Covenant on Civil and 434 Political Rights states, "Every human being has 435 the inherent right to life. This right shall be 436 protected by law. No one shall be arbitrarily 437 deprived of his life". The state of Missouri 438 takes seriously its obligation to comply with 439 the Covenant and to implement this paragraph as 440 it relates to the inherent right to life of 441 unborn human beings, protecting the rights of 442 unborn human beings by law, and ensuring that 443 such unborn human beings are not arbitrarily 444 deprived of life. The state of Missouri hereby 445 implements Article 6, Paragraph 1 of the 446 Covenant by the regulation of abortion in this 447 state. 448 5. The state of Missouri has interests 449 that include, but are not limited to: 450 (1) Protecting unborn children throughout 451 pregnancy and preserving and promoting their 452 lives from conception to birth; 453 (2) Encouraging childbirth over abortion; 454 (3) Ensuring respect for all human life 455 from conception to natural death; 456 SB 699 105 (4) Safeguarding an unborn child from the 457 serious harm of pain by an abortion method that 458 would cause the unborn child to experience pain 459 while she or he is being killed; 460 (5) Preserving the integrity of the 461 medical profession and regulating and 462 restricting practices that might cause the 463 medical profession or society as a whole to 464 become insensitive, even disdainful, to life. 465 This includes regulating and restricting 466 abortion methods that are not only brutal and 467 painful, but if allowed to continue, will 468 further coarsen society to the humanity of not 469 only unborn children, but all vulnerable and 470 innocent human life, making it increasingly 471 difficult to protect such life; 472 (6) Ending the incongruities in state law 473 by permitting some unborn children to be killed 474 by abortion, while requiring that unborn 475 children be protected in nonabortion 476 circumstances through, including, but not 477 limited to, homicide, assault, self-defense, and 478 defense of another statutes; laws guaranteeing 479 prenatal health care, emergency care, and 480 testing; state-sponsored health insurance for 481 unborn children; the prohibition of restraints 482 in correctional institutions to protect pregnant 483 offenders and their unborn children; and 484 protecting the interests of unborn children by 485 the appointment of conservators, guardians, and 486 representatives; 487 (7) Reducing the risks of harm to pregnant 488 women who obtain abortions later in pregnancy; 489 and 490 (8) Avoiding burdens on the health care 491 system, taxpayers, and the workforce because of 492 increased preterm births, low birthweight 493 babies, compromised pregnancies, extended 494 postpartum recoveries, and behavioral health 495 problems caused by the long-term effects of 496 abortions performed or induced later in the 497 pregnancy.] 498 [188.027. 1. Except in cases of medical 1 emergency, no abortion shall be performed or 2 induced on a woman without her voluntary and 3 informed consent, given freely and without 4 coercion. Consent to an abortion is voluntary 5 and informed and given freely and without 6 coercion if, and only if, at least seventy-two 7 hours prior to the abortion: 8 (1) The physician who is to perform or 9 induce the abortion, a qualified professional, 10 or the referring physician has informed the 11 woman orally, reduced to writing, and in person, 12 of the following: 13 SB 699 106 (a) The name of the physician who will 14 perform or induce the abortion; 15 (b) Medically accurate information that a 16 reasonable patient would consider material to 17 the decision of whether or not to undergo the 18 abortion, including: 19 a. A description of the proposed abortion 20 method; 21 b. The immediate and long-term medical 22 risks to the woman associated with the proposed 23 abortion method including, but not limited to, 24 infection, hemorrhage, cervical tear or uterine 25 perforation, harm to subsequent pregnancies or 26 the ability to carry a subsequent child to term, 27 and possible adverse psychological effects 28 associated with the abortion; and 29 c. The immediate and long-term medical 30 risks to the woman, in light of the anesthesia 31 and medication that is to be administered, the 32 unborn child's gestational age, and the woman's 33 medical history and medical condition; 34 (c) Alternatives to the abortion which 35 shall include making the woman aware that 36 information and materials shall be provided to 37 her detailing such alternatives to the abortion; 38 (d) A statement that the physician 39 performing or inducing the abortion is available 40 for any questions concerning the abortion, 41 together with the telephone number that the 42 physician may be later reached to answer any 43 questions that the woman may have; 44 (e) The location of the hospital that 45 offers obstetrical or gynecological care located 46 within thirty miles of the location where the 47 abortion is performed or induced and at which 48 the physician performing or inducing the 49 abortion has clinical privileges and where the 50 woman may receive follow-up care by the 51 physician if complications arise; 52 (f) The gestational age of the unborn 53 child at the time the abortion is to be 54 performed or induced; and 55 (g) The anatomical and physiological 56 characteristics of the unborn child at the time 57 the abortion is to be performed or induced; 58 (2) The physician who is to perform or 59 induce the abortion or a qualified professional 60 has presented the woman, in person, printed 61 materials provided by the department, which 62 describe the probable anatomical and 63 physiological characteristics of the unborn 64 child at two-week gestational increments from 65 conception to full term, including color 66 photographs or images of the developing unborn 67 child at two-week gestational increments. Such 68 descriptions shall include information about 69 brain and heart functions, the presence of 70 SB 699 107 external members and internal organs during the 71 applicable stages of development and information 72 on when the unborn child is viable. The printed 73 materials shall prominently display the 74 following statement: "The life of each human 75 being begins at conception. Abortion will 76 terminate the life of a separate, unique, living 77 human being."; 78 (3) The physician who is to perform or 79 induce the abortion, a qualified professional, 80 or the referring physician has presented the 81 woman, in person, printed materials provided by 82 the department, which describe the various 83 surgical and drug-induced methods of abortion 84 relevant to the stage of pregnancy, as well as 85 the immediate and long-term medical risks 86 commonly associated with each abortion method 87 including, but not limited to, infection, 88 hemorrhage, cervical tear or uterine 89 perforation, harm to subsequent pregnancies or 90 the ability to carry a subsequent child to term, 91 and the possible adverse psychological effects 92 associated with an abortion; 93 (4) The physician who is to perform or 94 induce the abortion or a qualified professional 95 shall provide the woman with the opportunity to 96 view at least seventy-two hours prior to the 97 abortion an active ultrasound of the unborn 98 child and hear the heartbeat of the unborn child 99 if the heartbeat is audible. The woman shall be 100 provided with a geographically indexed list 101 maintained by the department of health care 102 providers, facilities, and clinics that perform 103 ultrasounds, including those that offer 104 ultrasound services free of charge. Such 105 materials shall provide contact information for 106 each provider, facility, or clinic including 107 telephone numbers and, if available, website 108 addresses. Should the woman decide to obtain an 109 ultrasound from a provider, facility, or clinic 110 other than the abortion facility, the woman 111 shall be offered a reasonable time to obtain the 112 ultrasound examination before the date and time 113 set for performing or inducing an abortion. The 114 person conducting the ultrasound shall ensure 115 that the active ultrasound image is of a quality 116 consistent with standard medical practice in the 117 community, contains the dimensions of the unborn 118 child, and accurately portrays the presence of 119 external members and internal organs, if present 120 or viewable, of the unborn child. The 121 auscultation of fetal heart tone must also be of 122 a quality consistent with standard medical 123 practice in the community. If the woman chooses 124 to view the ultrasound or hear the heartbeat or 125 both at the abortion facility, the viewing or 126 hearing or both shall be provided to her at the 127 SB 699 108 abortion facility at least seventy-two hours 128 prior to the abortion being performed or induced; 129 (5) The printed materials provided by the 130 department shall include information on the 131 possibility of an abortion causing pain in the 132 unborn child. This information shall include, 133 but need not be limited to, the following: 134 (a) Unborn children as early as eight 135 weeks gestational age start to show spontaneous 136 movements and unborn children at this stage in 137 pregnancy show reflex responses to touch; 138 (b) In the unborn child, the area around 139 his or her mouth and lips is the first part of 140 the unborn child's body to respond to touch and 141 by fourteen weeks gestational age most of the 142 unborn child's body is responsive to touch; 143 (c) Pain receptors on the unborn child's 144 skin develop around his or her mouth at around 145 seven to eight weeks gestational age, around the 146 palms of his or her hands at ten to ten and a 147 half weeks, on the abdominal wall at fifteen 148 weeks, and over all of his or her body at 149 sixteen weeks gestational age; 150 (d) Beginning at sixteen weeks gestational 151 age and later, it is possible for pain to be 152 transmitted from receptors to the cortex of the 153 unborn child's brain, where thinking and 154 perceiving occur; 155 (e) When a physician performs a life- 156 saving surgery, he or she provides anesthesia to 157 unborn children as young as sixteen weeks 158 gestational age in order to alleviate the unborn 159 child's pain; and 160 (f) A description of the actual steps in 161 the abortion procedure to be performed or 162 induced and at which steps the abortion 163 procedure could be painful to the unborn child; 164 (6) The physician who is to perform or 165 induce the abortion or a qualified professional 166 has presented the woman, in person, printed 167 materials provided by the department explaining 168 to the woman alternatives to abortion she may 169 wish to consider. Such materials shall: 170 (a) Identify on a geographical basis 171 public and private agencies available to assist 172 a woman in carrying her unborn child to term, 173 and to assist her in caring for her dependent 174 child or placing her child for adoption, 175 including agencies commonly known and generally 176 referred to as pregnancy resource centers, 177 crisis pregnancy centers, maternity homes, and 178 adoption agencies. Such materials shall provide 179 a comprehensive list by geographical area of the 180 agencies, a description of the services they 181 offer, and the telephone numbers and addresses 182 of the agencies; provided that such materials 183 shall not include any programs, services, 184 SB 699 109 organizations, or affiliates of organizations 185 that perform or induce, or assist in the 186 performing or inducing of, abortions or that 187 refer for abortions; 188 (b) Explain the Missouri alternatives to 189 abortion services program under section 188.325, 190 and any other programs and services available to 191 pregnant women and mothers of newborn children 192 offered by public or private agencies which 193 assist a woman in carrying her unborn child to 194 term and assist her in caring for her dependent 195 child or placing her child for adoption, 196 including but not limited to prenatal care; 197 maternal health care; newborn or infant care; 198 mental health services; professional counseling 199 services; housing programs; utility assistance; 200 transportation services; food, clothing, and 201 supplies related to pregnancy; parenting skills; 202 educational programs; job training and placement 203 services; drug and alcohol testing and 204 treatment; and adoption assistance; 205 (c) Identify the state website for the 206 Missouri alternatives to abortion services 207 program under section 188.325, and any toll-free 208 number established by the state operated in 209 conjunction with the program; 210 (d) Prominently display the statement: 211 "There are public and private agencies willing 212 and able to help you carry your child to term, 213 and to assist you and your child after your 214 child is born, whether you choose to keep your 215 child or place him or her for adoption. The 216 state of Missouri encourages you to contact 217 those agencies before making a final decision 218 about abortion. State law requires that your 219 physician or a qualified professional give you 220 the opportunity to call agencies like these 221 before you undergo an abortion."; 222 (7) The physician who is to perform or 223 induce the abortion or a qualified professional 224 has presented the woman, in person, printed 225 materials provided by the department explaining 226 that the father of the unborn child is liable to 227 assist in the support of the child, even in 228 instances where he has offered to pay for the 229 abortion. Such materials shall include 230 information on the legal duties and support 231 obligations of the father of a child, including, 232 but not limited to, child support payments, and 233 the fact that paternity may be established by 234 the father's name on a birth certificate or 235 statement of paternity, or by court action. 236 Such printed materials shall also state that 237 more information concerning paternity 238 establishment and child support services and 239 enforcement may be obtained by calling the 240 SB 699 110 family support division within the Missouri 241 department of social services; and 242 (8) The physician who is to perform or 243 induce the abortion or a qualified professional 244 shall inform the woman that she is free to 245 withhold or withdraw her consent to the abortion 246 at any time without affecting her right to 247 future care or treatment and without the loss of 248 any state or federally funded benefits to which 249 she might otherwise be entitled. 250 2. All information required to be provided 251 to a woman considering abortion by subsection 1 252 of this section shall be presented to the woman 253 individually, in the physical presence of the 254 woman and in a private room, to protect her 255 privacy, to maintain the confidentiality of her 256 decision, to ensure that the information focuses 257 on her individual circumstances, to ensure she 258 has an adequate opportunity to ask questions, 259 and to ensure that she is not a victim of 260 coerced abortion. Should a woman be unable to 261 read materials provided to her, they shall be 262 read to her. Should a woman need an interpreter 263 to understand the information presented in the 264 written materials, an interpreter shall be 265 provided to her. Should a woman ask questions 266 concerning any of the information or materials, 267 answers shall be provided in a language she can 268 understand. 269 3. No abortion shall be performed or 270 induced unless and until the woman upon whom the 271 abortion is to be performed or induced certifies 272 in writing on a checklist form provided by the 273 department that she has been presented all the 274 information required in subsection 1 of this 275 section, that she has been provided the 276 opportunity to view an active ultrasound image 277 of the unborn child and hear the heartbeat of 278 the unborn child if it is audible, and that she 279 further certifies that she gives her voluntary 280 and informed consent, freely and without 281 coercion, to the abortion procedure. 282 4. No physician shall perform or induce an 283 abortion unless and until the physician has 284 obtained from the woman her voluntary and 285 informed consent given freely and without 286 coercion. If the physician has reason to 287 believe that the woman is being coerced into 288 having an abortion, the physician or qualified 289 professional shall inform the woman that 290 services are available for her and shall provide 291 her with private access to a telephone and 292 information about such services, including but 293 not limited to the following: 294 (1) Rape crisis centers, as defined in 295 section 455.003; 296 SB 699 111 (2) Shelters for victims of domestic 297 violence, as defined in section 455.200; and 298 (3) Orders of protection, pursuant to 299 chapter 455. 300 5. The physician who is to perform or 301 induce the abortion shall, at least seventy-two 302 hours prior to such procedure, inform the woman 303 orally and in person of: 304 (1) The immediate and long-term medical 305 risks to the woman associated with the proposed 306 abortion method including, but not limited to, 307 infection, hemorrhage, cervical tear or uterine 308 perforation, harm to subsequent pregnancies or 309 the ability to carry a subsequent child to term, 310 and possible adverse psychological effects 311 associated with the abortion; and 312 (2) The immediate and long-term medical 313 risks to the woman, in light of the anesthesia 314 and medication that is to be administered, the 315 unborn child's gestational age, and the woman's 316 medical history and medical conditions. 317 6. No physician shall perform or induce an 318 abortion unless and until the physician has 319 received and signed a copy of the form 320 prescribed in subsection 3 of this section. The 321 physician shall retain a copy of the form in the 322 patient's medical record. 323 7. In the event of a medical emergency, 324 the physician who performed or induced the 325 abortion shall clearly certify in writing the 326 nature and circumstances of the medical 327 emergency. This certification shall be signed 328 by the physician who performed or induced the 329 abortion, and shall be maintained under section 330 188.060. 331 8. No person or entity shall require, 332 obtain, or accept payment for an abortion from 333 or on behalf of a patient until at least seventy- 334 two hours have passed since the time that the 335 information required by subsection 1 of this 336 section has been provided to the patient. 337 Nothing in this subsection shall prohibit a 338 person or entity from notifying the patient that 339 payment for the abortion will be required after 340 the seventy-two-hour period has expired if she 341 voluntarily chooses to have the abortion. 342 9. The term "qualified professional" as 343 used in this section shall refer to a physician, 344 physician assistant, registered nurse, licensed 345 practical nurse, psychologist, licensed 346 professional counselor, or licensed social 347 worker, licensed or registered under chapter 348 334, 335, or 337, acting under the supervision 349 of the physician performing or inducing the 350 abortion, and acting within the course and scope 351 of his or her authority provided by law. The 352 provisions of this section shall not be 353 SB 699 112 construed to in any way expand the authority 354 otherwise provided by law relating to the 355 licensure, registration, or scope of practice of 356 any such qualified professional. 357 10. By November 30, 2010, the department 358 shall produce the written materials and forms 359 described in this section. Any written 360 materials produced shall be printed in a 361 typeface large enough to be clearly legible. 362 All information shall be presented in an 363 objective, unbiased manner designed to convey 364 only accurate scientific and medical 365 information. The department shall furnish the 366 written materials and forms at no cost and in 367 sufficient quantity to any person who performs 368 or induces abortions, or to any hospital or 369 facility that provides abortions. The 370 department shall make all information required 371 by subsection 1 of this section available to the 372 public through its department website. The 373 department shall maintain a toll-free, twenty- 374 four-hour hotline telephone number where a 375 caller can obtain information on a regional 376 basis concerning the agencies and services 377 described in subsection 1 of this section. No 378 identifying information regarding persons who 379 use the website shall be collected or 380 maintained. The department shall monitor the 381 website on a regular basis to prevent tampering 382 and correct any operational deficiencies. 383 11. In order to preserve the compelling 384 interest of the state to ensure that the choice 385 to consent to an abortion is voluntary and 386 informed, and given freely and without coercion, 387 the department shall use the procedures for 388 adoption of emergency rules under section 389 536.025 in order to promulgate all necessary 390 rules, forms, and other necessary material to 391 implement this section by November 30, 2010. 392 12. If the provisions in subsections 1 and 393 8 of this section requiring a seventy-two-hour 394 waiting period for an abortion are ever 395 temporarily or permanently restrained or 396 enjoined by judicial order, then the waiting 397 period for an abortion shall be twenty-four 398 hours; provided, however, that if such temporary 399 or permanent restraining order or injunction is 400 stayed or dissolved, or otherwise ceases to have 401 effect, the waiting period for an abortion shall 402 be seventy-two hours.] 403 [188.028. 1. Except in the case of a 1 medical emergency, no person shall knowingly 2 perform or induce an abortion upon a pregnant 3 woman under the age of eighteen years unless: 4 (1) The attending physician has secured 5 the informed written consent of the minor and 6 SB 699 113 one parent or guardian, and the consenting 7 parent or guardian of the minor has notified any 8 other custodial parent in writing prior to the 9 securing of the informed written consent of the 10 minor and one parent or guardian. For purposes 11 of this subdivision, "custodial parent" shall 12 only mean a parent of a minor who has been 13 awarded joint legal custody or joint physical 14 custody of such minor by a court of competent 15 jurisdiction. Notice shall not be required for 16 any parent: 17 (a) Who has been found guilty of any 18 offense in violation of chapter 565, relating to 19 offenses against the person; chapter 566, 20 relating to sexual offenses; chapter 567, 21 relating to prostitution; chapter 568, relating 22 to offenses against the family; or chapter 573, 23 related to pornography and related offenses, if 24 a child was a victim; 25 (b) Who has been found guilty of any 26 offense in any other state or foreign country, 27 or under federal, tribal, or military 28 jurisdiction if a child was a victim, which 29 would be a violation of chapters 565, 566, 567, 30 568, or 573 if committed in this state; 31 (c) Who is listed on the sexual offender 32 registry under sections 589.400 to 589.425; 33 (d) Against whom an order of protection 34 has been issued, including a foreign order of 35 protection given full faith and credit in this 36 state under section 455.067; 37 (e) Whose custodial, parental, or 38 guardianship rights have been terminated by a 39 court of competent jurisdiction; or 40 (f) Whose whereabouts are unknown after 41 reasonable inquiry, who is a fugitive from 42 justice, who is habitually in an intoxicated or 43 drugged condition, or who has been declared 44 mentally incompetent or incapacitated by a court 45 of competent jurisdiction; 46 (2) The minor is emancipated and the 47 attending physician has received the informed 48 written consent of the minor; 49 (3) The minor has been granted the right 50 to self-consent to the abortion by court order 51 pursuant to subsection 2 of this section, and 52 the attending physician has received the 53 informed written consent of the minor; or 54 (4) The minor has been granted consent to 55 the abortion by court order, and the court has 56 given its informed written consent in accordance 57 with subsection 2 of this section, and the minor 58 is having the abortion willingly, in compliance 59 with subsection 3 of this section. 60 2. The right of a minor to self-consent to 61 an abortion under subdivision (3) of subsection 62 1 of this section or court consent under 63 SB 699 114 subdivision (4) of subsection 1 of this section 64 may be granted by a court pursuant to the 65 following procedures: 66 (1) The minor or next friend shall make an 67 application to the juvenile court which shall 68 assist the minor or next friend in preparing the 69 petition and notices required pursuant to this 70 section. The minor or the next friend of the 71 minor shall thereafter file a petition setting 72 forth the initials of the minor; the age of the 73 minor; the names and addresses of each parent, 74 guardian, or, if the minor's parents are 75 deceased and no guardian has been appointed, any 76 other person standing in loco parentis of the 77 minor; that the minor has been fully informed of 78 the risks and consequences of the abortion; that 79 the minor is of sound mind and has sufficient 80 intellectual capacity to consent to the 81 abortion; that, if the court does not grant the 82 minor majority rights for the purpose of consent 83 to the abortion, the court should find that the 84 abortion is in the best interest of the minor 85 and give judicial consent to the abortion; that 86 the court should appoint a guardian ad litem of 87 the child; and if the minor does not have 88 private counsel, that the court should appoint 89 counsel. The petition shall be signed by the 90 minor or the next friend; 91 (2) A hearing on the merits of the 92 petition, to be held on the record, shall be 93 held as soon as possible within five days of the 94 filing of the petition. If any party is unable 95 to afford counsel, the court shall appoint 96 counsel at least twenty-four hours before the 97 time of the hearing. At the hearing, the court 98 shall hear evidence relating to the emotional 99 development, maturity, intellect and 100 understanding of the minor; the nature, possible 101 consequences, and alternatives to the abortion; 102 and any other evidence that the court may find 103 useful in determining whether the minor should 104 be granted majority rights for the purpose of 105 consenting to the abortion or whether the 106 abortion is in the best interests of the minor; 107 (3) In the decree, the court shall for 108 good cause: 109 (a) Grant the petition for majority rights 110 for the purpose of consenting to the abortion; 111 (b) Find the abortion to be in the best 112 interests of the minor and give judicial consent 113 to the abortion, setting forth the grounds for 114 so finding; or 115 (c) Deny the petition, setting forth the 116 grounds on which the petition is denied; 117 (4) If the petition is allowed, the 118 informed consent of the minor, pursuant to a 119 court grant of majority rights, or the judicial 120 SB 699 115 consent, shall bar an action by the parents or 121 guardian of the minor on the grounds of battery 122 of the minor by those performing or inducing the 123 abortion. The immunity granted shall only 124 extend to the performance or induction of the 125 abortion in accordance herewith and any 126 necessary accompanying services which are 127 performed in a competent manner. The costs of 128 the action shall be borne by the parties; 129 (5) An appeal from an order issued under 130 the provisions of this section may be taken to 131 the court of appeals of this state by the minor 132 or by a parent or guardian of the minor. The 133 notice of intent to appeal shall be given within 134 twenty-four hours from the date of issuance of 135 the order. The record on appeal shall be 136 completed and the appeal shall be perfected 137 within five days from the filing of notice to 138 appeal. Because time may be of the essence 139 regarding the performance or induction of the 140 abortion, the supreme court of this state shall, 141 by court rule, provide for expedited appellate 142 review of cases appealed under this section. 143 3. If a minor desires an abortion, then 144 she shall be orally informed of and, if 145 possible, sign the written consent required 146 under this chapter in the same manner as an 147 adult person. No abortion shall be performed or 148 induced on any minor against her will, except 149 that an abortion may be performed or induced 150 against the will of a minor pursuant to a court 151 order described in subdivision (4) of subsection 152 1 of this section that the abortion is necessary 153 to preserve the life of the minor.] 154 [188.030. 1. Except in the case of a 1 medical emergency, no abortion of a viable 2 unborn child shall be performed or induced 3 unless the abortion is necessary to preserve the 4 life of the pregnant woman whose life is 5 endangered by a physical disorder, physical 6 illness, or physical injury, including a life- 7 endangering physical condition caused by or 8 arising from the pregnancy itself, or when 9 continuation of the pregnancy will create a 10 serious risk of substantial and irreversible 11 physical impairment of a major bodily function 12 of the pregnant woman. For purposes of this 13 section, "major bodily function" includes, but 14 is not limited to, functions of the immune 15 system, normal cell growth, digestive, bowel, 16 bladder, neurological, brain, respiratory, 17 circulatory, endocrine, and reproductive 18 functions. 19 2. Except in the case of a medical 20 emergency: 21 SB 699 116 (1) Prior to performing or inducing an 22 abortion upon a woman, the physician shall 23 determine the gestational age of the unborn 24 child in a manner consistent with accepted 25 obstetrical and neonatal practices and 26 standards. In making such determination, the 27 physician shall make such inquiries of the 28 pregnant woman and perform or cause to be 29 performed such medical examinations, imaging 30 studies, and tests as a reasonably prudent 31 physician, knowledgeable about the medical facts 32 and conditions of both the woman and the unborn 33 child involved, would consider necessary to 34 perform and consider in making an accurate 35 diagnosis with respect to gestational age; 36 (2) If the physician determines that the 37 gestational age of the unborn child is twenty 38 weeks or more, prior to performing or inducing 39 an abortion upon the woman, the physician shall 40 determine if the unborn child is viable by using 41 and exercising that degree of care, skill, and 42 proficiency commonly exercised by a skillful, 43 careful, and prudent physician. In making this 44 determination of viability, the physician shall 45 perform or cause to be performed such medical 46 examinations and tests as are necessary to make 47 a finding of the gestational age, weight, and 48 lung maturity of the unborn child and shall 49 enter such findings and determination of 50 viability in the medical record of the woman; 51 (3) If the physician determines that the 52 gestational age of the unborn child is twenty 53 weeks or more, and further determines that the 54 unborn child is not viable and performs or 55 induces an abortion upon the woman, the 56 physician shall report such findings and 57 determinations and the reasons for such 58 determinations to the health care facility in 59 which the abortion is performed and to the state 60 board of registration for the healing arts, and 61 shall enter such findings and determinations in 62 the medical records of the woman and in the 63 individual abortion report submitted to the 64 department under section 188.052; 65 (4) (a) If the physician determines that 66 the unborn child is viable, the physician shall 67 not perform or induce an abortion upon the woman 68 unless the abortion is necessary to preserve the 69 life of the pregnant woman or that a 70 continuation of the pregnancy will create a 71 serious risk of substantial and irreversible 72 physical impairment of a major bodily function 73 of the woman. 74 (b) Before a physician may proceed with 75 performing or inducing an abortion upon a woman 76 when it has been determined that the unborn 77 child is viable, the physician shall first 78 SB 699 117 certify in writing the medical threat posed to 79 the life of the pregnant woman, or the medical 80 reasons that continuation of the pregnancy would 81 cause a serious risk of substantial and 82 irreversible physical impairment of a major 83 bodily function of the pregnant woman. Upon 84 completion of the abortion, the physician shall 85 report the reasons and determinations for the 86 abortion of a viable unborn child to the health 87 care facility in which the abortion is performed 88 and to the state board of registration for the 89 healing arts, and shall enter such findings and 90 determinations in the medical record of the 91 woman and in the individual abortion report 92 submitted to the department under section 93 188.052. 94 (c) Before a physician may proceed with 95 performing or inducing an abortion upon a woman 96 when it has been determined that the unborn 97 child is viable, the physician who is to perform 98 the abortion shall obtain the agreement of a 99 second physician with knowledge of accepted 100 obstetrical and neonatal practices and standards 101 who shall concur that the abortion is necessary 102 to preserve the life of the pregnant woman, or 103 that continuation of the pregnancy would cause a 104 serious risk of substantial and irreversible 105 physical impairment of a major bodily function 106 of the pregnant woman. This second physician 107 shall also report such reasons and 108 determinations to the health care facility in 109 which the abortion is to be performed and to the 110 state board of registration for the healing 111 arts, and shall enter such findings and 112 determinations in the medical record of the 113 woman and the individual abortion report 114 submitted to the department under section 115 188.052. The second physician shall not have 116 any legal or financial affiliation or 117 relationship with the physician performing or 118 inducing the abortion, except that such 119 prohibition shall not apply to physicians whose 120 legal or financial affiliation or relationship 121 is a result of being employed by or having staff 122 privileges at the same hospital as the term 123 "hospital" is defined in section 197.020. 124 (d) Any physician who performs or induces 125 an abortion upon a woman when it has been 126 determined that the unborn child is viable shall 127 utilize the available method or technique of 128 abortion most likely to preserve the life or 129 health of the unborn child. In cases where the 130 method or technique of abortion most likely to 131 preserve the life or health of the unborn child 132 would present a greater risk to the life or 133 health of the woman than another legally 134 permitted and available method or technique, the 135 SB 699 118 physician may utilize such other method or 136 technique. In all cases where the physician 137 performs an abortion upon a viable unborn child, 138 the physician shall certify in writing the 139 available method or techniques considered and 140 the reasons for choosing the method or technique 141 employed. 142 (e) No physician shall perform or induce 143 an abortion upon a woman when it has been 144 determined that the unborn child is viable 145 unless there is in attendance a physician other 146 than the physician performing or inducing the 147 abortion who shall take control of and provide 148 immediate medical care for a child born as a 149 result of the abortion. During the performance 150 of the abortion, the physician performing it, 151 and subsequent to the abortion, the physician 152 required to be in attendance, shall take all 153 reasonable steps in keeping with good medical 154 practice, consistent with the procedure used, to 155 preserve the life or health of the viable unborn 156 child; provided that it does not pose an 157 increased risk to the life of the woman or does 158 not pose an increased risk of substantial and 159 irreversible physical impairment of a major 160 bodily function of the woman. 161 3. Any person who knowingly performs or 162 induces an abortion of an unborn child in 163 violation of the provisions of this section is 164 guilty of a class D felony, and, upon a finding 165 of guilt or plea of guilty, shall be imprisoned 166 for a term of not less than one year, and, 167 notwithstanding the provisions of section 168 558.002, shall be fined not less than ten 169 thousand nor more than fifty thousand dollars. 170 4. Any physician who pleads guilty to or 171 is found guilty of performing or inducing an 172 abortion of an unborn child in violation of this 173 section shall be subject to suspension or 174 revocation of his or her license to practice 175 medicine in the state of Missouri by the state 176 board of registration for the healing arts under 177 the provisions of sections 334.100 and 334.103. 178 5. Any hospital licensed in the state of 179 Missouri that knowingly allows an abortion of an 180 unborn child to be performed or induced in 181 violation of this section may be subject to 182 suspension or revocation of its license under 183 the provisions of section 197.070. 184 6. Any abortion facility licensed in the 185 state of Missouri that knowingly allows an 186 abortion of an unborn child to be performed or 187 induced in violation of this section may be 188 subject to suspension or revocation of its 189 license under the provisions of section 197.220. 190 7. A woman upon whom an abortion is 191 performed or induced in violation of this 192 SB 699 119 section shall not be prosecuted for a conspiracy 193 to violate the provisions of this section. 194 8. Nothing in this section shall be 195 construed as creating or recognizing a right to 196 abortion, nor is it the intention of this 197 section to make lawful any abortion that is 198 currently unlawful. 199 9. It is the intent of the legislature 200 that this section be severable as noted in 201 section 1.140. In the event that any section, 202 subsection, subdivision, paragraph, sentence, or 203 clause of this section be declared invalid under 204 the Constitution of the United States or the 205 Constitution of the State of Missouri, it is the 206 intent of the legislature that the remaining 207 provisions of this section remain in force and 208 effect as far as capable of being carried into 209 execution as intended by the legislature. 210 10. The general assembly may, by 211 concurrent resolution, appoint one or more of 212 its members who sponsored or co-sponsored this 213 act in his or her official capacity to intervene 214 as a matter of right in any case in which the 215 constitutionality of this law is challenged.] 216 [188.031. For purposes of section 188.028, 1 the term "next friend" shall not include another 2 minor child, or any entity or person in an 3 individual or representative capacity that has a 4 financial interest or potential gain from the 5 proposed abortion, or any employee of or 6 volunteer for such entity or person.] 7 [188.033. Whenever an abortion facility or 1 a family planning agency located in this state, 2 or any of its agents or employees acting within 3 the scope of his or her authority or employment, 4 provides to a woman considering an abortion the 5 name, address, telephone number, or website of 6 an abortion provider that is located outside of 7 the state, such abortion facility or family 8 planning agency or its agents or employees shall 9 also provide to such woman the printed materials 10 produced by the department under section 11 188.027. If the name, address, telephone 12 number, or website of such abortion provider is 13 not provided to such woman in person, such 14 printed materials shall be offered to her, and 15 if she chooses, sent to such woman at no cost to 16 her the same day or as soon as possible either 17 electronically or by U.S. mail overnight 18 delivery service or by other overnight or same- 19 day delivery service to an address of such 20 woman's choosing. The department shall furnish 21 such printed materials at no cost and in 22 sufficient quantities to abortion facilities and 23 family planning agencies located within the 24 state.] 25 SB 699 120 [188.035. Whoever, with intent to do so, 1 shall take the life of a child aborted alive, 2 shall be guilty of murder of the second degree.] 3 [188.036. 1. No physician shall perform 1 an abortion on a woman if the physician knows 2 that the woman conceived the unborn child for 3 the purpose of providing fetal organs or tissue 4 for medical transplantation to herself or 5 another, and the physician knows that the woman 6 intends to procure the abortion to utilize those 7 organs or tissue for such use for herself or 8 another. 9 2. No person shall utilize the fetal 10 organs or tissue resulting from an abortion for 11 medical transplantation, if the person knows 12 that the abortion was procured for the purpose 13 of utilizing those organs or tissue for such use. 14 3. No person shall offer any inducement, 15 monetary or otherwise, to a woman or a 16 prospective father of an unborn child for the 17 purpose of conceiving an unborn child for the 18 medical, scientific, experimental or therapeutic 19 use of the fetal organs or tissue. 20 4. No person shall offer any inducement, 21 monetary or otherwise, to the mother or father 22 of an unborn child for the purpose of procuring 23 an abortion for the medical, scientific, 24 experimental or therapeutic use of the fetal 25 organs or tissue. 26 5. No person shall knowingly offer or 27 receive any valuable consideration for the fetal 28 organs or tissue resulting from an abortion, 29 provided that nothing in this subsection shall 30 prohibit payment for burial or other final 31 disposition of the fetal remains, or payment for 32 a pathological examination, autopsy or 33 postmortem examination of the fetal remains. 34 6. If any provision in this section or the 35 application thereof to any person, circumstance 36 or period of gestation is held invalid, such 37 invalidity shall not affect the provisions or 38 applications which can be given effect without 39 the invalid provision or application, and to 40 this end the provisions of this section are 41 declared severable.] 42 [188.038. 1. The general assembly of this 1 state finds that: 2 (1) Removing vestiges of any past bias or 3 discrimination against pregnant women, their 4 partners, and their family members, including 5 their unborn children, is an important task for 6 those in the legal, medical, social services, 7 and human services professions; 8 (2) Ending any current bias or 9 discrimination against pregnant women, their 10 partners, and their family members, including 11 SB 699 121 their unborn children, is a legitimate purpose 12 of government in order to guarantee that those 13 who "are endowed by their Creator with certain 14 unalienable Rights" can enjoy "Life, Liberty and 15 the pursuit of Happiness"; 16 (3) The historical relationship of bias or 17 discrimination by some family planning programs 18 and policies towards poor and minority 19 populations, including, but not limited to, the 20 nonconsensual sterilization of mentally ill, 21 poor, minority, and immigrant women and other 22 coercive family planning programs and policies, 23 must be rejected; 24 (4) Among Missouri residents, the rate of 25 black or African-American women who undergo 26 abortions is significantly higher, about three 27 and one-half times higher, than the rate of 28 white women who undergo abortions. Among 29 Missouri residents, the rate of black or African- 30 American women who undergo repeat abortions is 31 significantly higher, about one and one-half 32 times higher, than the rate of white women who 33 undergo repeat abortions; 34 (5) Performing or inducing an abortion 35 because of the sex of the unborn child is 36 repugnant to the values of equality of females 37 and males and the same opportunities for girls 38 and boys, and furthers a false mindset of female 39 inferiority; 40 (6) Government has a legitimate interest 41 in preventing the abortion of unborn children 42 with Down Syndrome because it is a form of bias 43 or disability discrimination and victimizes the 44 disabled unborn child at his or her most 45 vulnerable stage. Eliminating unborn children 46 with Down Syndrome raises grave concerns for the 47 lives of those who do live with disabilities. 48 It sends a message of dwindling support for 49 their unique challenges, fosters a false sense 50 that disability is something that could have 51 been avoidable, and is likely to increase the 52 stigma associated with disability. 53 2. No person shall perform or induce an 54 abortion on a woman if the person knows that the 55 woman is seeking the abortion solely because of 56 a prenatal diagnosis, test, or screening 57 indicating Down Syndrome or the potential of 58 Down Syndrome in an unborn child. 59 3. No person shall perform or induce an 60 abortion on a woman if the person knows that the 61 woman is seeking the abortion solely because of 62 the sex or race of the unborn child. 63 4. Any physician or other person who 64 performs or induces or attempts to perform or 65 induce an abortion prohibited by this section 66 shall be subject to all applicable civil 67 SB 699 122 penalties under this chapter including, but not 68 limited to, sections 188.065 and 188.085.] 69 [188.039. 1. For purposes of this 1 section, "medical emergency" means a condition 2 which, on the basis of the physician's good 3 faith clinical judgment, so complicates the 4 medical condition of a pregnant woman as to 5 necessitate the immediate abortion of her 6 pregnancy to avert her death or for which a 7 delay will create a serious risk of substantial 8 and irreversible impairment of a major bodily 9 function. 10 2. Except in the case of medical 11 emergency, no person shall perform or induce an 12 abortion unless at least seventy-two hours prior 13 thereto the physician who is to perform or 14 induce the abortion, a qualified professional, 15 or the referring physician has conferred with 16 the patient and discussed with her the 17 indicators and contraindicators, and risk 18 factors including any physical, psychological, 19 or situational factors for the proposed 20 procedure and the use of medications, including 21 but not limited to mifepristone, in light of her 22 medical history and medical condition. For an 23 abortion performed or an abortion induced by a 24 drug or drugs, such conference shall take place 25 at least seventy-two hours prior to the writing 26 or communication of the first prescription for 27 such drug or drugs in connection with inducing 28 an abortion. Only one such conference shall be 29 required for each abortion. 30 3. The patient shall be evaluated by the 31 physician who is to perform or induce the 32 abortion, a qualified professional, or the 33 referring physician during the conference for 34 indicators and contraindicators, risk factors 35 including any physical, psychological, or 36 situational factors which would predispose the 37 patient to or increase the risk of experiencing 38 one or more adverse physical, emotional, or 39 other health reactions to the proposed procedure 40 or drug or drugs in either the short or long 41 term as compared with women who do not possess 42 such risk factors. 43 4. At the end of the conference, and if 44 the woman chooses to proceed with the abortion, 45 the physician who is to perform or induce the 46 abortion, a qualified professional, or the 47 referring physician shall sign and shall cause 48 the patient to sign a written statement that the 49 woman gave her informed consent freely and 50 without coercion after the physician or 51 qualified professional had discussed with her 52 the indicators and contraindicators, and risk 53 factors, including any physical, psychological, 54 SB 699 123 or situational factors. All such executed 55 statements shall be maintained as part of the 56 patient's medical file, subject to the 57 confidentiality laws and rules of this state. 58 5. The director of the department of 59 health and senior services shall disseminate a 60 model form that physicians or qualified 61 professionals may use as the written statement 62 required by this section, but any lack or 63 unavailability of such a model form shall not 64 affect the duties of the physician or qualified 65 professional set forth in subsections 2 to 4 of 66 this section. 67 6. As used in this section, the term 68 "qualified professional" shall refer to a 69 physician, physician assistant, registered 70 nurse, licensed practical nurse, psychologist, 71 licensed professional counselor, or licensed 72 social worker, licensed or registered under 73 chapter 334, 335, or 337, acting under the 74 supervision of the physician performing or 75 inducing the abortion, and acting within the 76 course and scope of his or her authority 77 provided by law. The provisions of this section 78 shall not be construed to in any way expand the 79 authority otherwise provided by law relating to 80 the licensure, registration, or scope of 81 practice of any such qualified professional. 82 7. If the provisions in subsection 2 of 83 this section requiring a seventy-two-hour 84 waiting period for an abortion are ever 85 temporarily or permanently restrained or 86 enjoined by judicial order, then the waiting 87 period for an abortion shall be twenty-four 88 hours; provided, however, that if such temporary 89 or permanent restraining order or injunction is 90 stayed or dissolved, or otherwise ceases to have 91 effect, the waiting period for an abortion shall 92 be seventy-two hours.] 93 [188.043. 1. No person shall perform or 1 induce an abortion on another unless such person 2 has medical malpractice insurance with coverage 3 amounts of at least one million dollars per 4 occurrence and three million dollars in the 5 annual aggregate. 6 2. For the purpose of this section, 7 "medical malpractice insurance" means insurance 8 coverage against the legal liability of the 9 insured and against loss, damage, or expense 10 incident to a claim arising out of the death or 11 injury of any person as a result of the 12 negligence or malpractice in rendering 13 professional service by any health care provider. 14 3. No abortion facility or hospital shall 15 employ or engage the services of a person to 16 perform or induce an abortion on another if the 17 SB 699 124 person does not have medical malpractice 18 insurance pursuant to this section, except that 19 the abortion facility or hospital may provide 20 medical malpractice insurance for the services 21 of persons employed or engaged by such facility 22 or hospital which is no less than the coverage 23 amounts set forth in this section. 24 4. Notwithstanding the provisions of 25 section 334.100, failure of a person to maintain 26 the medical malpractice insurance required by 27 this section shall be an additional ground for 28 sanctioning of a person's license, certificate, 29 or permit.] 30 [188.044. 1. When a drug or chemical, or 1 combination thereof, used by a person to induce 2 an abortion carries a warning from its 3 manufacturer or distributor, a peer-reviewed 4 medical journal article, or a Food and Drug 5 Administration label that its use may cause 6 birth defects, disability, or other injury in a 7 child who survives the abortion, then in 8 addition to the requirements of section 188.043, 9 such person shall also carry tail insurance with 10 coverage amounts of at least one million dollars 11 per occurrence and three million dollars in the 12 annual aggregate for personal injury to or death 13 of a child who survives such abortion. Such 14 policy shall be maintained in force or be in 15 effect for a period of twenty-one years after 16 the person used the drug or chemical, or 17 combination thereof, to induce the abortion. 18 2. For the purpose of this section, "tail 19 insurance" means insurance which covers the 20 legal liability of the insured once a medical 21 malpractice insurance policy is cancelled, not 22 renewed, or terminated, and covers claims made 23 after such cancellation or termination for acts 24 occurring during the period the prior medical 25 malpractice insurance was in effect. 26 3. No abortion facility or hospital shall 27 employ or engage the services of a person to 28 induce an abortion on another using any drug or 29 chemical, or combination thereof, which may 30 cause birth defects, disability, or other injury 31 in a child who survives the abortion if the 32 person does not have tail insurance pursuant to 33 this section, except that the abortion facility 34 or hospital may provide tail insurance for the 35 services of persons employed or engaged by such 36 facility or hospital which is no less than the 37 coverage amounts and duration set forth in this 38 section. 39 4. Notwithstanding the provisions of 40 section 334.100 to the contrary, failure of a 41 person to maintain the tail insurance required 42 by this section shall be an additional ground 43 SB 699 125 for sanctioning of a person's license, 44 certificate, or permit.] 45 [188.047. 1. All tissue, except that 1 tissue needed for purposes described in 2 subsection 5 of this section, removed at the 3 time of abortion shall be submitted within five 4 days to a board-eligible or certified 5 pathologist for gross and histopathological 6 examination. The pathologist shall file a copy 7 of the tissue report with the state department 8 of health and senior services, and shall provide 9 within seventy-two hours a copy of the report to 10 the abortion facility or hospital in which the 11 abortion was performed or induced. The 12 pathologist's report shall be made a part of the 13 patient's permanent record. If the pathological 14 examination fails to identify evidence of a 15 completed abortion, the pathologist shall notify 16 the abortion facility or hospital within twenty- 17 four hours. 18 2. The department shall reconcile each 19 notice of abortion with its corresponding tissue 20 report. If the department does not receive the 21 notice of abortion or the tissue report, the 22 department shall make an inquiry of the abortion 23 facility or hospital. After such inquiry, if 24 the hospital or abortion facility has not 25 satisfactorily responded to said inquiry and the 26 department finds that the abortion facility or 27 hospital where the abortion was performed or 28 induced was not in compliance with the 29 provisions of this section, the department shall 30 consider such noncompliance a deficiency 31 requiring an unscheduled inspection of the 32 facility to ensure the deficiency is remedied, 33 subject to the provisions of chapter 197 34 regarding license suspensions, reviews, and 35 appeals. 36 3. Beginning January 1, 2018, the 37 department shall make an annual report to the 38 general assembly. The report shall include the 39 number of any deficiencies and inquiries by the 40 department of each abortion facility in the 41 calendar year and whether any deficiencies were 42 remedied and, for each abortion facility, 43 aggregated de-identified data about the total 44 number of abortions performed at the facility, 45 the termination procedures used, the number and 46 type of complications reported for each type of 47 termination procedure, whether the department 48 received the tissue report for each abortion, 49 and the existence and nature, if any, of any 50 inconsistencies or concerns between the abortion 51 reports submitted under section 188.052 and the 52 tissue report submitted under this section. The 53 report shall not contain any personal patient 54 SB 699 126 information the disclosure of which is 55 prohibited by state or federal law. 56 4. All reports provided by the department 57 to the general assembly under this section shall 58 maintain confidentiality of all personal 59 information of patients, facility personnel, and 60 facility physicians. 61 5. Nothing in this section shall prohibit 62 the utilization of fetal organs or tissue 63 resulting from an abortion for medical or 64 scientific purposes to determine the cause or 65 causes of any anomaly, illness, death, or 66 genetic condition of the fetus, the paternity of 67 the fetus, or for law enforcement purposes. 68 6. The department may adopt rules, 69 regulations, and standards governing the reports 70 required under this section. In doing so, the 71 department shall ensure that these reports 72 contain all information necessary to ensure 73 compliance with all applicable laws and 74 regulations. Any rule or portion of a rule, as 75 that term is defined in section 536.010, that is 76 created under the authority delegated in this 77 section shall become effective only if it 78 complies with and is subject to all of the 79 provisions of chapter 536 and, if applicable, 80 section 536.028. This section and chapter 536 81 are nonseverable and if any of the powers vested 82 with the general assembly pursuant to chapter 83 536 to review, to delay the effective date, or 84 to disapprove and annul a rule are subsequently 85 held unconstitutional, then the grant of 86 rulemaking authority and any rule proposed or 87 adopted after October 24, 2017, shall be invalid 88 and void.] 89 [188.052. 1. An individual abortion 1 report for each abortion performed or induced 2 upon a woman shall be completed by the physician 3 who performed or induced the abortion. Abortion 4 reports shall include, but not be limited to, a 5 certification that the physician does not have 6 any knowledge that the woman sought the abortion 7 solely because of a prenatal diagnosis, test, or 8 screening indicating Down Syndrome or the 9 potential of Down Syndrome in the unborn child 10 and a certification that the physician does not 11 have any knowledge that the woman sought the 12 abortion solely because of the sex or race of 13 the unborn child. 14 2. An individual complication report for 15 any post-abortion care performed upon a woman 16 shall be completed by the physician providing 17 such post-abortion care. This report shall 18 include: 19 (1) The date of the abortion; 20 SB 699 127 (2) The name and address of the abortion 21 facility or hospital where the abortion was 22 performed or induced; 23 (3) The nature of the abortion 24 complication diagnosed or treated. 25 3. All abortion reports shall be signed by 26 the attending physician who performed or induced 27 the abortion and submitted to the department 28 within forty-five days from the date of the 29 abortion. All complication reports shall be 30 signed by the physician providing the post- 31 abortion care and submitted to the department 32 within forty-five days from the date of the post- 33 abortion care. 34 4. A copy of the abortion report shall be 35 made a part of the medical record of the patient 36 of the abortion facility or hospital in which 37 the abortion was performed or induced. 38 5. The department shall be responsible for 39 collecting all abortion reports and complication 40 reports and collating and evaluating all data 41 gathered therefrom and shall annually publish a 42 statistical report based on such data from 43 abortions performed or induced in the previous 44 calendar year.] 45 [188.055. 1. Every abortion facility, 1 hospital, and physician shall be supplied with 2 forms by the department of health and senior 3 services for use in regards to the consents and 4 reports required by sections 188.010 to 5 188.085. A purpose and function of such 6 consents and reports shall be the preservation 7 of maternal health and life by adding to the sum 8 of medical knowledge through the compilation of 9 relevant maternal health and life data and to 10 monitor all abortions performed to assure that 11 they are done only under and in accordance with 12 the provisions of the law. 13 2. All information obtained by physician, 14 hospital, or abortion facility from a patient 15 for the purpose of preparing reports to the 16 department of health and senior services under 17 sections 188.010 to 188.085 or reports received 18 by the division of health shall be confidential 19 and shall be used only for statistical 20 purposes. Such records, however, may be 21 inspected and health data acquired by local, 22 state, or national public health officers.] 23 [188.056. 1. Notwithstanding any other 1 provision of law to the contrary, no abortion 2 shall be performed or induced upon a woman at 3 eight weeks gestational age or later, except in 4 cases of medical emergency. Any person who 5 knowingly performs or induces an abortion of an 6 unborn child in violation of this subsection 7 shall be guilty of a class B felony, as well as 8 SB 699 128 subject to suspension or revocation of his or 9 her professional license by his or her 10 professional licensing board. A woman upon whom 11 an abortion is performed or induced in violation 12 of this subsection shall not be prosecuted for a 13 conspiracy to violate the provisions of this 14 section. 15 2. It shall be an affirmative defense for 16 any person alleged to have violated the 17 provisions of subsection 1 of this section that 18 the person performed or induced an abortion 19 because of a medical emergency. The defendant 20 shall have the burden of persuasion that the 21 defense is more probably true than not. 22 3. Prosecution under this section shall 23 bar prosecution under section* 188.057, 188.058, 24 or 188.375 if prosecution under such sections 25 would violate the provisions of Amendment V to 26 the Constitution of the United States or Article 27 I, Section 19 of the Constitution of Missouri. 28 4. If any one or more provisions, 29 subsections, sentences, clauses, phrases, or 30 words of this section or the application thereof 31 to any person, circumstance, or period of 32 gestational age is found to be unenforceable, 33 unconstitutional, or invalid by a court of 34 competent jurisdiction, the same is hereby 35 declared to be severable and the balance of the 36 section shall remain effective notwithstanding 37 such unenforceability, unconstitutionality, or 38 invalidity. The general assembly hereby 39 declares that it would have passed this section, 40 and each provision, subsection, sentence, 41 clause, phrase, or word thereof, irrespective of 42 the fact that any one or more provisions, 43 subsections, sentences, clauses, phrases, or 44 words of the section, or the application of the 45 section to any person, circumstance, or period 46 of gestational age, would be declared 47 unenforceable, unconstitutional, or invalid.] 48 [188.057. 1. Notwithstanding any other 1 provision of law to the contrary, no abortion 2 shall be performed or induced upon a woman at 3 fourteen weeks gestational age or later, except 4 in cases of medical emergency. Any person who 5 knowingly performs or induces an abortion of an 6 unborn child in violation of this subsection 7 shall be guilty of a class B felony, as well as 8 subject to suspension or revocation of his or 9 her professional license by his or her 10 professional licensing board. A woman upon whom 11 an abortion is performed or induced in violation 12 of this subsection shall not be prosecuted for a 13 conspiracy to violate the provisions of this 14 section. 15 SB 699 129 2. It shall be an affirmative defense for 16 any person alleged to have violated the 17 provisions of subsection 1 of this section that 18 the person performed or induced an abortion 19 because of a medical emergency. The defendant 20 shall have the burden of persuasion that the 21 defense is more probably true than not. 22 3. Prosecution under this section shall 23 bar prosecution under section 188.056, 188.058, 24 or 188.375 if prosecution under such sections 25 would violate the provisions of Amendment V to 26 the Constitution of the United States or Article 27 I, Section 19 of the Constitution of Missouri. 28 4. If any one or more provisions, 29 subsections, sentences, clauses, phrases, or 30 words of this section or the application thereof 31 to any person, circumstance, or period of 32 gestational age is found to be unenforceable, 33 unconstitutional, or invalid by a court of 34 competent jurisdiction, the same is hereby 35 declared to be severable and the balance of the 36 section shall remain effective notwithstanding 37 such unenforceability, unconstitutionality, or 38 invalidity. The general assembly hereby 39 declares that it would have passed this section, 40 and each provision, subsection, sentence, 41 clause, phrase, or word thereof, irrespective of 42 the fact that any one or more provisions, 43 subsections, sentences, clauses, phrases, or 44 words of the section, or the application of the 45 section to any person, circumstance, or period 46 of gestational age, would be declared 47 unenforceable, unconstitutional, or invalid.] 48 [188.058. 1. Notwithstanding any other 1 provision of law to the contrary, no abortion 2 shall be performed or induced upon a woman at 3 eighteen weeks gestational age or later, except 4 in cases of medical emergency. Any person who 5 knowingly performs or induces an abortion of an 6 unborn child in violation of this subsection 7 shall be guilty of a class B felony, as well as 8 subject to suspension or revocation of his or 9 her professional license by his or her 10 professional licensing board. A woman upon whom 11 an abortion is performed or induced in violation 12 of this section shall not be prosecuted for a 13 conspiracy to violate the provisions of this 14 section. 15 2. It shall be an affirmative defense for 16 any person alleged to have violated the 17 provisions of subsection 1 of this section that 18 the person performed or induced an abortion 19 because of a medical emergency. The defendant 20 shall have the burden of persuasion that the 21 defense is more probably true than not. 22 SB 699 130 3. Prosecution under this section shall 23 bar prosecution under section188.056, 188.057, 24 or 188.375 if prosecution under such sections 25 would violate the provisions of Amendment V to 26 the Constitution of the United States or Article 27 I, Section 19 of the Constitution of Missouri. 28 4. If any one or more provisions, 29 subsections, sentences, clauses, phrases, or 30 words of this section or the application thereof 31 to any person, circumstance, or period of 32 gestational age is found to be unenforceable, 33 unconstitutional, or invalid by a court of 34 competent jurisdiction, the same is hereby 35 declared to be severable and the balance of the 36 section shall remain effective notwithstanding 37 such unenforceability, unconstitutionality, or 38 invalidity. The general assembly hereby 39 declares that it would have passed this section, 40 and each provision, subsection, sentence, 41 clause, phrase, or word thereof, irrespective of 42 the fact that any one or more provisions, 43 subsections, sentences, clauses, phrases, or 44 words of the section, or the application of the 45 section to any person, circumstance, or period 46 of gestational age, would be declared 47 unenforceable, unconstitutional, or invalid.] 48 [188.060. All medical records, reports, 1 and other documents required to be kept under 2 sections 188.010 to 188.085 shall be maintained 3 in the permanent files of the abortion facility 4 or hospital in which the abortion was performed 5 for a period of seven years.] 6 [188.065. Any practitioner of medicine, 1 surgery, or nursing, or other health personnel 2 who shall willfully and knowingly do or assist 3 any action made unlawful by sections 188.010 to 4 188.085 shall be subject to having his license, 5 application for license, or authority to 6 practice his profession as a physician, surgeon, 7 or nurse in the state of Missouri rejected or 8 revoked by the appropriate state licensing 9 board.] 10 [188.070. Any physician or other person 1 who fails to maintain the confidentiality of any 2 records or reports required under sections 3 188.010 to 188.085 is guilty of a misdemeanor 4 and, upon conviction, shall be punished as 5 provided by law.] 6 [188.075. 1. Any person who contrary to 1 the provisions of sections 188.010 to 188.085 2 knowingly performs, induces, or aids in the 3 performance or inducing of any abortion or 4 knowingly fails to perform any action required 5 by sections 188.010 to 188.085 shall be guilty 6 of a class A misdemeanor, unless a different 7 SB 699 131 penalty is provided for in state law, and, upon 8 conviction, shall be punished as provided by law. 9 2. It shall be an affirmative defense for 10 any person alleged to have violated any 11 provision of this chapter that the person 12 performed an action or did not perform an action 13 because of a medical emergency. This 14 affirmative defense shall be available in 15 criminal, civil, and administrative actions or 16 proceedings. The defendant shall have the 17 burden of persuasion that the defense is more 18 probably true than not. 19 3. The attorney general shall have 20 concurrent original jurisdiction throughout the 21 state, along with each prosecuting attorney and 22 circuit attorney within their respective 23 jurisdictions, to commence actions for a 24 violation of any provision of this chapter, for 25 a violation of any state law on the use of 26 public funds for an abortion, or for a violation 27 of any state law which regulates an abortion 28 facility or a person who performs or induces an 29 abortion. The attorney general, or prosecuting 30 attorney or circuit attorney within their 31 respective jurisdictions, may seek injunctive or 32 other relief against any person who, or entity 33 which, is in violation of any provision of this 34 chapter, misuses public funds for an abortion, 35 or violates any state law which regulates an 36 abortion facility or a person who performs or 37 induces an abortion.] 38 [188.080. Any person who is not a 1 physician who performs or induces or attempts to 2 perform or induce an abortion on another is 3 guilty of a class B felony, and, upon 4 conviction, shall be punished as provided by 5 law. Any physician performing or inducing an 6 abortion who does not have clinical privileges 7 at a hospital which offers obstetrical or 8 gynecological care located within thirty miles 9 of the location at which the abortion is 10 performed or induced shall be guilty of a class 11 A misdemeanor, and, upon conviction shall be 12 punished as provided by law.] 13 [188.100. Unless the language or context 1 clearly indicates a different meaning is 2 intended, the following words or phrases for the 3 purposes of sections 188.100 to 188.120 shall 4 mean: 5 (1) "Employer", the state, or any 6 political or civil subdivision thereof, or any 7 person employing two or more persons within the 8 state, and any person acting as an agent of the 9 employer; 10 (2) "Participate in abortion", to perform, 11 assist in, refer for, promote, procure, or 12 SB 699 132 counsel a woman to have an abortion not 13 necessary to save the life of the mother; or to 14 undergo an abortion; 15 (3) "Person" includes one or more 16 individuals, partnerships, associations, 17 organizations, corporations, legal 18 representatives, trustees, trustees in 19 bankruptcy, receivers, or other organized groups 20 of persons.] 21 [188.105. 1. It shall be unlawful: 1 (1) For an employer: 2 (a) To fail or refuse to hire or to 3 discharge any individual, or otherwise to 4 discriminate against any individual with respect 5 to his or her compensation, terms, conditions, 6 or privileges of employment, because of such 7 individual's refusal to participate in abortion; 8 (b) To limit, segregate, or classify his, 9 her, or its employees or applicants for 10 employment in any way which would deprive or 11 tend to deprive any individual of employment 12 opportunities or otherwise adversely affect his 13 or her status as an employee, because of such 14 individual's refusal to participate in abortion; 15 (c) To discharge, expel, or otherwise 16 discriminate against any person because he or 17 she has opposed any practices forbidden under 18 sections 188.100 to 188.120 or because he or she 19 has filed a complaint, testified, or assisted in 20 any legal proceeding under sections 188.100 to 21 188.120; 22 (2) For any person, whether an employer or 23 employee, or not, to aid, abet, incite, compel, 24 or coerce the doing of any of the acts forbidden 25 under sections 188.100 to 188.120, or to attempt 26 to do so. 27 2. Notwithstanding any other provision of 28 sections 188.100 to 188.120, the acts proscribed 29 in subsection 1 of this section shall not be 30 unlawful if there can be demonstrated an 31 inability to reasonably accommodate an 32 individual's refusal to participate in abortion 33 without undue hardship on the conduct of that 34 particular business or enterprise, or in those 35 certain instances where participation in 36 abortion is a bona fide occupational 37 qualification reasonably necessary to the normal 38 operation of that particular business or 39 enterprise. 40 3. Nothing contained in sections 188.100 41 to 188.120 shall be interpreted to require any 42 employer to grant preferential treatment to any 43 individual because of such individual's refusal 44 to participate in abortion.] 45 [188.110. 1. No public or private 1 college, university or hospital shall 2 SB 699 133 discriminate against any person for refusal to 3 participate in abortion. 4 2. No applicant, student, teacher, or 5 employee of any school shall be required to pay 6 any fees that would in whole or in part fund an 7 abortion for any other applicant, student, 8 teacher, or employee of that school, if the 9 individual required to pay the fee gives written 10 notice to the proper school authorities that it 11 would be in violation of his or her conscience 12 or beliefs to pay for or fund abortions. The 13 school may require the individual to pay that 14 part of the fees not funding abortions, if the 15 school makes reasonable precautions and gives 16 reasonable assurance that the fees that are paid 17 are segregated from any fund for the payment of 18 abortions.] 19 [188.115. If any provision of sections 1 188.100 to 188.120 is found by a court of 2 competent jurisdiction to be invalid or 3 unconstitutional as applied to a specific person 4 or class of persons, the provisions of sections 5 188.100 to 188.120 shall remain in full force 6 and effect as to every other person or class of 7 persons who is otherwise covered under these 8 sections.] 9 [188.120. Any individual injured by any 1 person, association, corporation, or entity by 2 reason of any action prohibited by sections 3 188.100 to 188.120, as now or hereafter amended, 4 may commence a civil cause of action against the 5 person, association, corporation, or entity who 6 caused the injury, and shall recover treble 7 damages, including pain and suffering, sustained 8 by such individual, the costs of the suit and 9 reasonable attorney's fees.] 10 [188.160. 1. Every hospital, abortion 1 facility, pathology lab, medical research 2 entity, and any other facility involved in 3 abortion shall establish and implement a written 4 policy relating to the protections for employees 5 who disclose information concerning actual, 6 potential, or alleged violations of applicable 7 federal or state laws or administrative rules, 8 regulations, or standards. 9 2. The department of health and senior 10 services is authorized to adopt rules, 11 regulations, and standards regarding the 12 establishment and implementation of policies 13 created under this section. Any rule or portion 14 of a rule, as that term is defined in section 15 536.010, that is created under the authority 16 delegated in this section shall become effective 17 only if it complies with and is subject to all 18 of the provisions of chapter 536 and, if 19 SB 699 134 applicable, section 536.028. This section and 20 chapter 536 are nonseverable and if any of the 21 powers vested with the general assembly pursuant 22 to chapter 536 to review, to delay the effective 23 date, or to disapprove and annul a rule are 24 subsequently held unconstitutional, then the 25 grant of rulemaking authority and any rule 26 proposed or adopted after October 24, 2017, 27 shall be invalid and void.] 28 [188.200. As used in sections 188.200 to 1 188.220, the following terms mean: 2 (1) "Public employee", any person employed 3 by this state or any agency or political 4 subdivision thereof; 5 (2) "Public facility", any public 6 institution, public facility, public equipment, 7 or any physical asset owned, leased, or 8 controlled by this state or any agency or 9 political subdivisions thereof; 10 (3) "Public funds", any funds received or 11 controlled by this state or any agency or 12 political subdivision thereof, including, but 13 not limited to, funds derived from federal, 14 state or local taxes, gifts or grants from any 15 source, public or private, federal grants or 16 payments, or intergovernmental transfers.] 17 [188.205. It shall be unlawful for any 1 public funds to be expended for the purpose of 2 performing or assisting an abortion, not 3 necessary to save the life of the mother, or for 4 the purpose of encouraging or counseling a woman 5 to have an abortion not necessary to save her 6 life.] 7 [188.210. It shall be unlawful for any 1 public employee within the scope of his 2 employment to perform or assist an abortion, not 3 necessary to save the life of the mother. It 4 shall be unlawful for a doctor, nurse or other 5 health care personnel, a social worker, a 6 counselor or persons of similar occupation who 7 is a public employee within the scope of his 8 public employment to encourage or counsel a 9 woman to have an abortion not necessary to save 10 her life.] 11 [188.215. It shall be unlawful for any 1 public facility to be used for the purpose of 2 performing or assisting an abortion not 3 necessary to save the life of the mother or for 4 the purpose of encouraging or counseling a woman 5 to have an abortion not necessary to save her 6 life.] 7 [188.220. Any taxpayer of this state or 1 its political subdivisions shall have standing 2 to bring suit in a circuit court of proper venue 3 SB 699 135 to enforce the provisions of sections 188.200 to 4 188.215.] 5 [188.230. Nothing in this act is intended 1 to authorize anyone other than a physician to 2 perform an abortion.] 3 [188.250. 1. No person shall 1 intentionally cause, aid, or assist a minor to 2 obtain an abortion without the consent or 3 consents required by section 188.028. 4 2. A person who violates subsection 1 of 5 this section shall be civilly liable to the 6 minor and to the person or persons required to 7 give the consent or consents under section 8 188.028. A court may award damages to the 9 person or persons adversely affected by a 10 violation of subsection 1 of this section, 11 including compensation for emotional injury 12 without the need for personal presence at the 13 act or event, and the court may further award 14 attorneys' fees, litigation costs, and punitive 15 damages. Any adult who engages in or consents 16 to another person engaging in a sex act with a 17 minor in violation of the provisions of chapter 18 566, 567, 568, or 573 which results in the 19 minor's pregnancy shall not be awarded damages 20 under this section. 21 3. It shall not be a defense to a claim 22 brought under this section that the abortion was 23 performed or induced pursuant to consent to the 24 abortion given in a manner that is otherwise 25 lawful in the state or place where the abortion 26 was performed or induced. 27 4. An unemancipated minor does not have 28 capacity to consent to any action in violation 29 of this section or section 188.028. 30 5. A court may enjoin conduct that would 31 be in violation of this section upon petition by 32 the attorney general, a prosecuting or circuit 33 attorney, or any person adversely affected or 34 who reasonably may be adversely affected by such 35 conduct, upon a showing that such conduct: 36 (1) Is reasonably anticipated to occur in 37 the future; or 38 (2) Has occurred in the past, whether with 39 the same minor or others, and that it is not 40 unreasonable to expect that such conduct will be 41 repeated.] 42 [188.325. 1. There is hereby established 1 the "Missouri Alternatives to Abortion Services 2 Program" which shall be administered by a state 3 agency or agencies, as designated by 4 appropriations to such or each agency. The 5 alternatives to abortion services program shall 6 consist of services or counseling to pregnant 7 women and continuing for one year after birth to 8 SB 699 136 assist women in carrying their unborn children 9 to term instead of having abortions, and to 10 assist women in caring for their dependent 11 children or placing their children for adoption. 12 2. Services provided under the 13 alternatives to abortion program shall include 14 but not be limited to the following: 15 (1) Prenatal care; 16 (2) Medical and mental health care; 17 (3) Parenting skills; 18 (4) Drug and alcohol testing and treatment; 19 (5) Child care, and newborn and infant 20 care; 21 (6) Housing and utilities; 22 (7) Educational services; 23 (8) Food, clothing, and supplies relating 24 to pregnancy, newborn care, and parenting; 25 (9) Adoption assistance; 26 (10) Job training and placement; 27 (11) Establishing and promoting 28 responsible paternity; 29 (12) Ultrasound services; 30 (13) Case management; 31 (14) Domestic abuse protection; and 32 (15) Transportation. 33 3. Actual provision and delivery of 34 services and counseling shall be dependent on 35 client needs and not otherwise prioritized by 36 the agency or agencies administering the 37 program. Services and counseling shall be 38 available only during pregnancy and continuing 39 for one year after birth, and shall exclude any 40 family planning services. The agency or 41 agencies administering the program may contract 42 with other public or private agencies or 43 entities to provide the services or counseling 44 on behalf of the agency or agencies 45 administering the program. Such other public or 46 private agencies or entities may provide 47 additional services or counseling, or services 48 or counseling for more than one year after 49 birth, that are not funded under the 50 alternatives to abortion services program, as 51 long as such services or counseling are not 52 inconsistent with the provisions of this 53 section. Contractors for the alternatives to 54 abortion services program may also be 55 contractors for the alternatives to abortion 56 public awareness program established in section 57 188.335. 58 4. The agency or agencies administering 59 the program shall to the greatest extent 60 possible supplement and match moneys 61 appropriated for the alternatives to abortion 62 services program with federal and other public 63 moneys and with private moneys. The agency or 64 agencies administering the program shall 65 SB 699 137 prioritize such additional federal, other 66 public, and private moneys so that they are used 67 preferentially for the alternatives to abortion 68 services program and the alternatives to 69 abortion public awareness program. 70 5. The alternatives to abortion services 71 program and the moneys expended under this 72 section shall not be used to perform or induce, 73 assist in the performing or inducing of or refer 74 for abortions. Moneys expended under this 75 section shall not be granted to organizations or 76 affiliates of organizations that perform or 77 induce, assist in the performing or inducing of 78 or refer for abortions.] 79 [188.335. 1. There is hereby established 1 the "Missouri Alternatives to Abortion Public 2 Awareness Program" which shall be administered 3 by a state agency or agencies, as designated by 4 appropriations to such or each agency. 5 2. The purpose of the alternatives to 6 abortion public awareness program is to help 7 pregnant women at risk for having abortions to 8 be made aware of the alternatives to abortion 9 agencies located and alternatives to abortion 10 services available to them in their local 11 communities. The alternatives to abortion 12 public awareness program shall include the 13 development and promotion of a website which 14 provides a geographically indexed list of 15 alternatives to abortion agencies as well as 16 contractors for the alternatives to abortion 17 services program established in section 188.325. 18 As used in this section, "alternatives to 19 abortion agencies" means agencies exempt from 20 income taxation pursuant to the United States 21 Internal Revenue Code that offer alternatives to 22 abortion services as defined within section 23 188.325, including but not limited to maternity 24 homes, pregnancy resource centers, and agencies 25 commonly known and referred to as crisis 26 pregnancy centers. The alternatives to abortion 27 public awareness program may also include but 28 need not be limited to the use of television, 29 radio, outdoor advertising, newspapers, 30 magazines, and other print media, and the 31 internet to provide information on these 32 alternatives to abortion agencies and services. 33 The state agency or agencies administering the 34 alternatives to abortion public awareness 35 program are encouraged to give first preference 36 to contracting with private agencies or 37 entities, which are exempt from income taxation 38 pursuant to the United States Internal Revenue 39 Code, to conduct the alternatives to abortion 40 public awareness program. Contractors for the 41 alternatives to abortion public awareness 42 SB 699 138 program may also be contractors for the 43 alternatives to abortion services program 44 established in section 188.325. 45 3. The agency or agencies administering 46 the program shall to the greatest extent 47 possible supplement and match moneys 48 appropriated for the alternatives to abortion 49 public awareness program with federal and other 50 public moneys and with private moneys. The 51 agency or agencies administering the program 52 shall prioritize such additional federal, other 53 public, and private moneys so that they are used 54 preferentially for the alternatives to abortion 55 public awareness program and the alternatives to 56 abortion services program. 57 4. The alternatives to abortion public 58 awareness program and the moneys expended under 59 this section shall not be used to perform or 60 induce, assist in the performing or inducing of 61 or refer for abortions. Moneys expended under 62 this section shall not be granted to 63 organizations or affiliates of organizations 64 that perform or induce, assist in the performing 65 or inducing of or refer for abortions.] 66 [188.375. 1. This section shall be known 1 and may be cited as the "Late-Term Pain-Capable 2 Unborn Child Protection Act". 3 2. As used in this section, the phrase 4 "late-term pain-capable unborn child" shall mean 5 an unborn child at twenty weeks gestational age 6 or later. 7 3. Notwithstanding any other provision of 8 law to the contrary, no abortion shall be 9 performed or induced upon a woman carrying a 10 late-term pain-capable unborn child, except in 11 cases of medical emergency. Any person who 12 knowingly performs or induces an abortion of a 13 late-term pain-capable unborn child in violation 14 of this subsection shall be guilty of a class B 15 felony, as well as subject to suspension or 16 revocation of his or her professional license by 17 his or her professional licensing board. A 18 woman upon whom an abortion is performed or 19 induced in violation of this subsection shall 20 not be prosecuted for a conspiracy to violate 21 the provisions of this subsection. 22 4. It shall be an affirmative defense for 23 any person alleged to have violated the 24 provisions of subsection 3 of this section that 25 the person performed or induced an abortion 26 because of a medical emergency. The defendant 27 shall have the burden of persuasion that the 28 defense is more probably true than not. 29 5. Prosecution under subsection 3 of this 30 section shall bar prosecution under 31 section188.056, 188.057, or 188.058 if 32 SB 699 139 prosecution under such sections would violate 33 the provisions of Amendment V to the 34 Constitution of the United States or Article I, 35 Section 19 of the Constitution of Missouri. 36 6. When in cases of medical emergency a 37 physician performs or induces an abortion upon a 38 woman in her third trimester carrying a late- 39 term pain-capable unborn child, the physician 40 shall utilize the available method or technique 41 of abortion most likely to preserve the life or 42 health of the unborn child. In cases where the 43 method or technique of abortion most likely to 44 preserve the life or health of the unborn child 45 would present a greater risk to the life or 46 health of the woman than another legally 47 permitted and available method or technique, the 48 physician may utilize such other method or 49 technique. In all cases where the physician 50 performs or induces an abortion upon a woman 51 during her third trimester carrying a late-term 52 pain-capable unborn child, the physician shall 53 certify in writing the available method or 54 techniques considered and the reasons for 55 choosing the method or technique employed. 56 7. When in cases of medical emergency a 57 physician performs or induces an abortion upon a 58 woman during her third trimester carrying a late- 59 term pain-capable unborn child, there shall be 60 in attendance a physician other than the 61 physician performing or inducing the abortion 62 who shall take control of and provide immediate 63 medical care for a child born as a result of the 64 abortion. 65 8. Any physician who knowingly violates 66 any of the provisions of subsection 6 or 7 of 67 this section shall be guilty of a class D 68 felony, as well as subject to suspension or 69 revocation of his or her professional license by 70 his or her professional licensing board. A 71 woman upon whom an abortion is performed or 72 induced in violation of subsection 6 or 7 of 73 this section shall not be prosecuted for a 74 conspiracy to violate the provisions of those 75 subsections. 76 9. If any one or more provisions, 77 subsections, sentences, clauses, phrases, or 78 words of this section or the application thereof 79 to any person, circumstance, or period of 80 gestational age is found to be unenforceable, 81 unconstitutional, or invalid by a court of 82 competent jurisdiction, the same is hereby 83 declared to be severable and the balance of the 84 section shall remain effective notwithstanding 85 such unenforceability, unconstitutionality, or 86 invalidity. The general assembly hereby 87 declares that it would have passed this section, 88 and each provision, subsection, sentence, 89 SB 699 140 clause, phrase, or word thereof, irrespective of 90 the fact that any one or more provisions, 91 subsections, sentences, clauses, phrases, or 92 words of the section, or the application of the 93 section to any person, circumstance, or period 94 of gestational age, would be declared 95 unenforceable, unconstitutional, or invalid.] 96 [194.390. Nothing in sections 194.375 to 1 194.390 shall be construed to prohibit a woman's 2 ability to obtain a legal abortion.] 3 [208.655. No funds used to pay for 1 insurance or for services pursuant to sections 2 208.631 to 208.657 may be expended to encourage, 3 counsel or refer for abortion unless the 4 abortion is done to save the life of the mother 5 or if the unborn child is the result of rape or 6 incest. No funds may be paid pursuant to 7 sections 208.631 to 208.657 to any person or 8 organization that performs abortions or counsels 9 or refers for abortion unless the abortion is 10 done to save the life of the mother or if the 11 unborn child is the result of rape or incest.] 12 [334.245. 1. Notwithstanding any other 1 provision of law to the contrary that may allow 2 a person to provide services relating to 3 pregnancy, including prenatal, delivery, and 4 postpartum services, no person other than a 5 licensed physician is authorized to perform or 6 induce an abortion. 7 2. Any person who violates the provisions 8 of this section is guilty of a class B felony.] 9 [376.805. 1. No health insurance 1 contracts, plans, or policies delivered or 2 issued for delivery in the state shall provide 3 coverage for elective abortions except by an 4 optional rider for which there must be paid an 5 additional premium. For purposes of this 6 section, an "elective abortion" means an 7 abortion for any reason other than a spontaneous 8 abortion or to prevent the death of the female 9 upon whom the abortion is performed. 10 2. Subsection 1 of this section shall be 11 applicable to all contracts, plans or policies 12 of: 13 (1) All health insurers subject to this 14 chapter; and 15 (2) All nonprofit hospital, medical, 16 surgical, dental, and health service 17 corporations subject to chapter 354; and 18 (3) All health maintenance organizations. 19 3. No health insurance exchange 20 established within this state or any health 21 insurance exchange administered by the federal 22 government or its agencies within this state 23 shall offer health insurance contracts, plans, 24 SB 699 141 or policies that provide coverage for elective 25 abortions, nor shall any health insurance 26 exchange operating within this state offer 27 coverage for elective abortions through the 28 purchase of an optional rider. 29 4. This section shall be applicable only 30 to contracts, plans or policies written, issued, 31 renewed or revised after September 28, 1983. 32 For the purposes of this subsection, if new 33 premiums are charged for a contract, plan or 34 policy, it shall be determined to be a new 35 contract, plan or policy.] 36 [565.300. 1. This section shall be known 1 and may be cited as the "Infant's Protection 2 Act". 3 2. As used in this section, and only in 4 this section, the following terms shall mean: 5 (1) "Born", complete separation of an 6 intact child from the mother regardless of 7 whether the umbilical cord is cut or the 8 placenta detached; 9 (2) "Living infant", a human child, born 10 or partially born, who is alive, as determined 11 in accordance with the usual and customary 12 standards of medical practice and is not dead as 13 determined pursuant to section 194.005, relating 14 to the determination of the occurrence of death, 15 and has not attained the age of thirty days post 16 birth; 17 (3) "Partially born", partial separation 18 of a child from the mother with the child's head 19 intact with the torso. If vaginally delivered, 20 a child is partially separated from the mother 21 when the head in a cephalic presentation, or any 22 part of the torso above the navel in a breech 23 presentation, is outside the mother's external 24 cervical os. If delivered abdominally, a child 25 is partially separated from the mother when the 26 child's head in a cephalic presentation, or any 27 part of the torso above the navel in a breech 28 presentation, is outside the mother's external 29 abdominal wall. 30 3. A person commits the offense of 31 infanticide if he or she causes the death of a 32 living infant with the purpose to cause said 33 death by an overt act performed when the infant 34 is partially born or born. 35 4. The offense of infanticide is a class A 36 felony. 37 5. A physician using procedures consistent 38 with the usual and customary standards of 39 medical practice to save the life of the mother 40 during pregnancy or birth or to save the life of 41 any unborn or partially born child of the same 42 pregnancy shall not be criminally responsible 43 under this section. In no event shall the 44 SB 699 142 mother be criminally responsible pursuant to 45 this section for the acts of the physician if 46 the physician is not held criminally responsible 47 pursuant to this section. 48 6. This section shall not apply to any 49 person who performs or attempts to perform a 50 legal abortion if the act that causes the death 51 is performed prior to the child being partially 52 born, even though the death of the child occurs 53 as a result of the abortion after the child is 54 partially born. 55 7. Only that person who performs the overt 56 act required under subsection 3 of this section 57 shall be culpable under this section, unless a 58 person, with the purpose of committing 59 infanticide, does any act which is a substantial 60 step towards the commission of the offense which 61 results in the death of the living infant. A 62 "substantial step" is conduct which is strongly 63 corroborative of the firmness of the actor's 64 purpose to complete the commission of the 65 offense. 66 8. Nothing in this section shall be 67 interpreted to exclude the defenses otherwise 68 available to any person under the law including 69 defenses provided pursuant to chapters 562 and 70 563.] 71 [574.200. 1. A person commits the offense 1 of interference with medical assistance if he or 2 she, while serving in his or her capacity as an 3 employee of an abortion facility: 4 (1) Knowingly orders or requests medical 5 personnel to deviate from any applicable 6 standard of care or ordinary practice while 7 providing medical assistance to a patient for 8 reasons unrelated to the patient's health or 9 welfare; or 10 (2) Knowingly attempts to prevent medical 11 personnel from providing medical assistance to a 12 patient in accordance with all applicable 13 standards of care or ordinary practice for 14 reasons unrelated to the patient's health or 15 welfare. 16 2. The offense of interference with 17 medical assistance is a class A misdemeanor. 18 3. For purposes of this section, the term 19 "medical personnel" shall include, but not be 20 limited to, the following: 21 (1) Physicians and surgeons licensed under 22 chapter 334; 23 (2) Nurses licensed under chapter 335; 24 (3) Emergency medical services personnel 25 as defined in section 190.600; or 26 (4) Any person operating under the 27 supervision of such medical personnel.] 28 SB 699 143 Section B. Any federal act, law, treaty, decision, 1 order, rule, or regulation that purports to supersede, stay, 2 or overrule section A of this act is in violation of the 3 Constitution of the state of Missouri and the Constitution 4 of the United States and is therefore void. The state of 5 Missouri and its political subdivisions, and agents thereof, 6 are not required to enter an appearance, special or 7 otherwise, in any federal suit challenging this act. 8 Section C. Because immediate action is necessary to 1 protect the unborn children in the state of Missouri, 2 section A of this act is deemed necessary for the immediate 3 preservation of the public health, welfare, peace, and 4 safety, and is hereby declared to be an emergency act within 5 the meaning of the constitution, and section A of this act 6 shall be in full force and effect upon its passage and 7 approval. 8 