Text of NC S 639 (2023)

GENERAL ASSEMBLY OF NORTH CAROLINA SESSION 2023 S D SENATE BILL DRS35149-NB-122 Short Title: Youth Health Protection Act. (Public) Sponsors: Senators Hise, B. Newton, and Sanderson (Primary Sponsors). Referred to: *DRS35149-NB-122* A BILL TO BE ENTITLED 1 AN ACT TO PROTECT MINORS FROM ADMINISTRATION OF PUBERTY BLOCKERS 2 AND CROSS-SEX HORMONES AND OTHER RELATED ACTIONS, PROCEDURES, 3 AND TREATMENTS. 4 Whereas, the State of North Carolina has a compelling government interest protecting 5 the health and safety of its citizens, especially vulnerable children; and 6 Whereas, the sex of a person is the biological state of being female or male, based on 7 sex organs, chromosomes, and endogenous hormone profiles, and is genetically encoded into a 8 person at the moment of conception, and it cannot be changed; and 9 Whereas, some individuals, including minors, may experience discordance between 10 their sex and their internal sense of identity, and individuals who experience severe psychological 11 distress as a result of this discordance may be diagnosed with gender dysphoria; and 12 Whereas, the cause of the individual's impression of discordance between sex and 13 identity is unknown, and the diagnosis is based exclusively on the individual's self-report of 14 feelings and beliefs; and 15 Whereas, this internal sense of discordance is not permanent or fixed, but to the 16 contrary, numerous studies have shown that a substantial majority of children who experience 17 discordance between their sex and identity will outgrow the discordance once they go through 18 puberty and will eventually have an identity that aligns with their sex; and 19 Whereas, as a result, taking a "wait-and-see" approach to children who reveal signs 20 of gender nonconformity results in a large majority of those children resolving to an identity 21 congruent with their sex by late adolescence; and 22 Whereas, some in the medical community are aggressively pushing for interventions 23 on minors that medically alter the child's hormonal balance and remove healthy external and 24 internal sex organs when the child expresses a desire to appear as a sex different from his or her 25 own; and 26 Whereas, this course of treatment for minors commonly begins with encouraging and 27 assisting the child to socially transition to dressing and presenting as the opposite sex. In the case 28 of prepubertal children, as puberty begins, doctors then administer long-acting GnRH agonist 29 (puberty blockers) that suppress the pubertal development of the child. This use of puberty 30 blockers for gender nonconforming children is experimental and not FDA-approved; and 31 Whereas, after puberty blockade, the child is later administered "cross-sex" hormonal 32 treatments that induce the development of secondary sex characteristics of the other sex, such as 33 causing the development of breasts and wider hips in male children taking estrogen and greater 34 muscle mass, bone density, body hair, and a deeper voice in female children taking testosterone. 35 Some children are administered these hormones independent of any prior pubertal blockade; and 36 FILED SENATE Apr 5, 2023 S.B. 639 PRINCIPAL CLERK General Assembly Of North Carolina Session 2023 Page 2 DRS35149-NB-122 Whereas, the final phase of treatment is for the individual to undergo cosmetic and 1 other surgical procedures, often to create an appearance similar to that of the opposite sex. These 2 surgical procedures may include a mastectomy to remove a female adolescent's breasts and 3 "bottom surgery" that removes a minor's healthy reproductive organs and creates an artificial 4 form aiming to approximate the appearance of the genitals of the opposite sex; and 5 Whereas, for minors who are placed on puberty blockers that inhibit their bodies from 6 experiencing the natural process of sexual development, the overwhelming majority will 7 continue down a path toward cross-sex hormones and cosmetic surgery; and 8 Whereas, this unproven, poorly studied series of interventions results in numerous 9 harmful effects for minors, as well as risks of effects simply unknown due to the new and 10 experimental nature of these interventions; and 11 Whereas, among the known harms from puberty blockers is diminished bone density; 12 the full effect of puberty blockers on brain development and cognition is yet unknown, though 13 reason for concern is now present. There is no research on the long-term risks to minors of 14 persistent exposure to puberty blockers. With the administration of cross-sex hormones comes 15 increased risks of cardiovascular disease, thromboembolic stroke, asthma, COPD, and cancer; 16 and 17 Whereas, puberty blockers prevent gonadal maturation and thus render patients taking 18 these drugs infertile. Introducing cross-sex hormones to children with immature gonads as a 19 direct result of pubertal blockade is expected to cause irreversible sterility. Sterilization is also 20 permanent for those who undergo surgery to remove reproductive organs, and such persons are 21 likely to suffer through a lifetime of complications from the surgery, infections, and other 22 difficulties requiring yet more medical intervention; and 23 Whereas, several studies demonstrate that hormonal and surgical interventions often 24 do not resolve the underlying psychological issues affecting the individual. For example, 25 individuals who undergo cross-sex cosmetic surgical procedures have been found to suffer from 26 elevated mortality rates higher than the general population. They experience significantly higher 27 rates of substance abuse, depression, and psychiatric hospitalizations; and 28 Whereas, minors, and often their parents, are unable to comprehend and fully 29 appreciate the risk and life implications–including permanent sterility–that result from the use of 30 puberty blockers, cross-sex hormones, and surgical procedures; and 31 Whereas, it is of grave concern to this legislature that the medical community is 32 allowing individuals who experience distress with their biological sex to be subjects of 33 irreversible and drastic non-genital gender reassignment surgery and irreversible, permanently 34 sterilizing genital gender reassignment surgeries, despite the lack of studies showing that such 35 extreme interventions have benefits that outweigh their risks or chances of cure. In fact, they may 36 increase the risk of suicide; and 37 Whereas, for these reasons, the decision to pursue a course of hormonal and surgical 38 interventions to address a discordance between the individual's sex and sense of identity should 39 not be presented to or determined for minors who are incapable of comprehending the negative 40 implications and life-course difficulties attending to these interventions; Now, therefore, 41 The General Assembly of North Carolina enacts: 42 SECTION 1.(a) Chapter 90 of the General Statutes is amended by adding a new 43 Article to read: 44 "Article 1M. 45 "Youth Health Protection Act. 46 "§ 90-21.140. Definitions. 47 The following definitions apply in this Article: 48 (1) Government agent. – Any agent, employee, volunteer, or contractor of a 49 public child services agency, private child placing agency, court, or school 50 district. 51 General Assembly Of North Carolina Session 2023 DRS35149-NB-122 Page 3 (2) Medical professional. – Any physician, surgeon, physician assistant, nurse, 1 clinical nurse specialist, nurse practitioner, anesthetist, psychiatrist, or 2 medical assistant licensed under this Chapter. 3 (3) Mental health care professional or counselor. – Any licensed medical, mental 4 health, or human services professional licensed under this Chapter, including 5 any psychologist, social worker, psychiatric nurse, allied mental health and 6 human services professional, licensed marriage and family therapist, certified 7 rehabilitation counselor, licensed clinical mental health counselor, or any of 8 their respective interns or trainees, or any other person designated or licensed 9 as a mental health or human service professional. 10 (4) Minor. – Any individual who is below 18 years of age. 11 (5) Political subdivision. – Any division of local government, county, city, 12 assessment district, municipal corporation, special purpose district, board, 13 department, commission, or any division of local government delegated the 14 right to exercise part of the sovereign power of that subdivision. 15 (6) Sex. – The biological state of being female or male, based on sex organs, 16 chromosomes, and endogenous hormone profiles, without regard to an 17 individual's psychological, chosen, or subjective experience of gender. 18 "§ 90-21.141. Prohibition of certain practices and health care services. 19 (a) Notwithstanding any other provision of law, it shall be unlawful for any medical 20 professional or mental health care professional or counselor to knowingly engage in any of the 21 following practices upon a minor, or cause them to be performed for the purpose of attempting 22 to alter the appearance of or affirm the minor's perception of his or her gender or sex, if that 23 appearance or perception is inconsistent with the minor's sex: 24 (1) Performing surgeries that sterilize, including castration, vasectomy, 25 hysterectomy, oophorectomy, orchiectomy, or penectomy. 26 (2) Performing surgeries that artificially construct tissue with the appearance of 27 genitalia that differs from the individual's sex, including metoidioplasty, 28 phalloplasty, and vaginoplasty. 29 (3) Performing a mastectomy. 30 (4) Prescribing, administering, or supplying gonadotropin releasing hormone 31 analogues or other synthetic drugs used to stop luteinizing hormone and 32 follicle stimulating hormone secretion, synthetic antiandrogen drugs used to 33 block the androgen receptor, or any drug to suppress or delay normal puberty. 34 (5) Prescribing, administering, or supplying testosterone, estrogen, or 35 progesterone to a minor in an amount greater than would normally be 36 produced endogenously in a healthy individual of that individual's age and 37 sex. 38 (6) Removing any otherwise healthy or nondiseased body part or tissue. 39 (b) It shall be unlawful for any medical professional or mental health care professional 40 or counselor to knowingly engage in conduct that aids or abets the practices described in 41 subsection (a) of this section to a minor. This section may not be construed to impose liability on 42 any speech protected by federal or State law. 43 (c) A medical professional or mental health care professional or counselor who engages 44 in any of the practices identified in subsection (a) of this section or causes them to be performed 45 shall be considered to have engaged in unprofessional conduct and shall be subject to revocation 46 of licensure for a minimum of one year and other appropriate discipline by the medical 47 professional's licensing or certifying board. The medical professional shall also be subject to a 48 civil penalty of up to one thousand dollars ($1,000) per occurrence. The clear proceeds of civil 49 penalties provided for in this subsection shall be remitted to the Civil Penalty and Forfeiture Fund 50 in accordance with G.S. 115C-457.2. 51 General Assembly Of North Carolina Session 2023 Page 4 DRS35149-NB-122 (d) This section does not apply to any of the following: 1 (1) The good-faith medical decision of a parent or guardian of a minor born with 2 a medically verifiable genetic disorder of sexual development, including any 3 of the following: 4 a. A minor with external biological sex characteristics that are 5 irresolvably ambiguous, such as a minor born having 46 XX 6 chromosomes with virilization, 46 XY chromosomes with 7 under-virilization, or having both ovarian and testicular tissue. 8 b. When a physician has otherwise diagnosed a disorder of sexual 9 development, in which the physician has determined through genetic 10 testing that the minor does not have the normal sex chromosome 11 structure, sex steroid hormone production, or sex steroid hormone 12 action for male or female sexes. 13 (2) The treatment of any infection, disease, or disorder that has been caused or 14 exacerbated by the performance of a procedure described in subsection (a) of 15 this section, whether or not the procedures were performed in accordance with 16 State or federal law. 17 (3) Any procedure undertaken because an individual suffers from a physical 18 disorder, physical injury, or physical illness that is certified by a physician and 19 that would place the individual in imminent danger of death or impairment of 20 major bodily function unless surgery is performed. 21 (e) Notwithstanding any other provision of law, it shall be unlawful for any health care 22 provider, as defined in G.S. 90-21.11, that receives State funds to furnish, provide, or perform 23 any health care service that constitutes the performance of or preparation for a gender transition 24 procedure to a minor. 25 "§ 90-21.142. Counseling. 26 A State office, agency, political subdivision of the State or local government, or any 27 organization with authority to license or discipline the members of a profession may not prohibit, 28 impose any penalty, or take any adverse action against any individual who gives or receives 29 counsel, advice, guidance, or any other speech or communication, whether described as therapy 30 or provided for a fee, consistent with conscience or religious belief. 31 "§ 90-21.143. Protection of parental rights. 32 (a) Parents, guardians, or custodians, in exercising the fundamental right to care for their 33 child, may withhold consent for any treatment, activity, or mental health care services that are 34 designed and intended to form their child's conceptions of sex and gender or to treat gender 35 dysphoria or gender nonconformity. The State, its agents, and political subdivisions shall not 36 infringe upon or impede the exercise of this right under this section. 37 (b) No government agent, nor any employee of this State, any political subdivision of this 38 State, or any other governmental entity, except for law enforcement personnel, shall encourage 39 or coerce a minor to withhold information from the minor's parent. Nor shall any such employee 40 withhold from a minor's parents information that is relevant to the physical or mental health of 41 their child and of a sort that parents interested in and responsible for the well-being of a minor 42 reasonably would demand and should be apprised of. Such conduct shall be grounds for 43 discipline of the employee, in addition to any other remedies provided to a parent under this 44 Article. 45 (c) If a government agent has knowledge that a minor under its care or supervision has 46 exhibited symptoms of gender dysphoria, gender nonconformity, or otherwise demonstrates a 47 desire to be treated in a manner incongruent with the minor's sex, the government agent or entity 48 with knowledge of that circumstance shall immediately notify, in writing, each of the minor's 49 parents, guardians, or custodians. The notice shall describe all of the relevant circumstances with 50 reasonable specificity. 51 General Assembly Of North Carolina Session 2023 DRS35149-NB-122 Page 5 "§ 90-21.144. Whistleblower protection. 1 (a) No person shall be discriminated against in any manner because the person does any 2 of the following: 3 (1) Provided, caused to be provided, or takes steps to provide or cause to be 4 provided to his or her employer, the Attorney General, any State agency, the 5 United States Department of Health and Human Services, or any other federal 6 agency any information or an act or omission that is a violation of any 7 provision of this Article. 8 (2) Testified or prepared to testify in a proceeding concerning a violation of this 9 Article. 10 (3) Assisted or participated in a proceeding concerning a violation of this Article. 11 (b) Unless a disclosure or report of information is specifically prohibited by law, no 12 person shall be discriminated against in any manner because the person disclosed any information 13 under this Article that the person believes evinces any of the following: 14 (1) Any violation of law, rule, or regulation. 15 (2) Any violation of any standard of care or other ethical guidelines for the 16 provision of any health care service. 17 (3) Gross mismanagement, a gross waste of funds, an abuse of authority, or a 18 substantial and specific danger to public health or safety. 19 "§ 90-21.145. Civil remedies. 20 (a) A civil action for compensatory or special damages, injunctive relief, or any other 21 relief available under law may be brought by any person for any violation of any provision of 22 this Article against the clinic, health care system, medical professional, or other person 23 responsible for the violation. 24 (b) Any party aggrieved or harmed by any violation of this Article shall be required to 25 bring suit for violation of this Article no later than two years after the day the cause of action 26 accrued. Minors injured by practices prohibited under this Article may bring an action during 27 their minority through a parent and may bring an action in their own name upon reaching majority 28 at any time from that date until 20 years from the date the minor attained the age of majority. 29 (c) Persons who prevail on a claim brought pursuant to this section shall be entitled, upon 30 the finding of a violation, to recover the following: 31 (1) Monetary damages, including all psychological, emotional, and physical harm 32 suffered. 33 (2) Total costs of the action and reasonable attorneys' fees. 34 (3) Any other appropriate relief. 35 (d) Standing to assert a claim or defense under this section shall be governed by the 36 general rules of standing. 37 "§ 90-21.146. Preemption. 38 (a) A political subdivision of this State is preempted from enacting, adopting, 39 maintaining, or enforcing any order, ordinance, rule, regulation, policy, or other similar measure 40 that prohibits, restricts, limits, controls, directs, or otherwise interferes with the professional 41 conduct and judgment of a mental health care professional or counselor, including speech, 42 undertaken within the course of treatment and communication with clients, patients, other 43 persons, or the public, including therapies, counseling, referrals, and education. 44 (b) The Attorney General or a mental health care professional or counselor may bring an 45 action for an injunction to prevent or restrain violations of this section. A mental health care 46 professional may recover reasonable costs and attorneys' fees incurred in obtaining an injunction 47 under this section. 48 (c) Sovereign and governmental immunity to suit and from liability is waived and 49 abolished to the extent of the liability created by this section." 50 General Assembly Of North Carolina Session 2023 Page 6 DRS35149-NB-122 SECTION 1.(b) Article 6 of Chapter 143C of the General Statutes is amended by 1 adding a new section to read: 2 "§ 143C-6-5.6. Limitation on use of State funds for gender transition procedures. 3 No State funds may be used, directly or indirectly, for the performance of or in furtherance 4 of gender transition procedures or to support the administration of any governmental health plan 5 or government-offered insurance policy offering gender transition procedures." 6 SECTION 2. G.S. 90-21.5 reads as rewritten: 7 "§ 90-21.5. Minor's Emanicipated minor consent sufficient for certain medical health 8 services. 9 (a) Subject to subsection (a1) of this section, any minor may give effective consent to a 10 physician licensed to practice medicine in North Carolina for medical health services for the 11 prevention, diagnosis and treatment of (i) venereal disease and other diseases reportable under 12 G.S. 130A-135, (ii) pregnancy, (iii) abuse of controlled substances or alcohol, and (iv) emotional 13 disturbance. This section does not authorize the inducing of an abortion, performance of a 14 sterilization operation, or admission to a 24-hour facility licensed under Article 2 of Chapter 15 122C of the General Statutes except as provided in G.S. 122C-223. This section does not prohibit 16 the admission of a minor to a treatment facility upon his own written application in an emergency 17 situation as authorized by G.S. 122C-223. 18 (a1) Notwithstanding any other provision of law to the contrary, a health care provider 19 shall obtain written consent from a parent or legal guardian prior to administering any vaccine 20 that has been granted emergency use authorization and is not yet fully approved by the United 21 States Food and Drug Administration to an individual under 18 years of age. 22 (b) Any minor who is emancipated may consent to any medical treatment, dental and 23 health services for himself or for his child." 24 SECTION 3. If any provision of this act or its application is held invalid, the 25 invalidity does not affect other provisions or applications of this act that can be given effect 26 without the invalid provisions or application and, to this end, the provisions of this act are 27 severable. 28 SECTION 4. This act becomes effective October 1, 2023. 29