Bill Text: MI HB5643 | 2013-2014 | 97th Legislature | Introduced
Bill Title: Health; abortion; performing an abortion without first determining whether there is a detectable heartbeat; prohibit except in an emergency. Amends secs. 17015 & 17515 of 1978 PA 368 (MCL 333.17015 & 333.17515) & adds sec. 17015b.
Spectrum: Strong Partisan Bill (Republican 16-1)
Status: (Introduced - Dead) 2014-06-11 - Printed Bill Filed 06/11/2014 [HB5643 Detail]
Download: Michigan-2013-HB5643-Introduced.html
HOUSE BILL No. 5643
June 10, 2014, Introduced by Reps. Hooker, Kurtz, Rendon, Genetski, Heise, Zorn, Lauwers, Johnson, Haveman, Olumba, Potvin, Outman, Yonker, Goike, Muxlow, McMillin and Callton and referred to the Committee on Health Policy.
A bill to amend 1978 PA 368, entitled
"Public health code,"
by amending sections 17015 and 17515 (MCL 333.17015 and 333.17515),
as amended by 2012 PA 499, and by adding section 17015b.
THE PEOPLE OF THE STATE OF MICHIGAN ENACT:
Sec. 17015. (1) Subject to subsection (10), a physician shall
not perform an abortion otherwise permitted by law without the
patient's informed written consent, given freely and without
coercion to abort.
(2)
For purposes of this section and section sections 17015a
and 17015b:
(a) "Abortion" means the intentional use of an instrument,
drug, or other substance or device to terminate a woman's pregnancy
for a purpose other than to increase the probability of a live
birth, to preserve the life or health of the child after live
birth, or to remove a fetus that has died as a result of natural
causes, accidental trauma, or a criminal assault on the pregnant
woman. Abortion does not include the use or prescription of a drug
or device intended as a contraceptive or any medical treatment of a
woman who is experiencing a miscarriage or has been diagnosed with
an extrauterine pregnancy.
(b) "Coercion to abort" means an act committed with the intent
to
coerce an individual to have an abortion. , which act is
prohibited
by section 213a of the Michigan penal code, 1931 PA 328,
MCL
750.213a.
(c) "Domestic violence" means that term as defined in section
1 of 1978 PA 389, MCL 400.1501.
(d) "Fetus" means an individual organism of the species homo
sapiens in utero.
(e) "Local health department representative" means a person
who meets 1 or more of the licensing requirements listed in
subdivision (h) and who is employed by, or under contract to
provide services on behalf of, a local health department.
(f)
"Medical emergency" means that a condition which, that, on
the basis of the physician's good faith clinical judgment, so
complicates the medical condition of a pregnant woman as to
necessitate the immediate abortion of her pregnancy to avert her
death or for which a delay will create serious risk of substantial
and irreversible impairment of a major bodily function.
(g) "Medical service" means the provision of a treatment,
procedure, medication, examination, diagnostic test, assessment, or
counseling, including, but not limited to, a pregnancy test,
ultrasound, pelvic examination, or an abortion.
(h) "Qualified person assisting the physician" means another
physician or a physician's assistant licensed under this part or
part 175, a fully licensed or limited licensed psychologist
licensed under part 182, a professional counselor licensed under
part 181, a registered professional nurse or a licensed practical
nurse licensed under part 172, or a social worker licensed under
part 185.
(i) "Probable gestational age of the fetus" means the
gestational age of the fetus at the time an abortion is planned to
be performed.
(j) "Provide the patient with a physical copy" means
confirming that the patient accessed the internet website described
in subsection (5) and received a printed valid confirmation form
from the website and including that form in the patient's medical
record or giving a patient a copy of a required document by 1 or
more of the following means:
(i) In person.
(ii) By registered mail, return receipt requested.
(iii) By parcel delivery service that requires the recipient to
provide a signature in order to receive delivery of a parcel.
(iv) By facsimile transmission.
(3) Subject to subsection (10), a physician or a qualified
person assisting the physician shall do all of the following not
less than 24 hours before that physician performs an abortion upon
a patient who is a pregnant woman:
(a) Confirm that, according to the best medical judgment of a
physician, the patient is pregnant, and determine the probable
gestational age of the fetus.
(b) Orally describe, in language designed to be understood by
the patient, taking into account her age, level of maturity, and
intellectual capability, each of the following:
(i) The probable gestational age of the fetus she is carrying.
(ii) Information about what to do and whom to contact should
medical complications arise from the abortion.
(iii) Information about how to obtain pregnancy prevention
information through the department of community health.
(c) Provide the patient with a physical copy of the written
standardized summary described in subsection (11)(b) that
corresponds to the procedure the patient will undergo and is
provided by the department of community health. If the procedure
has not been recognized by the department, but is otherwise allowed
under Michigan law, and the department has not provided a written
standardized summary for that procedure, the physician shall
develop and provide a written summary that describes the procedure,
any known risks or complications of the procedure, and risks
associated with live birth and meets the requirements of subsection
(11)(b)(iii) through (vii).
(d) Provide the patient with a physical copy of a medically
accurate depiction, illustration, or photograph and description of
a fetus supplied by the department of community health pursuant to
subsection (11)(a) at the gestational age nearest the probable
gestational age of the patient's fetus.
(e) Provide the patient with a physical copy of the prenatal
care and parenting information pamphlet distributed by the
department of community health under section 9161.
(f) Provide the patient with a physical copy of the
prescreening summary on prevention of coercion to abort described
in subsection (11)(i).
(4) The requirements of subsection (3) may be fulfilled by the
physician or a qualified person assisting the physician at a
location other than the health facility where the abortion is to be
performed. The requirement of subsection (3)(a) that a patient's
pregnancy be confirmed may be fulfilled by a local health
department under subsection (18). The requirements of subsection
(3) cannot be fulfilled by the patient accessing an internet
website other than the internet website that is maintained and
operated by the department under subsection (11)(g).
(5) The requirements of subsection (3)(c) through (f) may be
fulfilled by a patient accessing the internet website that is
maintained and operated by the department under subsection (11)(g)
and receiving a printed, valid confirmation form from the website
that the patient has reviewed the information required in
subsection (3)(c) through (f) at least 24 hours before an abortion
being performed on the patient. The website shall not require any
information be supplied by the patient. The department shall not
track, compile, or otherwise keep a record of information that
would identify a patient who accesses this website. The patient
shall supply the valid confirmation form to the physician or
qualified person assisting the physician to be included in the
patient's medical record to comply with this subsection.
(6) Subject to subsection (10), before obtaining the patient's
signature on the acknowledgment and consent form described in
subsection (11)(c), a physician personally and in the presence of
the patient shall do all of the following:
(a) Provide the patient with the physician's name, confirm
with the patient that the coercion to abort screening required
under section 17015a was performed, and inform the patient of her
right to withhold or withdraw her consent to the abortion at any
time before performance of the abortion.
(b) Orally describe, in language designed to be understood by
the patient, taking into account her age, level of maturity, and
intellectual capability, each of the following:
(i) The specific risk, if any, to the patient of the
complications that have been associated with the procedure the
patient will undergo, based on the patient's particular medical
condition and history as determined by the physician.
(ii) The specific risk of complications, if any, to the patient
if she chooses to continue the pregnancy based on the patient's
particular medical condition and history as determined by a
physician.
(7) To protect a patient's privacy, the information set forth
in subsection (3) and subsection (6) shall not be disclosed to the
patient in the presence of another patient.
(8) If at any time before the performance of an abortion, a
patient undergoes an ultrasound examination, or a physician
determines that ultrasound imaging will be used during the course
of a patient's abortion, the physician or qualified person
assisting the physician shall provide the patient with the
opportunity to view or decline to view an active ultrasound image
of the fetus, and offer to provide the patient with a physical
picture of the ultrasound image of the fetus before the performance
of the abortion. After the expiration of the 24-hour period
prescribed under subsection (3) but before performing an abortion
on a patient who is a pregnant woman, a physician or a qualified
person assisting the physician shall do all of the following:
(a) Obtain the patient's signature on the acknowledgment and
consent form described in subsection (11)(c) confirming that she
has received the information required under subsection (3).
(b) Provide the patient with a physical copy of the signed
acknowledgment and consent form described in subsection (11)(c).
(c) Retain a copy of the signed acknowledgment and consent
form described in subsection (11)(c) and, if applicable, a copy of
the pregnancy certification form completed under subsection
(18)(b), in the patient's medical record.
(9) This subsection does not prohibit notifying the patient
that payment for medical services will be required or that
collection of payment in full for all medical services provided or
planned may be demanded after the 24-hour period described in this
subsection has expired. A physician or an agent of the physician
shall not collect payment, in whole or in part, for a medical
service provided to or planned for a patient before the expiration
of 24 hours from the time the patient has done either or both of
the following, except in the case of a physician or an agent of a
physician receiving capitated payments or under a salary
arrangement for providing those medical services:
(a) Inquired about obtaining an abortion after her pregnancy
is confirmed and she has received from that physician or a
qualified person assisting the physician the information required
under subsection (3)(c) and (d).
(b) Scheduled an abortion to be performed by that physician.
(10) If the attending physician, utilizing his or her
experience, judgment, and professional competence, determines that
a medical emergency exists and necessitates performance of an
abortion before the requirements of subsections (1), (3), and (6)
can be met, the physician is exempt from the requirements of
subsections (1), (3), and (6), may perform the abortion, and shall
maintain a written record identifying with specificity the medical
factors upon which the determination of the medical emergency is
based.
(11) The department of community health shall do each of the
following:
(a) Produce medically accurate depictions, illustrations, or
photographs of the development of a human fetus that indicate by
scale the actual size of the fetus at 2-week intervals from the
fourth week through the twenty-eighth week of gestation. Each
depiction, illustration, or photograph shall be accompanied by a
printed description, in nontechnical English, Arabic, and Spanish,
of the probable anatomical and physiological characteristics of the
fetus at that particular state of gestational development.
(b) Subject to subdivision (e), develop, draft, and print, in
nontechnical English, Arabic, and Spanish, written standardized
summaries, based upon the various medical procedures used to abort
pregnancies, that do each of the following:
(i) Describe, individually and on separate documents, those
medical procedures used to perform abortions in this state that are
recognized by the department.
(ii) Identify the physical complications that have been
associated with each procedure described in subparagraph (i) and
with live birth, as determined by the department. In identifying
these complications, the department shall consider the annual
statistical report required under section 2835, and shall consider
studies concerning complications that have been published in a peer
review medical journal, with particular attention paid to the
design of the study, and shall consult with the federal centers for
disease control and prevention, the American congress of
obstetricians and gynecologists, the Michigan state medical
society, or any other source that the department determines
appropriate for the purpose.
(iii) State that as the result of an abortion, some women may
experience depression, feelings of guilt, sleep disturbance, loss
of interest in work or sex, or anger, and that if these symptoms
occur and are intense or persistent, professional help is
recommended.
(iv) State that not all of the complications listed in
subparagraph (ii) may pertain to that particular patient and refer
the patient to her physician for more personalized information.
(v) Identify services available through public agencies to
assist the patient during her pregnancy and after the birth of her
child, should she choose to give birth and maintain custody of her
child.
(vi) Identify services available through public agencies to
assist the patient in placing her child in an adoptive or foster
home, should she choose to give birth but not maintain custody of
her child.
(vii) Identify services available through public agencies to
assist the patient and provide counseling should she experience
subsequent adverse psychological effects from the abortion.
(c) Develop, draft, and print, in nontechnical English,
Arabic, and Spanish, an acknowledgment and consent form that
includes only the following language above a signature line for the
patient:
"I, _____________________________ , voluntarily and willfully
hereby authorize Dr. __________________ ("the physician") and any
assistant designated by the physician to perform upon me the
following operation(s) or procedure(s):
__________________________________________________________
(Name of operation(s) or procedure(s))
__________________________________________________________
A. I understand that I am approximately _____ weeks pregnant.
I consent to an abortion procedure to terminate my pregnancy. I
understand that I have the right to withdraw my consent to the
abortion procedure at any time before performance of that
procedure.
B. I understand that it is illegal for anyone to coerce me
into seeking an abortion.
C. I acknowledge that at least 24 hours before the scheduled
abortion I have received a physical copy of each of the following:
1. A medically accurate depiction, illustration, or photograph
of a fetus at the probable gestational age of the fetus I am
carrying.
2. A written description of the medical procedure that will be
used to perform the abortion.
3. A prenatal care and parenting information pamphlet.
D. If any of the documents listed in paragraph C were
transmitted by facsimile, I certify that the documents were clear
and legible.
E. I acknowledge that the physician who will perform the
abortion has orally described all of the following to me:
1. The specific risk to me, if any, of the complications that
have been associated with the procedure I am scheduled to undergo.
2. The specific risk to me, if any, of the complications if I
choose to continue the pregnancy.
F. I acknowledge that I have received all of the following
information:
1. Information about what to do and whom to contact in the
event that complications arise from the abortion.
2. Information pertaining to available pregnancy related
services.
G. I have been given an opportunity to ask questions about the
operation(s) or procedure(s).
H. I certify that I have not been required to make any
payments for an abortion or any medical service before the
expiration of 24 hours after I received the written materials
listed in paragraph C, or 24 hours after the time and date listed
on the confirmation form if the information described in paragraph
C was viewed from the state of Michigan internet website.".
(d) Make available to physicians through the Michigan board of
medicine and the Michigan board of osteopathic medicine and
surgery, and to any person upon request, the copies of medically
accurate depictions, illustrations, or photographs described in
subdivision (a), the written standardized summaries described in
subdivision (b), the acknowledgment and consent form described in
subdivision (c), the prenatal care and parenting information
pamphlet described in section 9161, the pregnancy certification
form described in subdivision (f), and the materials regarding
coercion to abort described in subdivision (i).
(e)
The department shall not develop In developing the written
standardized summaries for abortion procedures under subdivision
(b), that
utilize include in the summaries
only medication that has
not
been approved by the United States
food and drug administration
for use in performing an abortion.
(f) Develop, draft, and print a certification form to be
signed by a local health department representative at the time and
place a patient has a pregnancy confirmed, as requested by the
patient, verifying the date and time the pregnancy is confirmed.
(g) Develop, operate, and maintain an internet website that
allows a patient considering an abortion to review the information
required in subsection (3)(c) through (f). After the patient
reviews the required information, the department shall assure that
a confirmation form can be printed by the patient from the internet
website that will verify the time and date the information was
reviewed. A confirmation form printed under this subdivision
becomes invalid 14 days after the date and time printed on the
confirmation form.
(h) Include on the informed consent internet website operated
under subdivision (g) a list of health care providers, facilities,
and clinics that offer to perform ultrasounds free of charge. The
list shall be organized geographically and shall include the name,
address, and telephone number of each health care provider,
facility, and clinic.
(i) After considering the standards and recommendations of the
joint commission on accreditation of healthcare organizations, the
Michigan domestic and sexual violence prevention and treatment
board, the Michigan coalition to end domestic and sexual violence
or successor organization, and the American medical association, do
all of the following:
(i) Develop, draft, and print or make available in printable
format, in nontechnical English, Arabic, and Spanish, a notice that
is required to be posted in facilities and clinics under section
17015a. The notice shall be at least 8-1/2 inches by 14 inches,
shall be printed in at least 44-point type, and shall contain at a
minimum all of the following:
(A) A statement that it is illegal under Michigan law to
coerce a woman to have an abortion.
(B) A statement that help is available if a woman is being
threatened or intimidated; is being physically, emotionally, or
sexually harmed; or feels afraid for any reason.
(C) The telephone number of at least 1 domestic violence
hotline and 1 sexual assault hotline.
(ii) Develop, draft, and print or make available in printable
format, in nontechnical English, Arabic, and Spanish, a
prescreening summary on prevention of coercion to abort that, at a
minimum, contains the information required under subparagraph (i)
and notifies the patient that an oral screening for coercion to
abort will be conducted before her giving written consent to obtain
an abortion.
(iii) Develop, draft, and print screening and training tools and
accompanying training materials to be utilized by a physician or
qualified person assisting the physician while performing the
coercion to abort screening required under section 17015a. The
screening tools shall instruct the physician or qualified person
assisting the physician to orally communicate information to the
patient regarding coercion to abort and to document the findings
from the coercion to abort screening in the patient's medical
record.
(iv) Develop, draft, and print protocols and accompanying
training materials to be utilized by a physician or a qualified
person assisting the physician if a patient discloses coercion to
abort or that domestic violence is occurring, or both, during the
coercion to abort screening. The protocols shall instruct the
physician or qualified person assisting the physician to do, at a
minimum, all of the following:
(A) Follow the requirements of section 17015a as applicable.
(B) Assess the patient's current level of danger.
(C) Explore safety options with the patient.
(D) Provide referral information to the patient regarding law
enforcement and domestic violence and sexual assault support
organizations.
(E) Document any referrals in the patient's medical record.
(12) A physician's duty to inform the patient under this
section does not require disclosure of information beyond what a
reasonably well-qualified physician licensed under this article
would possess.
(13) A written consent form meeting the requirements set forth
in this section and signed by the patient is presumed valid. The
presumption created by this subsection may be rebutted by evidence
that establishes, by a preponderance of the evidence, that consent
was obtained through fraud, negligence, deception,
misrepresentation, coercion, or duress.
(14) A completed certification form described in subsection
(11)(f) that is signed by a local health department representative
is presumed valid. The presumption created by this subsection may
be rebutted by evidence that establishes, by a preponderance of the
evidence, that the physician who relied upon the certification had
actual knowledge that the certificate contained a false or
misleading statement or signature.
(15) This section does not create a right to abortion.
(16) Notwithstanding any other provision of this section, a
person shall not perform an abortion that is prohibited by law.
(17) If any portion of this act or the application of this act
to any person or circumstances is found invalid by a court, that
invalidity does not affect the remaining portions or applications
of the act that can be given effect without the invalid portion or
application, if those remaining portions are not determined by the
court to be inoperable.
(18) Upon a patient's request, each local health department
shall:
(a) Provide a pregnancy test for that patient to confirm the
pregnancy as required under subsection (3)(a) and determine the
probable gestational stage of the fetus. The local health
department need not comply with this subdivision if the
requirements of subsection (3)(a) have already been met.
(b) If a pregnancy is confirmed, ensure that the patient is
provided with a completed pregnancy certification form described in
subsection (11)(f) at the time the information is provided.
(19) The identity and address of a patient who is provided
information or who consents to an abortion pursuant to this section
is confidential and is subject to disclosure only with the consent
of the patient or by judicial process.
(20) A local health department with a file containing the
identity and address of a patient described in subsection (19) who
has been assisted by the local health department under this section
shall do both of the following:
(a) Only release the identity and address of the patient to a
physician or qualified person assisting the physician in order to
verify the receipt of the information required under this section.
(b) Destroy the information containing the identity and
address of the patient within 30 days after assisting the patient
under this section.
Sec. 17015b. (1) Except when a medical emergency exists that
prevents compliance with this section, a physician shall not
perform an abortion on a pregnant woman before determining, in
accordance with standard medical practice, whether evidence of a
fetal heartbeat has been detected in the fetus the pregnant woman
is carrying. An individual who performs an abortion in a medical
emergency without determining whether the fetus has a detectable
heartbeat shall note in the pregnant woman's medical record the
specific nature of the medical emergency that existed. Compliance
with this section does not require the use of an intravaginal
diagnostic procedure.
(2) If during the examination required under subsection (1)
evidence of a fetal heartbeat is detected, the physician or a
qualified person assisting the physician shall do all of the
following:
(a) Offer to the pregnant woman the option of hearing or
seeing the evidence of the fetal heartbeat.
(b) Inform the pregnant woman of the probability of
maintaining the pregnancy versus experiencing a miscarriage, given
the stage of pregnancy and other factors known to affect the
possibility of a miscarriage.
(3) If the examination required under subsection (1) does not
produce evidence of a fetal heartbeat, the physician or a qualified
person assisting the physician shall do all of the following that
apply:
(a) Advise the pregnant woman of the physician's
recommendation either to immediately perform an additional
diagnostic procedure or procedures that may detect a fetal
heartbeat or to delay until a later date performing a diagnostic
procedure to determine if the fetus is physically developing.
(b) If the fetus has been visibly identified but is not
exhibiting a heartbeat or other signs of physical activity, advise
the pregnant woman that a procedure to remove a fetus that has died
is not considered an abortion under law and inform the pregnant
woman of the relative risks and benefits of different means of
terminating the pregnancy, including medical inducement, a surgical
procedure, or allowing a miscarriage to occur spontaneously.
Sec. 17515. A physician, before performing an abortion on a
patient,
shall comply with sections 17015 and 17015a.to 17015b.
