Hawaii-2023-HB891-Introduced

SECTION 1. The legislature finds that the culture war continues to rage on in the United States. Over the years, there have been many social disputes arising within the cultural conversations of the United States surrounding gender, gender identity, gender expression, and now the topic of transgenderism has a firm grip on the public discourse. Topics such as transgenderism evoke many powerful emotions from people with various opinions, across all levels of society. This appears to be the next big society issue that will be addressed either in the legislative branch or the judicial branch of government.

The legislature also finds that the human brain does not reach full development until roughly age 25. This is a widely known and accepted fact, and one that has been instrumental in the background of enacting laws to protect minors. This is why minors cannot own firearms, buy alcohol, vote, and in most circumstances cannot make other decisions of legal consequence such as enter into contracts. However, the new cultural movement seems to be perfectly fine with allowing minors to request life-altering medical surgeries that alter their bodies permanently. These "gender transition" surgeries include but are not limited to such operations as double mastectomies, feminizing vaginoplasty, masculinizing phalloplasty, scrotoplasty, metoidioplasty, and facial reconstruction surgery.

The legislature further finds that protecting children from decisions that they have no capacity to fully understand is both necessary and proper. There is a growing number of "detransitioners," or those individuals who have undergone gender transition surgeries or therapy, but have since decided to transition back to their original gender. There are many stories of detransitioners that have started to permeate the discussion of transgenderism, and these experiences only reinforce the need to protect minors from making irreversible medical decisions that they are unable to fully understand. To preserve the innocence of childhood and prevent future regret among the current youth population, it is imperative that this state prohibit gender reassignment / gender transition surgeries on minors.

The purpose of this Act is to prohibit gender reassignment / transition surgeries for minors.

SECTION 2. Chapter 453, Hawaii Revised Statutes, is amended by adding a new section to be properly designated and to read as follows:

"§453 - Prohibition of gender transition surgeries on minors. (a) As used in this section:

"Sex" means the biological state of being female or male, based on the individual's sex organs, chromosomes, and endogenous hormone profiles.

"Professional incompetency" means:

(1) One or more instances involving failure to adhere to the applicable standard of care to a degree that constitutes gross negligence.

(2) Repeated instances involving failure to adhere to the applicable standard of care to a degree that constitutes ordinary negligence.

(3) A pattern of practice or other behavior that demonstrates a manifest incapacity or incompetence to practice the healing arts.

"Unprofessional conduct" means:

(1) Solicitating professional patronage through the use of fraudulent or false advertisements, or profiting by the acts of those representing themselves to be agents of the licensee.

(2) Representing to a patient that a manifestly incurable disease, condition, or injury can be permanently cured.

(3) Assisting in the care or treatment of a patient without the consent of the patient, the attending physician, or the patient's legal representatives.

(4) The use of any letters, words, or terms as an affix, on stationary, in advertisements or otherwise indicating that such person is entitled to practice a branch of the healing arts for which such person is not licensed.

(5) Performing, procuring, or aiding and abetting in the performance or procurement of a criminal abortion.

(6) Willfully betraying confidential information.

(7) Advertising professional superiority or the performance of professional services in a superior manner.

(8) Advertising to guarantee any professional service or to perform any operation painlessly.

(9) Participating in any action as a staff member of a medical care facility that is designed to exclude or that results in the exclusion of any person licensed to practice medicine and surgery from the medical staff of a nonprofit medical care facility licensed in this state because of the branch of the healing arts practiced by such person or without just cause.

(10) Engaging in conduct likely to deceive, defraud, or harm the public.

(11) Making a false or misleading statement regarding the licensee's skill or the efficacy or value of the drug, treatment, or remedy prescribed by the licensee or at the licensee's direction in the treatment of any disease or other condition of the body or mind.

(12) Aiding or abetting the practice of the healing arts by an unlicensed, incompetent, or impaired person.

(13) Allowing another person or organization to use the license's license to practice the healing arts.

(14) Committing any acts of sexual abuse, misconduct, or other improper sexual contact that exploits the licensee-patient relationship with a patient or person responsible for the healthcare decisions concerning such patient.

(15) Using any false, fraudulent, or deceptive statement in any document connected with the practice of the healing arts including the intentional falsifying or fraudulent altering of a patient or medical care facility record.

(16) Obtaining any fee by fraud, deceit, or misrepresentation.

(17) Directly or indirectly giving or receiving any fee, commission, rebate, or other compensation for professional services not actually and personally rendered, other than through the legal functioning of lawful professional partnerships, corporations, limited liability companies, or associations.

(18) Failing to transfer patient records through another licensee when requested to do so by the subject patient or by such patient's legally designated representative.

(19) Performing unnecessary tests, examinations, or services that have no legitimate medical purpose.

(20) Charging an excessive fee for services rendered.

(21) Prescribing, dispensing, administering, or distributing a prescription drug or substance, including a controlled substance, in an improper or inappropriate manner, or for other than a valid medical purpose, or not in the course of the licensee's professional practice.

(22) Failing repeatedly to practice healing arts with that level of care, skill, and treatment that is recognized by a reasonably prudent similar practitioner as being acceptable under similar conditions and circumstances.

(23) Failing to keep written medical records that accurately describe the services rendered to the patient, including patient histories, pertinent findings, examination results, and test results.

(24) Delegating professional responsibilities to a person when the licensee knows or has reason to know that such a person is not qualified by training, experience, or licensure to perform them.

(25) Using experimental forms of therapy without proper informed patient consent, without conforming to generally accepted criteria or standard protocols, without keeping detailed legible records, or without having periodic analysis of the study and results reviewed by a committee or peers.

(26) Prescribing, dispensing, administering, or distributing an anabolic steroid or human growth hormone for other than a valid medical purpose. Bodybuilding, muscle enhancement, or increasing muscle bulk or strength through the use of an anabolic steroid or human growth hormone by a person who is in good health is not a valid medical purpose.

(27) Referring a patient to a health care entity for services if the licensee has a significant investment interest in the health care entity, unless the licensee informs the patient in writing of a significant investment interest and that the patient may obtain such services elsewhere.

(28) Failing to properly supervise, direct, or delegate acts that constitute the healing arts to a persons who perform services pursuant to each licensee's direction, supervision, order, referral, delegation, or practice protocols. I

(29) Charging, billing, or otherwise soliciting payment from any patient, patient's representative, or insurer for anatomic pathology services, if such services are not personally rendered by the licensee, or under such license's direct supervision.

(30) Engaging in a conduct that violates patient trust and exploits the licensee-patient relationship for personal gain.

(31) Obstructing a board investigation including, but not limited to, engaging in one or more of the following acts:

(A) Falsifying or concealing a material fact;

(B) Knowingly making or causing to be made any false or misleading statement or writing; or

(b) Unlawful gender transition / gender reassignment surgery is knowingly performing, or causing to be performed, any of the following upon a child under 18 years of age for the purpose of attempting to change or affirm the child's perception of the child's sex, if that perception is inconsistent with the child's sex:

(1) Performing a surgery that sterilizes, including, but not limited to, castration, vasectomy, hysterectomy, oophorectomy, orchiectomy, and penectomy;

(2) Performing a surgery that artificially constructs tissue with the appearance of genitalia, including, but not limited to, metoidioplasty, phalloplasty, and vaginoplasty;

(3) Performing a mastectomy;

(4) Prescribing, dispensing, administering, or otherwise supplying the following medications:

(A) Puberty-blocking medication to stop normal puberty;

(B) Supraphysiologic doses of testosterone to females; or

(5) Removing any otherwise healthy or nondiseased body part or tissue.

(c) Unlawful gender reassignment / gender transition surgery is a Class A Felony. The individual performing the surgery shall be solely liable under this section.

(d) The provisions of this section shall not apply if a child was born with a medically verifiable disorder of sex development, including:

(1) A child with external biological sex characteristics that are irresolvably ambiguous, such as a child born with having 46,XX chromosomes with virilization, 46,XY Chromosomes with undervirilization, or both ovarian and testicular tissue; or

(2) When a physician has otherwise diagnosed a disorder of sexual development, in which the physician has determined through genetic or biochemical testing that the child does not have the normal sex chromosome structure, sex steroid hormone production or sex steroid hormone action for a male or female.

SECTION 3. New statutory material is underscored.

SECTION 4. This Act shall take effect upon its approval.

INTRODUCED BY:	_____________________________

HOUSE OF REPRESENTATIVES	H.B. NO.	891
THIRTY-SECOND LEGISLATURE, 2023
STATE OF HAWAII