Bill Text: MI HB4760 | 2017-2018 | 99th Legislature | Introduced

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Bill Title: Health; abortion; informed consent provision; remove 24-hour waiting period before the performance of an abortion. Amends secs. 17015 & 17015a of 1978 PA 368 (MCL 333.17015 & 333.17015a) & repeals sec. 17014 of 1978 PA 368 (MCL 333.17014).

Spectrum: Partisan Bill (Democrat 1-0)

Status: (Introduced - Dead) 2017-06-15 - Bill Electronically Reproduced 06/14/2017 [HB4760 Detail]

Download: Michigan-2017-HB4760-Introduced.html

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HOUSE BILL No. 4760

 

 

June 14, 2017, Introduced by Reps. Faris, Cochran, Dianda, Sneller, Chang, Sabo, Jones, Sowerby, Wittenberg, Geiss, Pagan, Hoadley, Brinks, Hertel, Greig, Moss, Hammoud, Durhal and Greimel and referred to the Committee on Health Policy.

 

     A bill to amend 1978 PA 368, entitled

 

"Public health code,"

 

by amending sections 17015 and 17015a (MCL 333.17015 and

 

333.17015a), section 17015 as amended and section 17015a as added

 

by 2012 PA 499; and to repeal acts and parts of acts.

 

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 17015a:

 

     (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.

 

     (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

 

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 and human

 

services.

 

     (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 and human services.

 

If the procedure has not been recognized by the department of

 

health and human services, but is otherwise allowed under Michigan

 

law, and the department of health and human services 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 to (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 and human

 

services 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 and human services 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 of health and human services under

 

subsection (11)(g).

 

     (5) The requirements of subsection (3)(c) through to (f) may

 

be fulfilled by a patient accessing the internet website that is

 

maintained and operated by the department of health and human

 

services 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 to (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 of health and human services 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 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 and human services

 

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 must 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 of health and human services.

 

     (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 of health and

 

human services. In identifying these complications, the department

 

of health and human services 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 Centers for

 

disease control Disease Control and prevention, Prevention, the

 

American congress Congress of obstetricians Obstetricians and

 

gynecologists, Gynecologists, the Michigan state medical society,

 

State Medical Society, or any other source that the department of

 

health and human services 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 Food and drug

 

administration 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 to (f). After the patient

 

reviews the required information, the department shall assure

 

ensure 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 must be organized geographically and shall must 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 Joint Commission on accreditation Accreditation of

 

healthcare organizations,Healthcare Organizations, the Michigan

 

domestic and sexual violence prevention and treatment board, the

 

Michigan coalition Coalition to end domestic End Domestic and

 

sexual violence Sexual Violence or successor organization, and the

 

American medical association, 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 must be at least 8-1/2 inches by 14

 

inches, shall must 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 must 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 must 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 a local health department

 

shall comply with the following:

 

     (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. 17015a. (1) At the time a patient first presents at a

 

private office, freestanding surgical outpatient facility, or other

 

facility or clinic in which abortions are performed for the purpose

 

of obtaining an abortion, whether before or after the expiration of

 

the 24-hour period described in section 17015(3), the physician or

 

qualified person assisting the physician shall orally screen the

 

patient for coercion to abort using the screening tools developed

 

by the department under section 17015(11). The oral screening

 

required under this subsection may occur before the requirements of

 

section 17015(3) have been met with regard to that patient.

 

     (2) If a patient discloses that she is the victim of domestic

 

violence that does not include coercion to abort, the physician or

 

qualified person assisting the physician shall follow the protocols

 

developed by the department under section 17015(11).

     (3) If a patient discloses coercion to abort, the physician or

 

qualified person assisting the physician shall follow the protocols

 

developed by the department under section 17015(11).

 

     (4) If a patient who is under the age of 18 discloses domestic

 

violence or coercion to abort by an individual responsible for the

 

health or welfare of the minor patient, the physician or qualified

 

person assisting the physician shall report that fact to a local

 

child protective services office.

 

     (5) A private office, freestanding surgical outpatient

 

facility, or other facility or clinic in which abortions are

 

performed shall post in a conspicuous place in an area of its

 

facility that is accessible to patients, employees, and visitors

 

the notice described in section 17015(11)(i). A private office,

 

freestanding surgical outpatient facility, or other facility or

 

clinic in which abortions are performed shall make available in an

 

area of its facility that is accessible to patients, employees, and

 

visitors publications that contain information about violence

 

against women.

 

     (6) This section does not create a right to abortion.

 

Notwithstanding any other provision of this section, a person shall

 

not perform an abortion that is prohibited by law.

 

     Enacting section 1. Section 17014 of the public health code,

 

1978 PA 368, MCL 333.17014, is repealed.

 

     Enacting section 2. This amendatory act takes effect 90 days

 

after the date it is enacted into law.