Second Regular Session Seventy-third General Assembly STATE OF COLORADO INTRODUCED LLS NO. 22-0653.01 Kristen Forrestal x4217 HOUSE BILL 22-1075 House Committees Senate Committees Health & Insurance A BILL FOR AN ACT C ONCERNING INFORMATION REG ARDING INDUCED TERMINATIONS OF101 PREGNANCIES REPORTED TO THE STATE REGISTRAR OF VITAL102 STATISTICS.103 Bill Summary (Note: This summary applies to this bill as introduced and does not reflect any amendments that may be subsequently adopted. If this bill passes third reading in the house of introduction, a bill summary that applies to the reengrossed version of this bill will be available at http://leg.colorado.gov .) The bill requires health-care providers that perform induced terminations of pregnancies to report specified information concerning the women who obtain the procedure to the state registrar of vital statistics in the department of public health and environment in an electronic format as prescribed by the state registrar. The reported HOUSE SPONSORSHIP Luck, Pico, Ransom SENATE SPONSORSHIP (None), Kirkmeyer Shading denotes HOUSE amendment. Double underlining denotes SENATE amendment. Capital letters or bold & italic numbers indicate new material to be added to existing statute. Dashes through the words indicate deletions from existing statute. information must not include information that could identify the women who obtained induced terminations of pregnancies. The bill requires the state registrar to annually create a summary report of the information reported by health-care providers and to make the report available to the public. The bill places limitations on how and to whom the state registrar may release the information reported to the state registrar. A physician or physician assistant who falsifies or fails to submit the required information engages in unprofessional conduct pursuant to the "Colorado Medical Practice Act". An advanced practice registered nurse who falsifies or fails to submit the required information is subject to discipline pursuant to the "Nurse and Nurse Aide Practice Act". Be it enacted by the General Assembly of the State of Colorado:1 SECTION 1. Legislative declaration. (1) The general assembly2 hereby finds and declares that:3 (a) The goals of the department of public health and environment4 (department) regarding the vital statistics program include:5 (I) Analyzing and disseminating timely, complete, and6 high-quality vital statistics data;7 (II) Transforming data into products and information that drive8 evidence-based decisions;9 (III) Helping to translate data into meaningful information and10 action;11 (IV) Assisting with disease, injury, and violence prevention;12 (V) Supporting maternal and child health activities;13 (VI) Informing the public about policy and health promotion14 efforts; and15 (VII) Improving the health and lives of all Coloradans;16 (b) Current vital statistics data regarding induced terminations of17 pregnancies are inaccurate and, according to the department, health-care18 providers do not consistently report such vital statistics to the state. The19 HB22-1075-2- Guttmacher Institute has previously reported that abortions occur1 approximately 40% more frequently than the figures published by the2 department suggest.3 (c) Regardless of one's position on abortion rights, accurate vital4 statistics data is widely regarded as crucial to reproductive health research5 and public health policy. The American College of Obstetricians and6 Gynecologists recognizes that "Obstetrician-gynecologists play an7 essential role in ensuring accurate representation of pregnancy-related and8 pregnancy-associated deaths and other vital statistics for policy makers,9 public health institutions, and researchers." As noted in Maternal Health,10 "Incomplete reporting of pregnancy remains a fundamental shortcoming11 to the study of US fertility-related experiences. Efforts to improve12 abortion reporting are needed to strengthen the quality of pregnancy data13 to support maternal, child, and reproductive health research." Without14 accurate abortion statistics, it is impossible for the state to assess the15 impact of public and private health interventions on the incidence of16 abortion in Colorado.17 (d) The reasons women pursue abortion in Colorado are18 incompletely understood. National surveys by the Guttmacher Institute19 have identified the principal reasons women seek abortions at large20 abortion clinics. However, these surveys are compromised by poor21 participation and do not reflect the specific demographics of Colorado.22 (e) The standard of care for abortion providers entails obtaining23 a complete reproductive health-care history, including family planning24 methods, sexual history, and reasons for pursuing an abortion; and25 (f) Sex trafficking of adolescents and young adults is both a26 human rights violation and a public health problem in Colorado. Studies27 HB22-1075 -3- suggest that 37% to 50% of sex trafficking victims encounter health-care1 providers while they are being trafficked. Abortion providers are one of2 the well-recognized health-care interfaces, and thus abortion providers3 can play an important role in the identification of and response to the sex4 trafficking of minors. Studies have suggested that over 50% of victims5 have an abortion and 30% reported having multiple abortions because of6 sex trafficking. Conducting a comprehensive reproductive health-care7 history is one way to flag at-risk individuals.8 (2) Therefore, the state of Colorado has a compelling interest in9 requiring:10 (a) Health-care providers who perform induced terminations of11 pregnancies to report to the state registrar of vital statistics certain12 information concerning women who obtain the procedure; and13 (b) The state registrar to annually create a summary report of such14 information and make the report available to the public.15 SECTION 2. In Colorado Revised Statutes, 12-240-121, add16 (1)(hh) as follows:17 12-240-121. Unprofessional conduct - definitions.18 (1) "Unprofessional conduct" as used in this article 240 means:19 (hh) F ALSIFYING OR FAILING TO SUBMIT TO THE STATE REGISTRAR20 OF VITAL STATISTICS INFORMATION CONCERNING INDUCED TERMINATIONS21 OF PREGNANCIES AS REQUIRED BY SECTION 25-2-110.3.22 SECTION 3. In Colorado Revised Statutes, 12-255-120, amend23 (1)(gg); and add (1)(ii) as follows:24 12-255-120. Grounds for discipline - definitions. (1) "Grounds25 for discipline", as used in this part 1, means any action by any person26 who:27 HB22-1075 -4- (gg) Is diverting or has diverted a controlled substance, as defined1 in section 18-18-102 (5), or any other drug having similar effects from the2 person's place of employment; or3 (ii) F ALSIFIES OR FAILS TO SUBMIT TO THE STATE REGISTRAR OF4 VITAL STATISTICS INFORMATION CONCERNING INDUCED TERMINATIONS OF5 PREGNANCIES AS REQUIRED BY SECTION 25-2-110.3.6 SECTION 4. In Colorado Revised Statutes, add 25-2-110.3 as7 follows:8 25-2-110.3. Induced termination of pregnancy - report9 required - unprofessional conduct - rules - definitions. (1) A S USED IN10 THIS SECTION, UNLESS THE CONTEXT OTHERWISE REQUIRES :11 (a) "H EALTH-CARE PROVIDER" MEANS:12 (I) A PHYSICIAN OR PHYSICIAN ASSISTANT LICENSED PURSUANT TO13 ARTICLE 240 OF TITLE 12;14 (II) A N ADVANCED PRACTICE REGISTERED NURSE , AS DEFINED IN15 SECTION 12-255-104 (1); OR16 (III) A HEALTH FACILITY LICENSED OR CERTIFIED PURSUANT TO17 SECTION 25-1.5-103.18 (b) "ICD-11 CODE" MEANS A CODE CONTAINED IN THE ELEVENTH19 REVISION OF THE INTERNATIONAL CLASSIFICATION OF DISEASES CODING20 SYSTEM CREATED BY THE WORLD HEALTH ORGANIZATION, WHICH21 CLASSIFICATION IS USED BY HEALTH-CARE PROVIDERS TO CLASSIFY AND22 CODE ALL DIAGNOSES, SYMPTOMS, AND PROCEDURES.23 (2) A HEALTH-CARE PROVIDER THAT PERFORMS INDUCED24 TERMINATIONS OF PREGNANCIES IN THIS STATE SHALL FILE A REPORT WITH25 THE STATE REGISTRAR, IN AN ELECTRONIC FORM AND MANNER PRESCRIBED26 BY THE STATE REGISTRAR , OF EACH INDUCED TERMINATION OF27 HB22-1075 -5- PREGNANCY. THE REPORT SHALL BE BASED ON A COMPLETE1 REPRODUCTIVE HEALTH-CARE HISTORY OF EACH WOMAN WHO OBTAINS AN2 INDUCED TERMINATION OF PREGNANCY AND SHALL INCLUDE :3 (a) T HE WOMAN'S AGE;4 (b) T HE WOMAN'S RACE AND ETHNICITY;5 (c) T HE WOMAN'S MARITAL STATUS;6 (d) T HE NUMBER OF PREVIOUSLY INDUCED TERMINATIONS OF7 PREGNANCIES THE WOMAN HAS RECEIVED , IF ANY;8 (e) T HE NUMBER OF LIVING CHILDREN THE WOMAN HAS , IF ANY;9 (f) A CLINICAL ESTIMATE OF THE GESTATIONAL AGE OF THE FETUS;10 (g) T HE METHOD OF FAMILY PLANNING EMPLOYED BY THE WOMAN11 AT THE TIME OF HER PREGNANCY, INCLUDING:12 (I) N O METHOD UTILIZED;13 (II) N ATURAL FAMILY PLANNING TECHNIQUES ;14 (III) O RAL CONTRACEPTIVE PILLS; OR15 (IV) L ONG-ACTING REVERSIBLE CONTRACEPTIVES ;16 (h) T HE REASON FOR THE INDUCED TERMINATION OF PREGNANCY ,17 IF INDICATED BY THE WOMAN , INCLUDING WHETHER THE REASON WAS18 ELECTIVE DUE TO:19 (I) I NTERFERENCE WITH THE WOMAN 'S EDUCATION;20 (II) I NTERFERENCE WITH THE WOMAN 'S EMPLOYMENT OR CAREER;21 (III) T HE FINANCIAL INSECURITY OF THE WOMAN , INCLUDING IF22 SHE IS:23 (A) U NEMPLOYED;24 (B) C ANNOT SEPARATE FROM EMPLOYMENT TO CARE FOR A CHILD ;25 (C) C ANNOT AFFORD CHILD CARE;26 (D) C ANNOT AFFORD HOUSING; OR27 HB22-1075 -6- (E) CANNOT RELY ON ASSISTANCE FROM A PARTNER ;1 (IV) T HE WOMAN'S DETERMINATION THAT SHE WAS NOT READY OR2 WILLING TO BECOME A PARENT BECAUSE SHE :3 (A) I S NOT EMOTIONALLY OR MENTALLY PREPARED ;4 (B) I S NOT READY FOR ANOTHER CHILD ;5 (C) I S TOO YOUNG OR TOO OLD;6 (D) D OES NOT WANT OTHERS TO KNOW SHE WAS SEXUALLY7 ACTIVE OR PREGNANT; OR8 (E) D OES NOT WANT TO HAVE A CHILD OR PLACE A CHILD UP FOR9 ADOPTION;10 (V) A DYNAMIC RELATED TO THE WOMAN 'S PARTNER, SUCH AS11 SHE:12 (A) H AS NO PARTNER;13 (B) H AS A NEW PARTNER;14 (C) H AS A PARTNER THAT IS UNSUPPORTIVE AND DOES NOT WANT15 A CHILD;16 (D) H AS DETERMINED HER PARTNER TO BE WRONG FOR HER ;17 (E) H AS AN ABUSIVE PARTNER; OR18 (F) W ANTS TO BE MARRIED BEFORE HAVING CHILDREN ;19 (VI) T HE WOMAN'S DETERMINATION THAT SHE NEEDS TO FOCUS ON20 HER OTHER CHILDREN;21 (VII) T HE OPPOSITION OF THE WOMAN 'S FAMILY, FRIENDS, OR22 COMMUNITY;23 (VIII) M ATERNAL HEALTH CONSIDERATIONS , SPECIFIED BY ONE OR24 MORE ICD-11 CODES;25 (IX) A CONCERN WITH THE HEALTH OF THE FETUS AS A RESULT OF26 DRUG, ALCOHOL, OR PRESCRIPTION DRUG EXPOSURE DURING EARLY27 HB22-1075 -7- PREGNANCY;1 (X) A FETAL ABNORMALITY , SPECIFYING THE SPECIFIC2 ABNORMALITY;3 (XI) T HE PREGNANCY WAS THE RESULT OF INCEST OR RAPE ; OR4 (XII) A NY OTHER REASON SPECIFIED BY THE WOMAN ;5 (i) T HE TYPE OF INDUCED TERMINATION OF PREGNANCY6 PERFORMED, INCLUDING MEDICAL , SUCTION CURETTAGE , SHARP7 CURETTAGE, DILATION AND EVACUATION , HYSTEROTOMY , OR8 HYSTERECTOMY; AND9 (j) T HE NAME AND TYPE OF HEALTH FACILITY IN WHICH THE10 INDUCED TERMINATION OF PREGNANCY WAS PERFORMED , IF PERFORMED11 IN A HEALTH FACILITY.12 (3) I N ADDITION TO ANY OTHER PENALTIES AVAILABLE PURSUANT13 TO THIS ARTICLE 2:14 (a) A PHYSICIAN OR PHYSICIAN ASSISTANT WHO FALSIFIES OR FAILS15 TO SUBMIT THE INFORMATION AS REQUIRED BY SUBSECTION (2) OF THIS16 SECTION ENGAGES IN UNPROFESSIONAL CONDUCT PURSUANT TO SECTION17 12-240-121 (1)(hh); AND18 (b) A N ADVANCED PRACTICE REGISTERED NURSE WHO FALSIFIES19 OR FAILS TO SUBMIT THE INFORMATION AS REQUIRED BY SUBSECTION (2)20 OF THIS SECTION IS SUBJECT TO DISCIPLINE PURSUANT TO SECTION21 12-255-120 (1)(ii).22 (4) A HEALTH-CARE PROVIDER SHALL NEITHER IDENTIFY A WOMAN23 WHO HAS OBTAINED AN INDUCED TERMINATION OF PREGNANCY IN THE24 REPORT REQUIRED BY SUBSECTION (2) OF THIS SECTION NOR INCLUDE ANY25 INFORMATION OR IDENTIFIER THAT WOULD MAKE IT POSSIBLE TO IDENTIFY26 THE WOMAN IN ANY MANNER OR UNDER ANY CIRCUMSTANCES .27 HB22-1075 -8- (5) (a) THE STATE REGISTRAR:1 (I) S HALL ANNUALLY CREATE A SUMMARY REPORT OF THE2 INFORMATION PROVIDED TO THE STATE REGISTRAR PURSUANT TO3 SUBSECTION (2) OF THIS SECTION AND MAKE THE SUMMARY REPORT4 AVAILABLE TO THE PUBLIC;5 (II) S HALL NOT PERMIT INSPECTION OF OR DISCLOSE INFORMATION6 PROVIDED TO THE STATE REGISTRAR PURSUANT TO SUBSECTION (2) OF THIS7 SECTION OR COPY OR ISSUE A COPY OF ALL OR PART OF THE INFORMATION ,8 UNLESS THE STATE REGISTRAR IS SATISFIED THAT THE APPLICANT HAS A9 DIRECT AND TANGIBLE INTEREST IN THE INFORMATION ;10 (III) M AY PERMIT THE USE OF INFORMATION REPORTED IN11 SUBSECTION (2) OF THIS SECTION FOR STATISTICAL OR RESEARCH12 PURPOSES, SUBJECT TO CONDITIONS THE STATE REGISTRAR MAY IMPOSE .13 T HE INFORMATION MUST NOT BE FURNISHED FOR RESEARCH PURPOSES14 UNTIL:15 (A) T HE STATE REGISTRAR HAS PREPARED , IN WRITING, THE16 CONDITIONS UNDER WHICH THE RECORDS OR INFORMATION WILL BE USED ;17 AND18 (B) T HE STATE REGISTRAR HAS RECEIVED AN AGREEMENT SIGNED19 BY A RESPONSIBLE AGENT OF THE RESEARCH ORGANIZATION AGREEING TO20 THE CONDITIONS.21 (IV) M AY DISCLOSE INFORMATION REPORTED PURSUANT TO22 SUBSECTION (2) OF THIS SECTION TO FEDERAL , STATE, COUNTY, OR23 MUNICIPAL AGENCIES OF GOVERNMENT , OR DESIGNEES OF THE AGENCIES24 OF GOVERNMENT, THAT REQUEST THE INFORMATION IN THE CONDUCT OF25 THE AGENCIES' OFFICIAL DUTIES.26 (b) N OTWITHSTANDING SUBSECTION (5)(a) OF THIS SECTION, THE27 HB22-1075 -9- STATE REGISTRAR SHALL NOT RELEASE ANY INFORMATION THAT1 IDENTIFIES THE NAME OF ANY HEALTH FACILITY WHERE AN INDUCED2 TERMINATION OF PREGNANCY IS PERFORMED OR ANY HEALTH -CARE3 PROVIDER WHO PERFORMED AN INDUCED TERMINATION OF PREGNANCY .4 (6) T HE EXECUTIVE DIRECTOR OF THE DEPARTMENT OF PUBLIC5 HEALTH AND ENVIRONMENT MAY PROMULGATE RULES AS NECESSARY6 CONCERNING THE INFORMATION REQUIRED TO BE REPORTED PURSUANT TO7 THIS SECTION AND THE ELECTRONIC FORM , TIMELINESS, AND MANNER IN8 WHICH THE INFORMATION MUST BE REPORTED .9 SECTION 5. Act subject to petition - effective date. This act10 takes effect at 12:01 a.m. on the day following the expiration of the11 ninety-day period after final adjournment of the general assembly; except12 that, if a referendum petition is filed pursuant to section 1 (3) of article V13 of the state constitution against this act or an item, section, or part of this14 act within such period, then the act, item, section, or part will not take15 effect unless approved by the people at the general election to be held in16 November 2022 and, in such case, will take effect on the date of the17 official declaration of the vote thereon by the governor.18 HB22-1075 -10-