| 1 | 1 | | 23 LC 33 9316 |
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| 2 | 2 | | H. B. 653 |
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| 3 | 3 | | - 1 - |
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| 4 | 4 | | House Bill 653 |
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| 5 | 5 | | By: Representatives Bonner of the 73 |
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| 6 | 6 | | rd |
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| 7 | 7 | | , Jasperse of the 11 |
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| 8 | 8 | | th |
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| 9 | 9 | | , Jones of the 25 |
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| 10 | 10 | | th |
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| 11 | 11 | | , Newton of the |
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| 12 | 12 | | 127 |
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| 13 | 13 | | th |
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| 14 | 14 | | , Taylor of the 173 |
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| 15 | 15 | | rd |
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| 16 | 16 | | , and others |
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| 17 | 17 | | A BILL TO BE ENTITLED |
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| 18 | 18 | | AN ACT |
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| 19 | 19 | | To amend Chapter 1 of Title 43 of the Official Code of Georgia Annotated, relating to |
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| 20 | 20 | | 1 |
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| 21 | 21 | | general provisions relative to professions and businesses, so as to prohibit health care2 |
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| 22 | 22 | | providers from performing specified practices on minors relating to altering a person's3 |
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| 23 | 23 | | appearance relating to gender; to prohibit health care providers from aiding or abetting such4 |
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| 24 | 24 | | practices for minors; to provide for definitions; to provide for exceptions; to provide for5 |
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| 25 | 25 | | enforcement; to amend Part 3 of Article 16 of Chapter 2 of Title 20 of the Official Code of6 |
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| 26 | 26 | | Georgia Annotated, relating to student health, so as to prohibit school nurses and other7 |
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| 27 | 27 | | employees and officials from engaging in certain conduct relating to a minor's perception of8 |
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| 28 | 28 | | his or her gender; to provide for legislative findings; to provide for related matters; to provide9 |
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| 29 | 29 | | for an effective date; to repeal conflicting laws; and for other purposes.10 |
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| 30 | 30 | | BE IT ENACTED BY THE GENERAL ASSEMBLY OF GEORGIA:11 |
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| 31 | 31 | | SECTION 1.12 |
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| 32 | 32 | | The General Assembly finds and declares that:13 |
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| 33 | 33 | | (1) This state has a compelling government interest in protecting the health and safety of14 |
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| 34 | 34 | | its citizens, especially vulnerable children;15 23 LC 33 9316 |
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| 35 | 35 | | H. B. 653 |
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| 36 | 36 | | - 2 - |
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| 37 | 37 | | (2) Only a tiny percentage of the American population experiences distress at identifying |
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| 38 | 38 | | 16 |
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| 39 | 39 | | with their biological sex. According to the American Psychiatric Association, prevalence17 |
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| 40 | 40 | | ranges from 0.005 to 0.014 percent for natal adult males and from 0.002 to 0.003 percent18 |
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| 41 | 41 | | for natal females;19 |
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| 42 | 42 | | (3) Studies consistently demonstrate that the vast majority of children who are gender20 |
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| 43 | 43 | | nonconforming or experience distress at identifying with their biological sex come to21 |
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| 44 | 44 | | identify with their biological sex in adolescence or adulthood, thereby rendering most22 |
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| 45 | 45 | | medical health care interventions unnecessary;23 |
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| 46 | 46 | | (4) Scientific studies show that individuals struggling with distress at identifying with their24 |
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| 47 | 47 | | biological sex often have already experienced psychopathology, which indicates these25 |
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| 48 | 48 | | individuals should be encouraged to seek mental health care services before undertaking26 |
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| 49 | 49 | | any hormonal or surgical intervention;27 |
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| 50 | 50 | | (5) Suicide rates, psychiatric morbidities, and mortality rates remain markedly elevated28 |
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| 51 | 51 | | above the background population after inpatient gender reassignment procedures have been29 |
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| 52 | 52 | | performed;30 |
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| 53 | 53 | | (6) Some health care providers are prescribing puberty-blocking drugs in order to delay31 |
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| 54 | 54 | | the onset or progression of normally timed puberty in children who experience distress at32 |
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| 55 | 55 | | identifying with their biological sex. This is being done despite the lack of any long-term33 |
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| 56 | 56 | | longitudinal studies evaluating the risks and benefits of using these drugs for the treatment34 |
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| 57 | 57 | | of such distress or gender transition;35 |
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| 58 | 58 | | (7) Health care providers are also prescribing cross-sex hormones for children who36 |
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| 59 | 59 | | experience distress at identifying with their biological sex, despite the fact that no37 |
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| 60 | 60 | | randomized clinical trials have been conducted on the efficacy or safety of the use of38 |
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| 61 | 61 | | cross-sex hormones in adults or children for the purpose of treating such distress or gender39 |
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| 62 | 62 | | transition;40 |
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| 63 | 63 | | (8) The use of cross-sex hormones comes with the following serious known risks:41 23 LC 33 9316 |
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| 64 | 64 | | H. B. 653 |
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| 65 | 65 | | - 3 - |
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| 66 | 66 | | (A) For biological females, erythrocytosis, severe liver dysfunction, coronary artery |
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| 67 | 67 | | 42 |
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| 68 | 68 | | disease, cerebrovascular disease, hypertension, increased risk of breast and uterine43 |
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| 69 | 69 | | cancers, and irreversible infertility; and44 |
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| 70 | 70 | | (B) For biological males, thromboembolic disease, cholelithiasis, coronary artery45 |
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| 71 | 71 | | disease, macroprolactinoma, cerebrovascular disease, hypertriglyceridemia, breast cancer,46 |
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| 72 | 72 | | and irreversible infertility;47 |
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| 73 | 73 | | (9) Genital and non-genital reassignment surgeries are generally not recommended for48 |
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| 74 | 74 | | children, although evidence indicates referrals for children to have such surgeries are49 |
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| 75 | 75 | | becoming more frequent;50 |
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| 76 | 76 | | (10) Genital gender reassignment surgery includes several irreversible invasive procedures51 |
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| 77 | 77 | | for males and females and involves the following alterations of biologically normal and52 |
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| 78 | 78 | | functional body parts:53 |
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| 79 | 79 | | (A) For biological males, surgery may involve genital reconstruction including54 |
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| 80 | 80 | | penectomy, orchiectomy, vaginoplasty, clitoroplasty, and vulvoplasty; and55 |
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| 81 | 81 | | (B) For biological females, surgery may involve a hysterectomy or oophorectomy,56 |
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| 82 | 82 | | reconstruction of the urethra, genital reconstruction including metoidioplasty or57 |
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| 83 | 83 | | phalloplasty, vaginectomy, scrotoplasty, and implantation of erection or testicular58 |
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| 84 | 84 | | prostheses;59 |
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| 85 | 85 | | (11) The complications, risks, and long-term care concerns associated with genital gender60 |
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| 86 | 86 | | reassignment surgery for both males and females are numerous and complex;61 |
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| 87 | 87 | | (12) Non-genital gender reassignment surgery includes various invasive procedures for62 |
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| 88 | 88 | | males and females and also involves the alteration or removal of biologically normal and63 |
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| 89 | 89 | | functional body parts:64 |
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| 90 | 90 | | (A) For biological males, procedures may include augmentation mammoplasty, facial65 |
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| 91 | 91 | | feminization surgery, liposuction, lipofilling, voice surgery, thyroid cartilage reduction,66 |
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| 92 | 92 | | gluteal augmentation, hair reconstruction, and other aesthetic procedures; and67 23 LC 33 9316 |
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| 93 | 93 | | H. B. 653 |
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| 94 | 94 | | - 4 - |
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| 95 | 95 | | (B) For biological females, procedures may include subcutaneous mastectomy, voice |
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| 96 | 96 | | 68 |
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| 97 | 97 | | surgery, liposuction, lipofilling, pectoral implants, and other aesthetic procedures;69 |
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| 98 | 98 | | (13) It is an accepted principle of economics and public policy that when a service or70 |
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| 99 | 99 | | product is subsidized or paid for, demand for that service or product increases. Just71 |
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| 100 | 100 | | between 2015 and 2016, gender reassignment surgeries increased by 20 percent;72 |
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| 101 | 101 | | (14) It is of grave concern that the medical community is allowing individuals who73 |
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| 102 | 102 | | experience distress at identifying with their biological sex to be subjects of irreversible and74 |
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| 103 | 103 | | drastic non-genital gender reassignment surgery and irreversible, permanently sterilizing75 |
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| 104 | 104 | | genital gender reassignment surgery, despite the lack of studies showing that the benefits76 |
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| 105 | 105 | | of such extreme interventions outweigh the risks; and77 |
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| 106 | 106 | | (15) The risks of gender transition procedures far outweigh any benefit at this stage of78 |
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| 107 | 107 | | clinical study on these procedures.79 |
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| 108 | 108 | | SECTION 2.80 |
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| 109 | 109 | | Chapter 1 of Title 43 of the Official Code of Georgia Annotated, relating to general81 |
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| 110 | 110 | | provisions relative to professions and businesses, is amending by adding a new Code section82 |
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| 111 | 111 | | to read as follows:83 |
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| 112 | 112 | | "43-1-36. |
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| 113 | 113 | | 84 |
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| 114 | 114 | | (a) As used in this Code section, the term:85 |
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| 115 | 115 | | (1) 'Health care provider' means any person licensed under Chapter 9, 10A, 11, 11A, 26,86 |
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| 116 | 116 | | 28, 30, 33, 34, 35, 39, or 44 of Title 43 or any hospital, nursing home, home health87 |
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| 117 | 117 | | agency, institution, or medical facility licensed or defined under Chapter 7 of Title 31.88 |
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| 118 | 118 | | Such term shall also include any corporation, professional corporation, partnership,89 |
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| 119 | 119 | | limited liability company, limited liability partnership, authority, or other entity90 |
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| 120 | 120 | | composed of such health care providers.91 |
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| 121 | 121 | | (2) 'Sex' means the biological indication of male and female, including sex92 |
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| 122 | 122 | | chromosomes, naturally occurring sex hormones, gonads, and nonambiguous internal and93 23 LC 33 9316 |
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| 123 | 123 | | H. B. 653 |
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| 124 | 124 | | - 5 - |
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| 125 | 125 | | external genitalia present at birth, without regard to an individual's psychological, chosen,94 |
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| 126 | 126 | | or subjective experience of gender.95 |
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| 127 | 127 | | (b) Except as otherwise provided in subsection (d) of this Code section, no health care96 |
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| 128 | 128 | | provider in this state shall knowingly engage in or cause any of the following practices to97 |
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| 129 | 129 | | be performed upon any minor if the practice is performed for the purpose of attempting to98 |
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| 130 | 130 | | alter the appearance of or affirm the minor's perception of his or her gender or sex, if that99 |
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| 131 | 131 | | appearance or perception is inconsistent with the minor's sex:100 |
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| 132 | 132 | | (1) Prescribing or administering gonadotropin-releasing hormone analogues or other101 |
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| 133 | 133 | | synthetic drugs used to stop luteinizing hormone and follicle-stimulating hormone102 |
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| 134 | 134 | | secretion, synthetic antiandrogen drugs used to block the androgen receptor, or any drug103 |
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| 135 | 135 | | to suppress or delay normal puberty;104 |
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| 136 | 136 | | (2) Prescribing or administering testosterone, estrogen, or progesterone to a minor in an105 |
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| 137 | 137 | | amount greater than would normally be produced endogenously in a healthy individual106 |
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| 138 | 138 | | of that individual's age and sex;107 |
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| 139 | 139 | | (3) Performing surgeries that sterilize, including castration, vasectomy, hysterectomy,108 |
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| 140 | 140 | | oophorectomy, orchiectomy, and penectomy;109 |
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| 141 | 141 | | (4) Performing surgeries that artificially construct tissue with the appearance of genitalia110 |
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| 142 | 142 | | that differs from the individual's sex, including metoidioplasty, phalloplasty, and111 |
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| 143 | 143 | | vaginoplasty; or112 |
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| 144 | 144 | | (5) Removing any healthy or nondiseased body part or tissue.113 |
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| 145 | 145 | | (c) No health care provider shall knowingly engage in conduct that aids or abets the114 |
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| 146 | 146 | | practices described in subsection (b) of this Code section on any minor.115 |
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| 147 | 147 | | (d) Subsections (b) and (c) of this Code section shall not apply to:116 |
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| 148 | 148 | | (1) Services provided to individuals born with a medically verifiable disorder of sex117 |
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| 149 | 149 | | development, including a person with external biological sex characteristics that are118 |
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| 150 | 150 | | irresolvably ambiguous, such as an individual born with 46 XX chromosomes with119 23 LC 33 9316 |
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| 151 | 151 | | H. B. 653 |
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| 152 | 152 | | - 6 - |
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| 153 | 153 | | virilization, 46 XY chromosomes with undervirilization, or having both ovarian and120 |
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| 154 | 154 | | testicular tissue;121 |
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| 155 | 155 | | (2) Services provided to an individual when a physician has otherwise diagnosed a122 |
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| 156 | 156 | | disorder of sexual development, in which the physician has determined through genetic123 |
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| 157 | 157 | | or biochemical testing that the individual does not have normal sex chromosome124 |
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| 158 | 158 | | structure, sex steroid hormone production, or sex steroid hormone action for a biological125 |
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| 159 | 159 | | male or biological female;126 |
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| 160 | 160 | | (3) The treatment of any infection, injury, disease, or disorder that has been caused or127 |
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| 161 | 161 | | exacerbated by the performance of a procedure described in subsection (b) of this Code128 |
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| 162 | 162 | | section, whether or not the procedures were performed in accordance with state and129 |
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| 163 | 163 | | federal law; or130 |
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| 164 | 164 | | (4) Any procedure undertaken because an individual suffers from a physical disorder,131 |
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| 165 | 165 | | physical injury, or physical illness that is certified by a physician and that would place132 |
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| 166 | 166 | | the individual in imminent danger of death or impairment of major bodily function unless133 |
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| 167 | 167 | | surgery is performed.134 |
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| 168 | 168 | | (e)(1) The provision of services to or engaging in conduct regarding any minor described135 |
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| 169 | 169 | | in subsections (b) and (c) of this Code section shall be considered unprofessional conduct136 |
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| 170 | 170 | | and shall be subject to discipline by the licensing entity with jurisdiction over the health137 |
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| 171 | 171 | | care provider.138 |
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| 172 | 172 | | (2) A person may assert an actual or threatened violation of this Code section as a claim139 |
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| 173 | 173 | | or defense in a judicial or administrative proceeding and obtain compensatory damages,140 |
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| 174 | 174 | | injunctive relief, declaratory relief, or any other appropriate relief.141 |
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| 175 | 175 | | (3) A person shall be required to bring a claim for a violation of this Code section not142 |
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| 176 | 176 | | later than two years after the day the cause of action accrues. A minor may bring an143 |
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| 177 | 177 | | action before reaching 18 years of age through a parent or guardian, and may bring an144 |
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| 178 | 178 | | action in the minor's own name upon reaching 18 years of age at any time from that point145 |
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| 179 | 179 | | until he or she reaches 38 years of age.146 23 LC 33 9316 |
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| 180 | 180 | | H. B. 653 |
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| 181 | 181 | | - 7 - |
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| 182 | 182 | | (4) An action under this Code section may be commenced, and relief may be granted, in147 |
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| 183 | 183 | | a judicial proceeding without regard to whether the person commencing the action has148 |
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| 184 | 184 | | sought or exhausted available administrative remedies.149 |
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| 185 | 185 | | (5) In any action or proceeding to enforce a provision of this Code section, a prevailing150 |
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| 186 | 186 | | party who establishes a violation of this Code section shall be entitled to recover151 |
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| 187 | 187 | | reasonable attorney's fees.152 |
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| 188 | 188 | | (6) The Attorney General may bring an action to enforce compliance with this Code153 |
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| 189 | 189 | | section. Nothing in this Code section shall be construed to deny, impair, or otherwise154 |
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| 190 | 190 | | affect any right or authority of the Attorney General, the state, or any agency, officer, or155 |
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| 191 | 191 | | employee of the state to institute or intervene in any proceeding.156 |
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| 192 | 192 | | (f) Nothing in this Code section shall be construed to impose liability on any speech or157 |
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| 193 | 193 | | conduct protected by federal or state law."158 |
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| 194 | 194 | | SECTION 3.159 |
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| 195 | 195 | | Part 3 of Article 16 of Chapter 2 of Title 20 of the Official Code of Georgia Annotated,160 |
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| 196 | 196 | | relating to student health, is amended by adding a new Code section to read as follows:161 |
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| 197 | 197 | | "20-2-779.3.162 |
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| 198 | 198 | | (a) As used in this Code section, the term 'sex' means the biological indication of male and163 |
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| 199 | 199 | | female, including sex chromosomes, naturally occurring sex hormones, gonads, and164 |
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| 200 | 200 | | nonambiguous internal and external genitalia present at birth, without regard to an165 |
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| 201 | 201 | | individual's psychological, chosen, or subjective experience of gender.166 |
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| 202 | 202 | | (b) No school nurse, counselor, teacher, principal, or other official or staff at a public or167 |
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| 203 | 203 | | private school shall knowingly:168 |
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| 204 | 204 | | (1) Encourage or coerce a minor to withhold from the minor's parent or legal guardian169 |
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| 205 | 205 | | the fact that the minor's perception of his or her gender is inconsistent with his or her sex;170 |
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| 206 | 206 | | or171 23 LC 33 9316 |
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| 207 | 207 | | H. B. 653 |
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| 208 | 208 | | - 8 - |
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| 209 | 209 | | (2) Withhold from a minor's parent or legal guardian information related to the minor's172 |
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| 210 | 210 | | perception that his or her gender is inconsistent with his or her sex."173 |
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| 211 | 211 | | SECTION 4.174 |
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| 212 | 212 | | This Act shall become effective on January 1, 2024.175 |
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| 213 | 213 | | SECTION 5.176 |
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| 214 | 214 | | All laws and parts of laws in conflict with this Act are repealed.177 |
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