{As Amended by House Committee of the Whole}
Session of 2024
House Substitute for SENATE BILL No. 233
By Committee on Health and Human Services
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AN ACT concerning children and minors; relating to healthcare of minors;
enacting the forbidding abusive child transitions act; prohibiting
healthcare providers from treating a child whose gender identity is
inconsistent with the child's sex; authorizing a civil cause of action
against healthcare providers for providing such treatments; restricting
use of state funds to promote gender transitioning; prohibiting
professional liability insurance from covering damages for healthcare
providers that provide gender transition treatment to children; requiring
professional discipline against a healthcare provider who performs such
treatments; adding violation of the act to the definition of
unprofessional conduct for physicians and nurses; amending K.S.A. 65-
2837 and K.S.A. 2023 Supp. 65-1120 and repealing the existing
sections {section}.
Be it enacted by the Legislature of the State of Kansas:
New Section 1. (a) The provisions of sections 1 through 6, and
amendments thereto, shall be known and may be cited as the forbidding
abusive child transitions act.
(b) As used in this act:
(1) "Child" means an individual less than 18 years of age.
(2) "Female" means an individual who is a member of the female sex.
(3) "Gender" means the psychological, behavioral, social and cultural
aspects of being male or female.
(4) "Gender dysphoria" is the diagnosis of gender dysphoria in the
fifth edition of the diagnostic and statistical manual of mental disorders.
(5) "Healthcare provider" means an individual who is licensed,
certified or otherwise authorized by the laws of this state to administer
healthcare services in the ordinary course of the practice of such
individual's profession.
(6) "Male" means an individual who is a member of the male sex.
(7) "Perceived sex" is an individual's internal sense of such
individual's sex.
(8) "Perceived gender" is an individual's internal sense of such
individual's gender.
(9) "Sex" means the biological indication of male and female in the
context of reproductive potential or capacity, including sex chromosomes,
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naturally occurring sex hormones, gonads and nonambiguous internal and
external genitalia present at birth, without regard to an individual's
psychological, chosen or subjective experience of gender.
(10) "Social transitioning" means acts other than medical or surgical
interventions that are undertaken for the purpose of presenting as a
member of the opposite sex, including the changing of an individual's
preferred pronouns or manner of dress.
New Sec. 2. (a) A recipient of state funds shall not use such funds to
provide or subsidize medication or surgery as a treatment for a child's
perception of gender or sex that is inconsistent with such child's sex.
(b) An indiviudal or entity that receives state funds to pay for or
subsidize the treatment of children for psychological conditions, including
gender dysphoria, shall not promote or advocate medication or surgery as a
treatment for a child whose perceived gender or perceived sex is
inconsistent with such child's sex.
(c) The Kansas program of medical assistance and its managed care
organizations shall not reimburse or provide coverage for medication or
surgery as a treatment for a child whose perceived gender or perceived sex
is inconsistent with such child's sex.
(d) Except to the extent required by the first amendment to the United
States constitution, a state property, facility or building shall not be used to
promote or advocate the use of social transitioning, medication or surgery
as a treatment for a child whose perceived gender or perceived sex is
inconsistent with such child's sex.
(e) A state property, facility or building shall not be used to prescribe,
administer or dispense medication or perform surgery as a treatment for a
child whose perceived gender or perceived sex is inconsistent with such
child's sex.
(f) A state employee whose official duties include the care of children
shall not, while engaged in those official duties, provide or promote the
use of social transitioning, medication, or surgery as a treatment for a child
whose perceived gender or perceived sex is inconsistent with such child's
sex.
(g) As used in this section, "medication" means:
(1) Supraphysiologic doses of testosterone or other androgens; or
(2) puberty blockers such as GnRH agonists or other synthetic drugs
that suppress the production of estrogen and progesterone to delay or
suppress pubertal development in female children.
New Sec. 3. (a) Except as provided in subsection (c), a healthcare
provider shall not knowingly provide the following to a female child
whose perceived gender or sex is not female as treatment for distress
arising from such female child's perception that such child's gender or sex
is not female:
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(1) Surgical procedures, including vaginectomy, hysterectomy,
oophorectomy, ovariectomy, reconstruction of the urethra, metoidioplasty
phalloplasty, scrotoplasty, implantation of erection or testicular protheses,
subcutaneous mastectomy, voice surgery, liposuction, lipofilling or
pectoral implants;
(2) supraphysiologic doses of testosterone or other androgens; or
(3) puberty blockers such as GnRH agonists or other synthetic drugs
that suppress the production of estrogen and progesterone to delay or
suppress pubertal development in female children.
(b) Except as provided in subsection (c), a healthcare provider shall
not knowingly provide the following to a male child whose perceived
gender or sex is not male as treatment for distress arising from such male
child's perception that such child's gender or sex is not male:
(1) Surgical procedures, including a penectomy, orchiectomy,
vaginoplasty, clitoroplasty, vulvoplasty, augmentation mammoplasty, facial
feminization surgery, liposuction, lipofilling, voice surgery, thyroid
cartilage reduction or gluteal augmentation;
(2) supraphysiologic doses of estrogen; or
(3) puberty blockers such as GnRH agonists or other synthetic drugs
that suppress the production of testosterone or delay or suppress pubertal
development in male children.
(c) The treatments prohibited by subsections (a) and (b) shall not
apply to treatment provided for other purposes, including:
(1) Treatment for individuals born with a medically verifiable
disorder of sex development, including:
(A) An individual born with external biological sex characteristics
that are irresolvably ambiguous, including an individual born with 46 XX
chromosomes with virilization, 46 XY chromosomes with under
virilization or having both ovarian and testicular tissue; or
(B) an individual whom a physician has otherwise diagnosed with a
disorder of sexual development that the physician has determined through
genetic or biochemical testing that such individual does not have normal
sex chromosome structure, sex steroid hormone production or sex steroid
hormone action for a male or female; and
(2) treatment of any infection, injury, disease or disorder that has
been caused or exacerbated by the performance of a procedure listed in
subsections (a) or (b).
New Sec. 4. (a) If a healthcare provider violates the provisions of
section 3, and amendments thereto:
(1) The healthcare provider has engaged in unprofessional conduct
and, notwithstanding any provision of law to the contrary, the license of
such healthcare provider shall be revoked by the appropriate licensing
entity or disciplinary review board with competent jurisdiction in this
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state.
(b) A healthcare provider who provides treatment to a child in
violation of section 3(a) or (b), and amendments thereto, shall be held
strictly liable to such child if the treatment or effects of such treatment
results in any physical, psychological, emotional or physiological harms to
such child in the next 10 years from the date that the individual turns 18
years of age.
(c) The parents of a child who has experienced violation of section
3(a) or (b), and amendments thereto, shall have a private cause of action
against a healthcare provider for damages and equitable relief as the court
may determine is justified. A prevailing party may recover the costs of the
suit and reasonable attorney fees.
(d) (1) An individual who was provided treatment as a child in
violation of section 3(a) or (b), and amendments thereto, shall have a
private cause of action against the healthcare provider who provided such
treatment for actual damages, punitive damages, injunctive relief, the cost
of the suit and reasonable attorney fees.
(2) An action against a healthcare provider pursuant to this subsection
shall be filed within 10 years from the date that the individual turns 18
years of age.
New Sec. 5. A professional liability insurance policy issued to a
healthcare provider shall not include coverage for damages assessed
against the healthcare provider who provides treatment to a child in
violation of section 3(a) or (b), and amendments thereto.
New Sec. 6. If any provision or clause of this act or application
thereof to any person or circumstance is held invalid, such invalidity shall
not affect other provisions or applications of this act that can be given
effect without the invalid provision or application, and to this end the
provisions of this act are declared to be severable.
Sec. 7. K.S.A. 2023 Supp. 65-1120 is hereby amended to read as
follows: 65-1120. (a) Grounds for disciplinary actions. The board may
deny, revoke, limit or suspend any license or authorization to practice
nursing as a registered professional nurse, as a licensed practical nurse, as
an advanced practice registered nurse or as a registered nurse anesthetist
that is issued by the board or applied for under this act, or may require the
licensee to attend a specific number of hours of continuing education in
addition to any hours the licensee may already be required to attend or
may publicly or privately censure a licensee or holder of a temporary
permit or authorization, if the applicant, licensee or holder of a temporary
permit or authorization is found after hearing:
(1) To be guilty of fraud or deceit in practicing nursing or in
procuring or attempting to procure a license to practice nursing;
(2) to have been guilty of a felony or to have been guilty of a
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misdemeanor involving an illegal drug offense unless the applicant or
licensee establishes sufficient rehabilitation to warrant the public trust,
except that notwithstanding K.S.A. 74-120, and amendments thereto, no
license or authorization to practice nursing as a licensed professional
nurse, as a licensed practical nurse, as an advanced practice registered
nurse or registered nurse anesthetist shall be granted to a person with a
felony conviction for a crime against persons as specified in article 34 of
chapter 21 of the Kansas Statutes Annotated, prior to their repeal, or article
54 of chapter 21 of the Kansas Statutes Annotated, or K.S.A. 21-6104, 21-
6325, 21-6326 or 21-6418, and amendments thereto;
(3) has been convicted or found guilty or has entered into an agreed
disposition of a misdemeanor offense related to the practice of nursing as
determined on a case-by-case basis;
(4) to have committed an act of professional incompetency as defined
in subsection (e);
(5) to be unable to practice with skill and safety due to current abuse
of drugs or alcohol;
(6) to be a person who has been adjudged in need of a guardian or
conservator, or both, under the act for obtaining a guardian or conservator,
or both, and who has not been restored to capacity under that act;
(7) to be guilty of unprofessional conduct as defined by rules and
regulations of the board;
(8) to have willfully or repeatedly violated the provisions of the
Kansas nurse practice act or any rules and regulations adopted pursuant to
that act, including K.S.A. 65-1114 and 65-1122, and amendments thereto;
(9) to have a license to practice nursing as a registered nurse or as a
practical nurse denied, revoked, limited or suspended, or to be publicly or
privately censured, by a licensing authority of another state, agency of the
United States government, territory of the United States or country or to
have other disciplinary action taken against the applicant or licensee by a
licensing authority of another state, agency of the United States
government, territory of the United States or country. A certified copy of
the record or order of public or private censure, denial, suspension,
limitation, revocation or other disciplinary action of the licensing authority
of another state, agency of the United States government, territory of the
United States or country shall constitute prima facie evidence of such a
fact for purposes of this paragraph (9); or
(10) to have assisted suicide in violation of K.S.A. 21-3406, prior to
its repeal, or K.S.A. 21-5407, and amendments thereto, as established by
any of the following:
(A) A copy of the record of criminal conviction or plea of guilty for a
felony in violation of K.S.A. 21-3406, prior to its repeal, or K.S.A. 21-
5407, and amendments thereto.;
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(B) a copy of the record of a judgment of contempt of court for
violating an injunction issued under K.S.A. 2023 Supp. 60-4404, and
amendments thereto.; and
(C) a copy of the record of a judgment assessing damages under
K.S.A. 2023 Supp. 60-4405, and amendments thereto ; or
(11) violating the forbidding abusive child transitions act .
(b) Proceedings. Upon filing of a sworn complaint with the board
charging a person with having been guilty of any of the unlawful practices
specified in subsection (a), two or more members of the board shall
investigate the charges, or the board may designate and authorize an
employee or employees of the board to conduct an investigation. After
investigation, the board may institute charges. If an investigation, in the
opinion of the board, reveals reasonable grounds for believing the
applicant or licensee is guilty of the charges, the board shall fix a time and
place for proceedings, which shall be conducted in accordance with the
provisions of the Kansas administrative procedure act.
(c) Witnesses. No person shall be excused from testifying in any
proceedings before the board under this act or in any civil proceedings
under this act before a court of competent jurisdiction on the ground that
such testimony may incriminate the person testifying, but such testimony
shall not be used against the person for the prosecution of any crime under
the laws of this state except the crime of perjury as defined in K.S.A. 21-
5903, and amendments thereto.
(d) Costs. If final agency action of the board in a proceeding under
this section is adverse to the applicant or licensee, the costs of the board's
proceedings shall be charged to the applicant or licensee as in ordinary
civil actions in the district court, but if the board is the unsuccessful party,
the costs shall be paid by the board. Witness fees and costs may be taxed
by the board according to the statutes relating to procedure in the district
court. All costs accrued by the board, when it is the successful party, and
which if the attorney general certifies cannot be collected from the
applicant or licensee , shall be paid from the board of nursing fee fund. All
moneys collected following board proceedings shall be credited in full to
the board of nursing fee fund.
(e) Professional incompetency defined. As used in this section,
"professional incompetency" means:
(1) One or more instances involving failure to adhere to the
applicable standard of care to a degree which constitutes gross negligence,
as determined by the board;
(2) repeated instances involving failure to adhere to the applicable
standard of care to a degree which constitutes ordinary negligence, as
determined by the board; or
(3) a pattern of practice or other behavior which that demonstrates a
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manifest incapacity or incompetence to practice nursing.
(f) Criminal justice information. The board upon request shall receive
from the Kansas bureau of investigation such criminal history record
information relating to arrests and criminal convictions as necessary for
the purpose of determining initial and continuing qualifications of
licensees of and applicants for licensure by the board.
Sec. 8. {7.} K.S.A. 65-2837 is hereby amended to read as follows: 65-
2837. As used in K.S.A. 65-2836, and amendments thereto, and in this
section:
(a) "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, as
determined by the board.
(2) Repeated instances involving failure to adhere to the applicable
standard of care to a degree that constitutes ordinary negligence, as
determined by the board.
(3) A pattern of practice or other behavior that demonstrates a
manifest incapacity or incompetence to practice the healing arts.
(b) "Unprofessional conduct" means:
(1) Solicitation of 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 stationery, 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) Willful betrayal of 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) Failure to effectuate the declaration of a qualified patient as
provided in K.S.A. 65-28,107(a), and amendments thereto.
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(11) Prescribing, ordering, dispensing, administering, selling,
supplying or giving any amphetamines or sympathomimetic amines,
except as authorized by K.S.A. 65-2837a, and amendments thereto.
(12) Conduct likely to deceive, defraud or harm the public.
(13) 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.
(14) Aiding or abetting the practice of the healing arts by an
unlicensed, incompetent or impaired person.
(15) Allowing another person or organization to use the licensee's
license to practice the healing arts.
(16) Commission of any act of sexual abuse, misconduct or other
improper sexual contact that exploits the licensee-patient relationship with
a patient or a person responsible for health care healthcare decisions
concerning such patient.
(17) The use of 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.
(18) Obtaining any fee by fraud, deceit or misrepresentation.
(19) 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.
(20) Failure to transfer patient records to another licensee when
requested to do so by the subject patient or by such patient's legally
designated representative.
(21) Performing unnecessary tests, examinations or services that have
no legitimate medical purpose.
(22) Charging an excessive fee for services rendered.
(23) 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.
(24) Repeated failure 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.
(25) Failure to keep written medical records that accurately describe
the services rendered to the patient, including patient histories, pertinent
findings, examination results and test results.
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(26) Delegating professional responsibilities to a person when the
licensee knows or has reason to know that such person is not qualified by
training, experience or licensure to perform them.
(27) 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.
(28) 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.
(29) Referring a patient to a health care healthcare entity for services
if the licensee has a significant investment interest in the health care
healthcare entity, unless the licensee informs the patient in writing of such
significant investment interest and that the patient may obtain such
services elsewhere.
(30) Failing to properly supervise, direct or delegate acts that
constitute the healing arts to persons who perform professional services
pursuant to such licensee's direction, supervision, order, referral,
delegation or practice protocols.
(31) Violating K.S.A. 65-6703, and amendments thereto.
(32) Violating the forbidding abusive child transitions act.
(33) 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
licensee's direct supervision. As used in this subsection, "anatomic
pathology services" means the gross or microscopic examination of
histologic processing of human organ tissue or the examination of human
cells from fluids, aspirates, washings, brushings or smears, including blood
banking services, and subcellular or molecular pathology services,
performed by or under the supervision of a person licensed to practice
medicine and surgery or a clinical laboratory. Nothing in this subsection
shall be construed to prohibit billing for anatomic pathology services by:
(A) A hospital;
(B) a clinical laboratory when samples are transferred between
clinical laboratories for the provision of anatomic pathology services; or
(C) a physician providing services to a patient pursuant to a medical
retainer agreement in compliance with K.S.A. 65-4978, and amendments
thereto, when the bill to the patient for such services:
(i) Identifies the laboratory or physician that performed the services;
(ii) discloses in writing to the patient the actual amount charged by
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the physician or laboratory that performed the service; and
(iii) is consistent with rules and regulations adopted by the board for
appropriate billing standards applicable to such services when furnished
under these agreements.
(33)(34) Engaging in conduct that violates patient trust and exploits
the licensee-patient relationship for personal gain.
(34)(35) 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
(C) other acts or conduct likely to deceive or defraud the board.
(c) "False advertisement" means any advertisement that is false,
misleading or deceptive in a material respect. In determining whether any
advertisement is misleading, there shall be taken into account not only
representations made or suggested by statement, word, design, device,
sound or any combination thereof, but also the extent to which the
advertisement fails to reveal facts material in the light of such
representations made.
(d) "Advertisement" means all representations disseminated in any
manner or by any means for the purpose of inducing, or that are likely to
induce, directly or indirectly, the purchase of professional services.
(e) "Licensee" for purposes of this section and K.S.A. 65-2836, and
amendments thereto, means all persons issued a license, permit or special
permit pursuant to article 28 of chapter 65 of the Kansas Statutes
Annotated, and amendments thereto.
(f) "License" for purposes of this section and K.S.A. 65-2836, and
amendments thereto, means any license, permit or special permit granted
under article 28 of chapter 65 of the Kansas Statutes Annotated, and
amendments thereto.
(g) "Health careHealthcare entity" means any corporation, firm,
partnership or other business entity that provides services for diagnosis or
treatment of human health conditions and that is owned separately from a
referring licensee's principle practice.
(h) "Significant investment interest" means ownership of at least 10%
of the value of the firm, partnership or other business entity that owns or
leases the health care healthcare entity, or ownership of at least 10% of the
shares of stock of the corporation that owns or leases the health care
healthcare entity.
Sec. 9. {8.} K.S.A. 65-2837 and K.S.A. 2023 Supp. 65-1120 are {is}
hereby repealed.
Sec. 10. {9.} This act shall take effect and be in force from and after
its publication in the statute book.
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