SESSION OF 2024
SUPPLEMENTAL NOTE ON HOUSE SUBSTITUTE FOR
SENATE BILL NO. 233
As Recommended by House Committee on
Health and Human Services
Brief*
House Sub. for SB 233 would enact the Forbidding
Abusive Child Transitions Act (Act).
Definitions (New Section 1)
The bill would define various terms as used in the Act,
including:
●“Child” would mean an individual less than 18
years of age;
●“Gender dysphoria” would mean the diagnosis of
gender dysphoria in the fifth edition of the
Diagnostic and Statistical Manual of Mental
Disorders; and
●“Social transitioning” would mean 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.
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*Supplemental notes are prepared by the Legislative Research
Department and do not express legislative intent. The supplemental
note and fiscal note for this bill may be accessed on the Internet at
http://www.kslegislature.org Use of State Funds and Resources (New Section 2)
The bill would state that a recipient of state funds could
not use those funds to provide or subsidize medication or
surgery as a treatment for a child’s perception of gender or
sex that is inconsistent with the child’s sex.
The bill would state that an individual or entity that
receives state funds to pay for or subsidize the treatment of
children for psychological conditions, including gender
dysphoria, could not promote or advocate for medication or
surgery as a treatment for a child whose perceived gender or
perceived sex is inconsistent with the child’s sex.
The bill would prohibit the Kansas Program of Medical
Assistance and its managed care organizations from
reimbursing or providing coverage for medication or surgery
as a treatment for a child whose perceived gender or
perceived sex is inconsistent with the child’s sex.
Except to the extent required by the first amendment to
the U.S. Constitution, the bill would prohibit a state property,
facility, or building from being 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 the child’s sex.
A state property, facility, or building would also be
prohibited from being 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 the child’s sex.
The bill would also prohibit a state employee whose
official duties include the care of children from, while engaged
in official duties, providing or promoting the use of social
transitioning, medication, or surgery as a treatment for a child
whose perceived gender or perceived sex is inconsistent with
the child’s sex.
2- 233 For the purposes of this section, the bill would define
“medication” to mean:
●Supraphysiologic doses of testosterone or other
androgens; or
●Puberty blockers such as GnRH agonists or other
synthetic drugs that suppress the production of
estrogen and progesterone to delay or suppress
pubertal development.
Treatment Prohibitions (New Section 3)
Except as otherwise provided in the bill, the bill would
prohibit a health care provider from knowingly providing the
following to a female child whose perceived gender or sex is
not female as treatment for distress arising from the female
child’s perception that the child’s gender or sex is not female:
●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;
●Supraphysiologic doses of testosterone or other
androgens; or
●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.
Except as otherwise provided in the bill, the bill would
prohibit a health care provider from knowingly providing the
following to a male child whose perceived gender or sex is
not male as treatment for distress arising from the male
child’s perception that the child’s gender or sex is not male:
3- 233 ●Surgical procedures, including a penectomy,
orchietomy, vaginoplasty, clitoroplasty, vulvoplasty,
augmentation mammoplasty, facial feminization
surgery, liposuction, lipofilling, voice surgery,
thyroid cartilage reduction, or gluteal augmentation;
●Supraphysiologic doses of estrogen; or
●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.
The treatment prohibited in the bill would not apply to
treatment provided for other purposes, including:
●Treatment for individuals born with a medically
verifiable disorder of sex development, including:
○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
○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 the individual does not have
normal sex chromosome structure, sex
steroid hormone production, or sex steroid
hormone action for a male or female, and
●Treatment of any infection, injury, disease, or
disorder that has been caused or exacerbated by
the performance of a procedure listed in this
section of the bill.
4- 233 Discipline and Private Cause of Action (New Section 4)
If a health care professional violates the provisions of
the bill, the bill would state the health care professional has
engaged in unprofessional conduct and would have their
license revoked by the appropriate licensing entity or
disciplinary review board with competent jurisdiction in
Kansas.
The bill would state that a health care professional who
provides treatment to a child in violation of the bill would be
held strictly liable to the child if the treatment or effects of
such treatment results in any physical, psychological,
emotional, or physiological harms to the child in the next 10
years from the date that the individual turns 18 years old.
The bill would provide for the parents of a child who has
experienced a violation of the bill to have a private cause of
action against the health care provider who provided such
treatment for actual damages, punitive damages, injunctive
relief, the cost of the lawsuit, and reasonable attorney fees.
The bill would require an action against a health care
provider to be filed within 10 years from the date the
individual turns 18 years of age.
Liability Insurance (New Section 6)
The bill would state that a professional liability insurance
policy issued to a health care provider would not include
coverage for damages assessed against the health care
provider who provides treatments to a child in violation of the
Act.
Severability (New Section 7)
If any provision or clause of the Act to any person or
circumstance is held invalid, the bill would state the invalidity
5- 233 would not affect other provisions or applications of the Act
that could be given effect without the invalid provision or
application. The provisions of the bill would be severable.
Violations of the Act (Section 7)
The bill would add violations of the Act to laws regarding
grounds for disciplinary actions for registered professional
nurses, licensed practical nurses, advanced practice
registered nurses, or registered nurse anesthetists. The bill
would also add violations of the Act to the list of offenses
constituting “professional incompetency,” as it is defined in
the Kansas Healing Arts Act.
Background
The House Committee on Health and Human Services
recommended a substitute bill incorporating provisions of the
Act originally contained in HB 2791, as introduced by the
House Committee on Health and Human Services at the
request of Representative Bryce.
SB 233, as passed by the Senate Committee of the
Whole, would have created the Kansas Child Mutilation
Prevention Act to allow an individual who had gender
reassignment service performed as a child to bring a civil
cause of action against a physician who performed the
service. The provisions of SB 233 were not retained in the
substitute bill.
HB 2791 – Forbidding Abusive Child Transitions Act
HB 2791 was introduced by the House Committee on
Health and Human Services at the request of Representative
Bryce.
6- 233 House Committee on Health and Human Services
In the House Committee hearing, proponent testimony
was provided by Representative Bryce; representatives of
Family Policy Alliance, Kansas Catholic Conference, and
Kansas Family Voice; a licensed clinical social worker; a
retired physician; and four private citizens. The proponents
generally stated the bill would protect minors as multiple
studies on the appropriate treatment protocol for gender
dysphoria in minors are insufficient, but surgical and hormone
treatments can result in irreversible harms and lifelong
effects.
Written-only proponent testimony was provided by two
private citizens.
Neutral testimony was provided by a representative of
the Devos Center, who stated the bill would protect youth
from gender-affirming medical interventions that are
unproven.
Written-only neutral testimony was provided by a
representative of the State Board of Healing Arts.
Opponent testimony was provided by a representative
of ACLU of Kansas and six private citizens, who generally
stated the bill would remove the ability for minors and their
families to make private health care decisions and could
exacerbate mental health issues for transgender youth.
Written-only opponent testimony was provided by a
former state representative; representatives of Kansas
Association of Defense Counsel; Kansas Black Leadership
Council; Kansas Chapter, American Academy of Pediatrics;
Kansas National Education Association; Kansas NOW;
Kansas Public Health Association; Loud Light Civic Action;
Mainstream; Planned Parenthood Great Plains Votes; True
Colors Flint Hills; Unitarian Universalist Fellowship of
Manhattan; three representatives of Equality Kansas; five
representatives of Kansas Interfaith Action; a practicing
7- 233 advance practice registered nurse; three practicing
physicians; and 87 private citizens.
The House Committee amended the bill to:
●Remove Section 3 of the bill pertaining to informed
consent;
●Provide for a health care professional who violates
the provisions of the Act to have their license
revoked;
●Provide for health care professionals who violate
the Act to be held liable for 10 years from the date
that the individual who received treatment turns 18
years of age; and
●Provide a definition of “medication” in Section 2 of
the bill.
The House Committee removed the contents of SB 233,
inserted the amended contents of HB 2791, and
recommended a substitute bill be passed.
Fiscal Information
According to the fiscal note prepared by the Division of
the Budget on HB 2791, as introduced, the Office of Judicial
Administration (OJA) states enactment of the bill could
increase the number of cases filed in district courts because it
allows for a civil suit to be filed. This could result in more time
spent by judicial and nonjudicial personnel processing,
researching, and hearing these cases. OJA estimates
enactment of the bill could result in the collection of docket
fees and fines assessed in those cases filed under the bill’s
provisions, which would be deposited into the State General
Fund. The bill would not affect other revenues to the Judicial
Branch. However, a fiscal effect cannot be estimated.
8- 233 The Office of the Attorney General states that enactment
of the bill would not result in any fiscal effect for the agency.
The agency notes that the Act could be challenged in court,
but a related fiscal effect cannot be estimated.
The State Board of Healing Arts reports enactment of
the bill could increase actionable complaints, but a total fiscal
effect cannot be estimated. The agency notes the bill allows
for legal actions to be taken for 30 years after the date the
child turns 18, which could result in long-term implications.
The Board of Nursing indicates enactment of the bill
would require a revision to regulations and communications
to licensees, which could be handled with existing resources.
The agency was unable to determine whether enactment of
the bill would result in an increase in complaints or
investigations.
The Kansas Department for Health and Environment
states that enactment of the bill would not result in a fiscal
effect on agency operations.
Any fiscal effect associated with the bill is not reflected
in The FY 2025 Governor’s Budget Report.
Children; minors; health care; gender identity; physicians; health care providers
9- 233