House Substitute for SENATE BILL No. 233
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; amending K.S.A. 65-2837 and
repealing the existing 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, 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 House Substitute for SENATE BILL No. 233—page 2
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) or (d), 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:
(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).
(d) If a healthcare provider has initiated a course of treatment for a
child that includes prescribing, administering or dispensing of a drug
prohibited by subsection (a)(2), (a)(3), (b)(2) or (b)(3) prior to the
effective date of this act, the healthcare provider may continue such House Substitute for SENATE BILL No. 233—page 3
course of treatment if the healthcare provider:
(1) Develops a plan to systematically reduce the child's use of
such drug;
(2) determines and documents in the child's medical record that
immediately terminating the child's use of such drug would cause harm
to the child; and
(3) such course of treatment shall not extend beyond December
31, 2024.
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
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. 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. House Substitute for SENATE BILL No. 233—page 4
(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.
(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 House Substitute for SENATE BILL No. 233—page 5
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.
(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
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. House Substitute for SENATE BILL No. 233—page 6
(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. 8. K.S.A. 65-2837 is hereby repealed. House Substitute for SENATE BILL No. 233—page 7
Sec. 9. This act shall take effect and be in force from and after its
publication in the Kansas register.
I hereby certify that the above BILL originated in the
SENATE, and passed that body
__________________________
SENATE adopted
Conference Committee Report ________________
_________________________
President of the Senate.
_________________________
Secretary of the Senate.
Passed the HOUSE
as amended _________________________
HOUSE adopted
Conference Committee Report ________________
_________________________
Speaker of the House.
_________________________
Chief Clerk of the House.
APPROVED _____________________________
_________________________
Governor.