HLS 11RS-842 ORIGINAL Page 1 of 19 CODING: Words in struck through type are deletions from existing law; words underscored are additions. Regular Session, 2011 HOUSE BILL NO. 586 BY REPRESENTATIVE HOFFMANN Prefiled pursuant to Article III, Section 2(A)(4)(b)(i) of the Constitution of Louisiana. ABORTION: Provides for the Forced Abortion Prevention Sign and Woman's Right to Know laws AN ACT1 To amend and reenact R.S. 40:1299.35.6, 1299.35.9, and 1299.35.19 and to enact R.S.2 40:1299.35.5.1, relative to abortion; to require certain signage in abortion facilities;3 to provide for certain requirements of the Department of Health and Hospitals4 relative to abortion; to provide for informed consent; to provide for delivery of5 certain information to women under the Woman's Right to Know law; to provide6 relative to conscience in health care protection, including provisions relative to living7 human embryos; to provide for penalties; and to provide for related matters.8 Be it enacted by the Legislature of Louisiana:9 Section 1. R.S. 40:1299.35.6, 1299.35.9, and 1299.35.19 are hereby amended and10 reenacted and R.S. 40:1299.35.5.1 is hereby enacted to read as follows: 11 §1299.35.5.1. Prevention of forced abortion; signage in abortion facilities12 This Section shall be known and may be cited as the "Forced Abortion13 Prevention Sign Act".14 A. Any ambulatory surgical center, private office, freestanding outpatient15 clinic, or other facility or clinic in which abortions are performed, induced,16 prescribed for, or where the means for an abortion are provided shall conspicuously17 post a sign in a location defined in Subsection C of this Section which is clearly18 visible to patients, and which features the text contained in Paragraph (1) of this19 Subsection and the information contained in Paragraph (2) of this Subsection.20 HLS 11RS-842 ORIGINAL HB NO. 586 Page 2 of 19 CODING: Words in struck through type are deletions from existing law; words underscored are additions. (1) The sign shall feature the following text:1 "Notice: Women's Rights and Pregnancy Resources2 You can't be forced.3 * It is unlawful for an abortion to be forced on you without your voluntary4 and informed consent, regardless of your age.5 You and the father.6 * The father of your child is liable to assist in the support of the child, even7 if he has offered to pay for an abortion.8 You and adoption.9 * The law permits adoptive parents to pay costs of prenatal care, childbirth10 and newborn care.11 You are not alone.12 * Many public and private agencies are willing to help you to carry your child13 to term, and to assist after your child's birth."14 (2) The sign shall feature the web address of the pregnancy resources15 website maintained by the Department of Health and Hospitals pursuant to R.S.16 40:1299.35.6, which shall be shown on the sign in a large, bold font designed to be17 clearly visible to patients, along with any additional information as deemed18 necessary by the department and is in accordance with the provisions of R.S.19 40:1299.35.6.20 B. The department shall cause the sign provided for in this Section to be21 designed and produced. All signs produced shall incorporate color graphics and22 shall be printed on durable signage material measuring at least sixteen inches by23 twenty inches with lettering presented in a size and style of font designed to be24 clearly visible to the patient. The department shall assess all costs associated with25 design and production of the signs to the facilities which are required by law to post26 the signs.27 C. The sign provided for in this Section, shall be posted in each patient28 admission area, waiting room, and patient consultation room used by patients on29 HLS 11RS-842 ORIGINAL HB NO. 586 Page 3 of 19 CODING: Words in struck through type are deletions from existing law; words underscored are additions. whom abortions are performed, induced, prescribed for, or who are provided with1 the means for an abortion.2 §1299.35.6. Woman's Right To Know3 * * *4 B. Informed consent; requirements. After a woman is determined to be5 pregnant, no abortion shall be performed or induced without the voluntary and6 informed consent of the woman upon whom the abortion is to be performed or7 induced. Except in the case of a medical emergency, consent to an abortion is8 voluntary and informed if and only if :9 (1) the The provisions of R.S. 40:1299.35.2 requiring an ultrasound test and10 determination of viability are met , and:.11 (2) The information required by this Section to be communicated orally and12 in person to the woman is provided to her individually and in a private room to13 protect her privacy, for the purpose of ensuring that the information focuses on her14 individual circumstances and that she has an adequate opportunity to ask questions.15 (1) (3) Oral information from the physician. At least twenty-four hours16 before the abortion, the physician who is to perform the abortion or the referring17 physician has informed the woman, orally and in person, of:18 * * *19 (h) The requirement that at least two hours prior to the woman having any20 part of an abortion performed or induced, the physician, referring physician, or21 qualified person working in conjunction with either physician must perform an22 obstetric ultrasound under the provisions of R.S. 40:1299.35.2 for the purpose of23 preserving the woman's health and determining the viability of the unborn child, and24 that neither the physician nor the woman shall be penalized should the woman25 choose not to view the obstetric ultrasound images or to not accept the photographic26 print that shall be provided offered to her in a sealed envelope.27 (i) The inclusion in her printed materials of a comprehensive list, compiled28 by the Department of Health and Hospitals, of facilities that offer obstetric29 HLS 11RS-842 ORIGINAL HB NO. 586 Page 4 of 19 CODING: Words in struck through type are deletions from existing law; words underscored are additions. ultrasounds free of charge, along with an oral explanation of the provision that shall1 be included on the department's list that if the woman voluntarily chooses to obtain2 free ultrasound services, that ultrasound would likely be in addition to the ultrasound3 required by law for purposes of determining viability and preserving the woman's4 health, unless the free ultrasound is performed by the physician performing the5 abortion, the referring physician, or a qualified person working in conjunction with6 either physician. The list shall be and shall include the name, address, hours of7 operation, and telephone number of each entity.8 (2)(a) (4) Oral information from a physician or qualified person.9 (a) In the initial contact with any person seeking to schedule an abortion,10 whether such contact is by telephone, by internet communication, or in person, the11 physician who is to perform the abortion, the referring physician, or a qualified12 person informs the person of the website address of the Department of Health and13 Hospitals abortion alternatives resource page and informed consent website address14 as provided in this Section.15 (b) At least twenty-four hours before the a scheduled abortion, the physician16 who is to perform the abortion, the referring physician, or a qualified person has17 informed the woman, orally and in person, that:18 (i) Medical assistance benefits may be available for prenatal care, childbirth,19 and neonatal care, and that more detailed information on the availability of such20 assistance is contained on the Department of Health and Hospitals website and in the21 printed materials which shall be given to her and described as provided in this22 Section.23 (ii) The Department of Health and Hospitals website and printed materials24 describe the unborn child and list agencies which offer alternatives to abortion.25 * * *26 (b) (c) For purposes of this Paragraph, "qualified person" shall mean an27 agent of the physician who is a psychologist, licensed social worker, licensed28 professional counselor, registered nurse, or physician.29 HLS 11RS-842 ORIGINAL HB NO. 586 Page 5 of 19 CODING: Words in struck through type are deletions from existing law; words underscored are additions. (3) The information required by this Section is provided to the woman1 individually and in a private room to protect her privacy and maintain the2 confidentiality of her decision, to ensure that the information focuses on her3 individual circumstances, and that she has an adequate opportunity to ask questions.4 (4) (5) Provision of printed materials. At least twenty-four hours before the5 abortion, the woman is given a copy of the printed materials described in this Section6 by the physician who is to perform the abortion, the referring physician, or a7 qualified person as defined in Subparagraph (2)(b) (4)(c) of this Subsection. If the8 woman is unable to read the materials, they shall be read to her. If the woman asks9 questions concerning any of the information or materials, answers shall be provided10 to her in her own language. If an interpreter is necessary, the cost of such interpreter11 shall be borne by the state of Louisiana.12 (5) (6) Certification and reporting. The woman certifies in writing on a form13 provided by the Department of Health and Hospitals, prior to the abortion, that the14 information and materials required to be provided under this Section have been15 provided at least twenty-four hours prior to the abortion. All physicians who16 perform abortions shall report the total number of certifications received monthly to17 the department. The department shall make the number of certifications received18 available to the public on an annual basis.19 (6) (7) Prior to the performance of the abortion, the physician who is to20 perform the abortion or his agent receives a copy of the written certification required21 by this Section.22 (7) (8) The woman is not required to pay any amount for the abortion23 procedures until the twenty-four-hour period has expired.24 C.(1) Publication of materials abortion alternatives and informed consent25 website.26 (1) The Department of Health and Hospitals shall cause to be published in27 English with optional translations into other languages as determined by the28 secretary, within ninety one hundred twenty days after June 20, 1995 enactment of29 HLS 11RS-842 ORIGINAL HB NO. 586 Page 6 of 19 CODING: Words in struck through type are deletions from existing law; words underscored are additions. this Act, and shall update on an annual basis, or as needed, the following easily1 comprehensible printed materials: information on a stable internet website that shall2 be developed and maintained by the Department of Health and Hospitals3 (a) Geographically indexed materials designed to provide the informed4 consent information required by this section and to inform the woman of public and5 private agencies and services available to assist a woman through pregnancy, upon6 childbirth, and while her child is dependent, including but not limited to adoption7 agencies. The materials shall include a comprehensive list of the agencies, a8 description of the services they offer, and the telephone number and addresses of the9 agencies, and inform the woman about available the following information that shall10 indicate the agency or service's physical address, telephone number and web address11 if available:12 (a) Information about public or private agencies that provide medical13 assistance benefits that may be available for prenatal care, childbirth, and neonatal14 care, and easily comprehensible information on how to apply for such benefits.15 (b) Public or private pregnancy resource centers that provide information and16 services that may include free abortion alternatives counseling, prenatal care, pantry17 services and parenting skills, and that do not refer, counsel, perform, induce,18 prescribe, or provide any means for abortion.19 (c) and Information about the support obligations of the father of a child who20 is born alive.21 (d) Information on a separate and featured subpage of the department's22 website that lists facilities that provide free obstetric ultrasound services under the23 provisions of R.S. 40: 1299.35.2 and this Section.24 (e) Information on public and private adoption agencies.25 (f) Information on the anatomical and physiological characteristics of the26 unborn child under the provisions of this section, including color photographs or27 images consistent with the most current technology depicting the unborn child at28 two-week gestational increments or closer.29 HLS 11RS-842 ORIGINAL HB NO. 586 Page 7 of 19 CODING: Words in struck through type are deletions from existing law; words underscored are additions. (g) Information describing the various methods of abortion procedures, the1 short-term and long-term medical risks associated with abortion, and the medical2 risks associated with carrying a child to term.3 (h) Information on the unborn child's ability to experience pain under the4 provisions of this Section.5 (i) Video clips that convey objective and medically accurate information6 about abortion procedures, abortion risks, abortion alternative resources, and7 medically accurate information on the development of an unborn child. Video clips8 may be produced with the in-house resources of the department, or acquired for no9 cost to the state from third parties if the video is approved by the secretary as10 providing objective and medically accurate information.11 (j) Information that helps women identify unlawful abortion coercion,12 including but not limited to phone numbers or hotlines that a minor or adult woman13 may call if she is experiencing actual or threatened physical abuse or violence, loss14 of employment or employment privileges, loss of eligible social assistance, loss of15 educational scholarship, or loss of legally protected financial support or housing.16 (k) Information to assist minors who are considering abortion, including17 parental consent information, and resources to help minors seek the protection of18 Child and Family Services, temporary guardianship, and/or law enforcement19 authorities to report abuse as defined in Section 603 of the Children's Code. The20 information designed to assist minors shall also include a link to pregnancy resource21 centers as defined in Subparagraph (C)(1)(b) of this Section.22 (2) The home page of the department's main website shall feature a button23 linking to the department's abortion alternatives and informed consent website, and24 the home page of such website shall feature user-friendly buttons that link to the25 information required in this section. The department shall ensure that the materials26 resources described in this Section are comprehensive and user-friendly, and that27 they do not directly or indirectly promote, exclude, or discourage the use of any28 agency or service described in this Section.29 HLS 11RS-842 ORIGINAL HB NO. 586 Page 8 of 19 CODING: Words in struck through type are deletions from existing law; words underscored are additions. (3) No information regarding who uses the website shall be collected or1 maintained. The department shall monitor the website on a daily basis to prevent and2 correct tampering and shall immediately notify abortion providers of any change of3 the website address.4 (4) The search capabilities on the department's main website shall ensure that5 entering the term "abortion" yields the website and information required by this6 section, regardless of how the information is labeled.7 (5) The information on the department's abortion alternatives and informed8 consent website shall be printable, and must give clear, prominent instructions on9 how to receive the printed booklet, the list of free ultrasound resources and any other10 printed material required by this Section.11 (6) The department's abortion alternatives and informed consent website12 shall be accessible to the public without requiring registration or use of a user name,13 a password, or any user identification.14 (7) The department's abortion alternatives and informed consent website15 shall have the capability of detecting when it is being accessed by a mobile device16 and shall have the capability of converting to a platform designed to be easily17 viewable on mobile devices.18 (8) If an abortion provider has a website, the abortion provider's Internet19 website home page must include a prominent link to the department's abortion20 alternatives and informed consent website.21 D. Publication of printed materials. The Department of Health and Hospitals22 shall cause to be published in English with optional translations into other languages23 as determined by the Secretary, within one-hundred and twenty days after enactment24 of this Act and shall update on an annual basis or as needed, the following printed25 materials:26 (1) The signs provided for in the Forced Abortion Prevention Sign Act.27 (2) A list arranged geographically, including the name, address, hours of28 operation, website address if available, and telephone number of each entity. The list29 HLS 11RS-842 ORIGINAL HB NO. 586 Page 9 of 19 CODING: Words in struck through type are deletions from existing law; words underscored are additions. shall not include any facility that counsels, refers, performs, induces, prescribes, or1 provides any means for abortion.2 (3) A printed booklet that features the web address of the department's3 dedicated pregnancy resource website printed in a bold large typeface. The booklet4 shall contain an outline of the various topics on the website as provided in5 Subsection C of this Section along with an explanation that more detailed6 information can be found at the department's website.7 (4) The materials shall also contain a separate printed listing of facilities that8 provide obstetric ultrasound services free of charge, as described in Subparagraph9 (B)(1)(i) of this Section. All materials shall include a website address where the10 required materials can be accessed on the Internet. Such website shall be maintained11 by the Department of Health and Hospitals. The printed materials shall state that it12 is unlawful for any individual to coerce a minor or adult woman to undergo an13 abortion, that any physician who performs an abortion upon a woman without her14 informed consent may be liable to her for damages in a civil action at law, and that15 the law permits adoptive parents to pay costs of prenatal care, childbirth, and16 neonatal care. The department shall also design and print signs to be posted in17 abortion facilities according the provisions of the Forced Abortion Prevention Sign18 Act.19 (3) The department's website and printed materials shall include the20 following statements:21 (i) (a) "There are many public and private agencies willing and able to help22 you to carry your child to term, and to assist you and your child after your child is23 born, whether you choose to keep your child or to place her or him for adoption. The24 state of Louisiana strongly urges you to consult an independent physician about the25 risks of abortion to your physical and psychological well-being and to contact them26 the resources provided on our website before making a final decision about abortion.27 The law requires that your physician or his agent the abortion provider give you the28 opportunity to call contact agencies like these before you undergo an abortion."29 HLS 11RS-842 ORIGINAL HB NO. 586 Page 10 of 19 CODING: Words in struck through type are deletions from existing law; words underscored are additions. (ii) (b) "By twenty weeks gestation, the unborn child has the physical1 structures necessary to experience pain. There is evidence that by twenty weeks2 gestation unborn children seek to evade certain stimuli in a manner which in an3 infant or an adult would be interpreted to be a response to pain. Anesthesia is4 routinely administered to unborn children who are twenty weeks gestational age or5 older who undergo prenatal surgery."6 (b) (4) The printed booklet shall include Materials materials that inform the7 pregnant woman of the probable anatomical and physiological characteristics of the8 unborn child at two-week gestational increments from fertilization to full term,9 including color pictures or drawings representing photographs or medical images10 consistent with the most current technology depicting the development of unborn11 children at two-week gestational increments or closer, and any relevant information12 on the possibility of the unborn child's survival; provided that any such color pictures13 or drawings photographs or images must contain the dimensions of the unborn child14 and must be realistic medically accurate. The materials shall be objective,15 nonjudgmental, and designed to convey only accurate scientific information about16 the unborn child at the various gestational ages. The material shall also contain17 objective information describing the methods of abortion procedures commonly18 employed, the short-term and long-term medical risks commonly associated with19 each such procedure abortion, including the increased risk of breast cancer associated20 with the loss of protective effect of a first full-term pregnancy and any independent21 risk as supported by peer-reviewed medical journals, and the medical risks22 commonly associated with carrying a child to term.23 (c) (5) A certification form to be used by physicians or their agents as24 provided in Paragraph B(5) of this Section, which will list all the items of25 information which are to be given to women by physicians or their agents as required26 by this Section.27 (2) E. The materials provided for in Subsection D of this Section shall be28 printed in a typeface large enough to be clearly legible .,29 HLS 11RS-842 ORIGINAL HB NO. 586 Page 11 of 19 CODING: Words in struck through type are deletions from existing law; words underscored are additions. (3) The materials required under this Section and shall be available at no cost1 from the department upon request and in appropriate number to any person, facility,2 or hospital. The department's abortion alternatives and informed consent website3 shall contain information on ordering printed materials.4 (4) The department shall promulgate rules and regulations relative to the5 appropriate number methods of distribution of printed materials and methods of6 reporting at no cost.7 D. F. Medical emergency. Where a medical emergency compels the8 performance of an abortion, the physician shall orally inform the woman, before the9 abortion, if possible, of the medical indications supporting his judgment that an10 abortion is necessary to avert her death or to avert substantial and irreversible11 impairment of a major bodily function. If the informed consent requirements of this12 Section have not been met due to medical emergency, the physician shall employ a13 method of terminating the pregnancy that gives the unborn child the greatest chance14 of survival consistent with protecting the life and physical health of the mother. The15 physician shall record the medical indications supporting the necessity for an16 abortion without informed consent in the patient's medical record, which shall be17 maintained for seven years.18 E. G. Reporting requirements. Any physician who has provided the19 information and materials to any woman in accordance with the requirements of this20 Section shall provide to the department:21 (1) With respect to a woman upon whom an abortion is performed, all22 information as required by R.S. 40:1299.35.10 as well as the date upon which the23 information and materials required to be provided under this Section were provided,24 as well as an executed copy of the certification form required by Paragraph B(5) of25 this Section.26 (2) With respect to any woman to whom the printed and oral information and27 materials have been provided in accordance with this Section, but upon whom the28 physician has not performed an abortion, the name and address of the facility where29 HLS 11RS-842 ORIGINAL HB NO. 586 Page 12 of 19 CODING: Words in struck through type are deletions from existing law; words underscored are additions. the required information was provided and the information as required by R.S.1 40:1299.35.10(A)(1) and (4) through (18) inclusive, and if executed by the woman,2 a copy of the certification form required by Paragraph B(5) of this Section.3 F. H. Criminal penalties.4 (1) Any person who intentionally, knowingly, or recklessly fails to comply5 with all the requirements of this Section shall be subject to the penalties provided in6 R.S. 40:1299.35.18. 7 (2) No physician shall be guilty of violating this Section if he or she can8 demonstrate, by a preponderance of the evidence, that he or she reasonably believed9 that furnishing the required information would have resulted in a severely adverse10 effect on the physical or mental health of the pregnant woman.11 G. I. Civil penalties. In addition to whatever remedies are otherwise12 available under the law of this state, failure to comply with the requirements of this13 Section shall:14 * * *15 H. J. Limitation on civil liability. Any physician who complies with the16 provisions of this Section may not be held civilly liable to his patient for failure to17 obtain informed consent to the abortion under this Section. Any and all other rights18 and remedies are preserved to the patient.19 I. K. Severability. The provisions of the Act which originated as House Bill20 No. 2246 of the 1995 Regular Session of the Legislature are declared to be severable,21 and if any provision, word, phrase, or clause of the Act or the application thereof to22 any person shall be held invalid, such invalidity shall not affect the validity of the23 remaining portions of the Act.24 J. L. Construction.25 * * *26 (2) It is not the intention of this Section to make lawful an abortion that is27 unlawful on June 20, 1995 upon the effective date of this Act, or which later28 becomes unlawful.29 HLS 11RS-842 ORIGINAL HB NO. 586 Page 13 of 19 CODING: Words in struck through type are deletions from existing law; words underscored are additions. K. M. Right of intervention. The author and coauthors who sponsored or1 cosponsored the Act which originated as House Bill No. 2246 of the 1995 Regular2 Session of the Legislature in his or her official standing and capacity shall have the3 ability to intervene as a matter of right in any case in which the constitutionality of4 this Section is challenged.5 * * *6 §1299.35.9. Conscience in health care protection; definitions7 A.(1) Any person has the right not to participate in, and no person shall be8 required to participate in any health care service that violates his conscience to the9 extent that patient access to health care is not compromised. No person shall be held10 civilly or criminally liable, discriminated against, dismissed, demoted, or in any way11 prejudiced or damaged for declining to participate in any health care service that12 violates his conscience.13 * * *14 B. For purposes of this Section:15 * * *16 (2) "Health care service" is limited to abortion, dispensation of abortifacient17 drugs, human embryonic stem cell research including destruction of any living18 human embryo for the purpose of harvesting the inner cell mass, human embryo19 cloning, euthanasia, or physician-assisted suicide.20 * * *21 §1299.35.19. Penalties 22 A. Whoever violates the provisions of this Part shall be fined not more than23 one thousand dollars by the Department of Health and Hospitals according to the24 provisions of Subsection B of this Section, or imprisoned for not more than two25 years, or both.26 B. The Department of health and Hospitals shall establish a penalty schedule27 through administrative rule. Fines provided in the penalty schedule shall be:28 HLS 11RS-842 ORIGINAL HB NO. 586 Page 14 of 19 CODING: Words in struck through type are deletions from existing law; words underscored are additions. (1) In an amount not less than one thousand dollars for each violation1 associated with an individual patient record or the required reporting of such records2 to the Department of Health and Hospitals.3 (2) In an amount not less than ten thousand dollars per day for any private4 office, ambulatory surgical care center, freestanding outpatient clinic or other facility5 or clinic which fails to post a sign in knowing, reckless, or negligent violation of the6 Forced Abortion Prevention Sign Act for each day that the sign is not posted during7 any portion of business hours.8 (3) In an amount not less than fifty thousand dollars for each violation not9 provided for in Paragraphs (1) and (2) of this Subsection.10 C. The sanctions and actions provided in this Section shall not displace any11 other applicable sanction provided by law.12 D. The Department of Health and Hospitals shall promulgate rules in13 accordance with the Administrative Procedure Act for implementation of the14 provisions of this Section.15 Section 2. If any provision or item of this Act, or the application thereof, is held16 invalid, such invalidity shall not affect other provisions, items, or applications of the Act17 which can be given effect without the invalid provision, item, or application and to this end18 the provisions of this Act are hereby declared severable.19 DIGEST The digest printed below was prepared by House Legislative Services. It constitutes no part of the legislative instrument. The keyword, one-liner, abstract, and digest do not constitute part of the law or proof or indicia of legislative intent. [R.S. 1:13(B) and 24:177(E)] Hoffmann HB No. 586 Abstract: Provides for the Forced Abortion Prevention Sign and Woman's Right to Know laws. Proposed law provides for the Forced Abortion Prevention Sign Act. Proposed law provides that the Forced Abortion Prevention Sign Act applies to every facility in which abortions are performed, induced, prescribed for, or where the means for an abortion are provided. Proposed law requires such facilities to display signage which provides messages as specified in proposed law regarding women's rights, forced abortion, fatherhood, and HLS 11RS-842 ORIGINAL HB NO. 586 Page 15 of 19 CODING: Words in struck through type are deletions from existing law; words underscored are additions. adoptive parents; and provides the web address for the pregnancy resources website maintained by DHH. Proposed law assigns the duty of designing and producing such signs to DHH. Proposed law provides that DHH shall assess the full cost of design and production of such signs to facilities which are required by proposed law to display the signs. Proposed law requires that information delivered personally to women per the provisions of the Woman's Right to Know law be offered in a manner that ensures the woman's privacy, considers the woman's individual circumstances, and allows the woman to ask questions. Proposed law provides that except in the case of a medical emergency, this requirement is a condition for consent to an abortion being voluntary and informed. Present law provides that at least 24 hours before an abortion, the physician who is to perform the abortion or the referring physician shall provide, among other printed materials specified in present law, a list of facilities which offer obstetric ultrasounds free of charge. Proposed law requires that such list of facilities offering obstetric ultrasounds free of charge not include any facility that counsels, refers, performs, induces, prescribes, or provides any means for abortion. Proposed law requires that in the initial contact with the woman seeking an abortion, the physician who is to perform the abortion, the referring physician, or a qualified person inform the woman of the website address of the DHH abortion alternatives resource page and informed consent website address. Proposed law provides that except in the case of a medical emergency, this requirement is a condition for consent to an abortion being voluntary and informed. Proposed law requires that at least 24 hours prior to a scheduled abortion, the physician who is to perform the abortion, the referring physician, or a qualified person inform the woman, orally and in person, that the DHH website: (1)May indicate medical assistance benefits available for prenatal care, childbirth, and neonatal care. (2)Describes the unborn child and lists agencies which offer alternatives to abortion Proposed law provides that except in the case of a medical emergency, the above requirement concerning indication of information on the DHH website is a condition for consent to an abortion being voluntary and informed. Proposed law repeals present law which provides that if an interpreter is necessary to communicate certain required information to a woman, the cost of such interpreter shall be borne by the state of Louisiana. Present law requires that for consent to an abortion to be voluntary and informed, the woman shall certify in writing prior to the abortion on a form provided by DHH that the information and materials required to be provided under present law have been provided. Proposed law adds requirement that such certification also indicate that information and materials required to be provided under present law and proposed law was provided at least 24 hours prior to the abortion. Present law requires DHH to publish certain printed materials providing information on abortion, alternatives to abortion, and the physiology of the unborn child. HLS 11RS-842 ORIGINAL HB NO. 586 Page 16 of 19 CODING: Words in struck through type are deletions from existing law; words underscored are additions. Proposed law requires that in addition to certain printed materials provided for in proposed law, DHH also publish an abortion alternatives and informed consent website. Proposed law provides that such website shall: (1)Be published within 120 days of enactment of proposed law. (2)Provide the informed consent information required by proposed law. (3)Provide information about public or private agencies that provide medical assistance benefits that may be available for prenatal care, childbirth, and neonatal care, and easily comprehensible information on how to apply for such benefits. (4)Provide information about public or private pregnancy resource centers that provide information and services that may include free abortion alternatives counseling, prenatal care, pantry services and parenting skills, and that do not refer, counsel, perform, induce, prescribe, or provide any means for abortion. (5)Provide information about the support obligations of the father of a child who is born alive. (6)Provide information on a separate and featured subpage of the DHH website that lists facilities that provide free obstetric ultrasound services under the provisions of present law and proposed law. (7)Provide information on public and private adoption agencies. (8)Provide information on the anatomical and physiological characteristics of the unborn child under the provisions of this section, including color photographs or images consistent with the most current technology depicting the unborn child at two-week gestational increments or closer. (9)Provide information describing the various methods of abortion procedures, the short-term and long-term medical risks associated with abortion, and the medical risks associated with carrying a child to term. (10)Provide information on the unborn child's ability to experience pain under the provisions of this Section. (11)Provide video clips that convey objective and medically accurate information about abortion procedures, abortion risks, abortion alternative resources, and medically accurate information on the development of an unborn child. Proposed law provides that such video clips may be produced with the in-house resources of DHH, or acquired for no cost to the state from third parties if the video is approved by the secretary as providing objective and medically accurate information. (12)Provide information that helps women identify unlawful abortion coercion, including but not limited to phone numbers or hotlines that a minor or adult woman may call if she is experiencing actual or threatened physical abuse or violence, loss of employment or employment privileges, loss of eligible social assistance, loss of educational scholarship, or loss of legally protected financial support or housing. (13)Provide information to assist minors who are considering abortion, including parental consent information, and resources to help minors seek the protection of Child and Family Services [DCFS? or Child Protective Svcs?], temporary guardianship, and/or law enforcement authorities to report abuse as defined in Section 603 of the Children's Code. The information designed to assist minors shall also include a link to pregnancy resource centers as defined in section (C)(1)(b) of this Section. HLS 11RS-842 ORIGINAL HB NO. 586 Page 17 of 19 CODING: Words in struck through type are deletions from existing law; words underscored are additions. (14)Provide information on ordering printed materials provided for in proposed law. Proposed law provides that no information regarding who uses the DHH website required to be published under proposed law shall be collected or maintained, and that DHH shall monitor the website on a daily basis to prevent and correct tampering and shall immediately notify abortion providers of any change of the website address. Proposed law provides that the search capabilities on the DHH main website shall ensure that entering the term "abortion" yields the website and information required to be published under proposed law regardless of how the information is labeled. Proposed law provides that the information on the DHH website required to be published under proposed law shall be printable, and must give clear, prominent instructions on how to receive the printed booklet, the list of free ultrasound resources and any other printed material required by proposed law. Proposed law provides that the DHH website required to be published under proposed law shall be accessible to the public without requiring registration or use of a user name, a password, or any user identification. Proposed law provides that the DHH website required to be published under proposed law shall have the capability of detecting when it is being accessed by a mobile device and shall have the capability of converting to a platform designed to be easily viewable on mobile devices. Proposed law provides that if an abortion provider has a website, then the home page of such website must include a prominent link to the DHH website required to be published under proposed law. Proposed law provides that within 120 days of enactment of proposed law, DHH shall cause to be published a printed booklet that features the web address of the DHH website required to be published under proposed law featured in a bold large typeface. Proposed lawrequires that the printed booklet provided for in proposed law include the following: (1)An outline of the various topics on the DHH website required to be published under proposed law along with an explanation that more detailed information can be found at such website. (2)Materials that inform the pregnant woman of the probable anatomical and physiological characteristics of the unborn child at two-week gestational increments from fertilization to full term, including color photographs or medical images consistent with the most current technology depicting the development of unborn children at two-week gestational increments or closer, and any relevant information on the possibility of the unborn child's survival; provided that any such color photographs or images must contain the dimensions of the unborn child and must be medically accurate. Proposed law requires that the DHH website and printed materials provided for in proposed law include the following statements: (1)"There are many public and private agencies willing and able to help you to carry your child to term, and to assist you and your child after your child is born, whether you choose to keep your child or to place her or him for adoption. The state of Louisiana strongly urges you to consult an independent physician about the risks of abortion to your physical and psychological well-being and to contact the resources provided on our website before making a final decision about abortion. The law HLS 11RS-842 ORIGINAL HB NO. 586 Page 18 of 19 CODING: Words in struck through type are deletions from existing law; words underscored are additions. requires that the abortion provider give you the opportunity to contact agencies like these before you undergo an abortion." (2)"By twenty weeks gestation, the unborn child has the physical structures necessary to experience pain. There is evidence that by twenty weeks gestation unborn children seek to evade certain stimuli in a manner which in an infant or an adult would be interpreted to be a response to pain. Anesthesia is routinely administered to unborn children who are twenty weeks gestational age or older who undergo prenatal surgery." Proposed law requires the printed materials provided for in proposed law to be objective, nonjudgmental, and designed to convey only accurate scientific information about the unborn child at the various gestational ages. Proposed law requires that the printed materials provided for in proposed law contain objective information describing the methods of abortion procedures and the short-term and long-term medical risks associated with abortion, including the increased risk of breast cancer associated with the loss of protective effect of a first full-term pregnancy and any independent risk as supported by peer-reviewed medical journals, and the medical risks associated with carrying a child to term. Proposed law requires the printed materials provided for in proposed law to be available at no cost from DHH upon request and in appropriate number to any person, facility, or hospital. Proposed law provides that DHH shall promulgate rules and regulations relative to the methods of distribution of printed materials and methods of reporting. Proposed law provides that if the informed consent to abortion requirements of proposed law have not been met due to medical emergency, the physician shall employ a method of terminating the pregnancy that gives the unborn child the greatest chance of survival consistent with protecting the life and physical health of the mother. Proposed law provides that in such cases the physician shall record the medical indications supporting the necessity for an abortion without informed consent in the patient's medical record, which shall be maintained for seven years. Proposed law repeals present law providing that no physician shall be guilty of violating informed consent to abortion requirements if he or she can demonstrate, by a preponderance of the evidence, that he or she reasonably believed that furnishing the required information would have resulted in a severely adverse effect on the physical or mental health of the pregnant woman. Proposed law provides that it is not the intention of proposed law to make lawful an abortion that is unlawful upon the effective date of proposed law, or which later becomes unlawful. Present law provides that no person shall be required to participate in any health care service that violates his conscience to the extent that patient access to health care is not compromised. Proposed law repeals the provision of present law relating to compromise of patient access to health care, providing unconditionally that a person shall not be required to participate in any health care service that violates his conscience. Proposed law provides that for the purposes of proposed law, "human embryonic stem cell research" includes any destruction of a living human embryo for the purpose of harvesting the inner cell mass. HLS 11RS-842 ORIGINAL HB NO. 586 Page 19 of 19 CODING: Words in struck through type are deletions from existing law; words underscored are additions. Present law provides that whoever violates the provisions of the Part of present law relative to abortion (Part XVIII of Chapter 5 of Title 40 of the La. Revised Statutes) shall be fined not more than one thousand dollars, or imprisoned for not more than two years, or both. Proposed law retains imprisonment penalty provided in present law. Proposed law revises provisions for fines in present law, and provides that fines shall be assessed according to the following schedule: (1)In an amount not less than one thousand dollars for each violation associated with an individual patient record or the required reporting of such records to DHH. (2)In an amount not less than ten thousand dollars per day for any facility or clinic subject to provisions of the Forced Abortion Prevention Sign Act established by proposed law for failing to post a sign in knowing, reckless, or negligent violation of proposed law. (3)In an amount not less than fifty thousand dollars for each violation not provided for in (1) and (2) above. Proposed law specifies that DHH shall have the duty of assessing such fines, and shall promulgate such rules as are necessary to establish the penalty schedule prescribed by proposed law. Proposed law provides that the sanctions and actions prescribed in proposed law shall not displace any other applicable sanction provided by law. Proposed law provides that its provisions shall be severable. (Amends R.S. 40:1299.35.9 and 1299.35.19; Adds R.S. 40:1299.35.5.1)