FIRSTREGULARSESSION
HOUSEBILLNO.1304
103RDGENERALASSEMBLY
INTRODUCEDBYREPRESENTATIVEAUNE.
2712H.02I JOSEPHENGLER,ChiefClerk
ANACT
Torepealsections188.015,188.017,188.020,188.021,188.027,188.030,188.033,188.038,
188.039,188.047,188.052,188.056,188.057,188.058,188.075,188.080,188.230,
188.375,192.665,192.667,197.150,197.152,197.158,197.160,197.162,197.165,
197.200,197.205,197.215,197.220,197.225,197.230,197.235,197.240,197.285,
197.287,197.289,197.293,197.295,334.100,334.245,334.735,574.200,and
595.027,RSMo,andtoenactinlieuthereoftwenty-fivenewsectionsrelatingto
abortion.
BeitenactedbytheGeneralAssemblyofthestateofMissouri,asfollows:
SectionA.Sections188.015,188.017,188.020,188.021,188.027,188.030,188.033,
2188.038,188.039,188.047,188.052,188.056,188.057,188.058,188.075,188.080,188.230,
3188.375,192.665,192.667,197.150,197.152,197.158,197.160,197.162,197.165,197.200,
4197.205,197.215,197.220,197.225,197.230,197.235,197.240,197.285,197.287,197.289,
5197.293,197.295,334.100,334.245,334.735,574.200,and595.027,RSMo,arerepealedand
6twenty-fivenewsectionsenactedinlieuthereof,tobeknownassections188.015,192.665,
7192.667,197.150,197.152,197.158,197.160,197.162,197.165,197.200,197.205,197.215,
8197.220,197.225,197.230,197.235,197.240,197.285,197.287,197.289,197.293,197.295,
9334.100,334.735,and595.027,toreadasfollows:
188.015.Asusedinthischapter,thefollowingtermsmean:
2 (1)"Abortion":
3 (a)Theactofusingorprescribinganyinstrument,device,medicine,drug,orany
4othermeansorsubstancewiththeintentto[destroythelifeof]terminateanembryoorfetus
5[inhisorhermother'swomb]; or
EXPLANATION—Matterenclosedinbold-facedbrackets[thus] intheabovebillisnotenactedandis
intendedtobeomittedfromthelaw.Matterinbold-facetypeintheabovebillisproposedlanguage. 6 (b)Theintentionalterminationof[the]apregnancy[ofamother] byusingor
7prescribinganyinstrument,device,medicine,drug,orothermeansorsubstancewithan
8intentionotherthantoincreasetheprobabilityofalivebirthortoremovea[deadunborn
9child] deceasedembryoorfetus;
10 (2)["Abortionfacility",aclinic,physician'soffice,oranyotherplaceorfacilityin
11whichabortionsareperformedorinducedotherthanahospital;
12 (3)]"Affiliate",apersonwhoorentitythatentersinto,withanabortionfacility,a
13legalrelationshipcreatedorgovernedbyatleastonewritteninstrument,includinga
14certificateofformation,afranchiseagreement,standardsofaffiliation,bylaws,oralicense,
15thatdemonstrates:
16 (a)Commonownership,management,orcontrolbetweenthepartiestothe
17relationship;
18 (b)Afranchisegrantedbythepersonorentitytotheaffiliate;or
19 (c)Thegrantingorextensionofalicenseorotheragreementauthorizingtheaffiliate
20tousetheotherperson'sorentity'sbrandname,trademark,servicemark,orotherregistered
21identificationmark;
22 [(4)](3)"Conception",thefertilizationoftheovumofafemalebyaspermofamale;
23 [(5)](4)"Department",thedepartmentofhealthandseniorservices;
24 [(6)"DownSyndrome",thesamemeaningasdefinedinsection191.923;
25 (7)](5)"Gestationalage",lengthofpregnancyasmeasuredfromthefirstdayofthe
26woman'slastmenstrualperiod;
27 [(8)](6)"Medicalemergency",aconditionwhich,basedonreasonablemedical
28judgment,socomplicatesthemedicalconditionofapregnantwomanastonecessitatethe
29immediateabortionofherpregnancytoavertthedeathofthepregnantwomanorforwhicha
30delaywillcreateaseriousriskofsubstantialandirreversiblephysicalimpairmentofamajor
31bodilyfunctionofthepregnantwoman;
32 [(9)](7)"Physician",anypersonlicensedtopracticemedicineinthisstatebythe
33stateboardofregistrationforthehealingarts;
34 [(10)] (8)"Reasonablemedicaljudgment",amedicaljudgmentthatwouldbemade
35byareasonablyprudentphysician,knowledgeableaboutthecaseandthetreatment
36possibilitieswithrespecttothemedicalconditionsinvolved[;
37 (11)"Unbornchild",theoffspringofhumanbeingsfromthemomentofconception
38untilbirthandateverystageofitsbiologicaldevelopment,includingthehumanconceptus,
39zygote,morula,blastocyst,embryo,andfetus;
40 (12)"Viability"or"viable",thatstageoffetaldevelopmentwhenthelifeofthe
41unbornchildmaybecontinuedindefinitelyoutsidethewombbynaturalorartificiallife-
42supportivesystems;
HB1304 2 43 (13)"Viablepregnancy"or"viableintrauterinepregnancy",inthefirsttrimesterof
44pregnancy,anintrauterinepregnancythatcanpotentiallyresultinalivebornbaby].
192.665.Asusedinthissection,section192.667,andsections197.150to197.165,
2thefollowingtermsmean:
3 (1)"Chargedata",informationsubmittedbyhealthcareprovidersoncurrentcharges
4forleadingproceduresanddiagnoses;
5 (2)"Chargesbypayer",informationsubmittedbyhospitalsonamountbilledto
6Medicare,Medicaid,othergovernmentsourcesandallnongovernmentsourcescombinedas
7onedataelement;
8 (3)"Department",thedepartmentofhealthandseniorservices;
9 (4)"Financialdata",informationsubmittedbyhospitalsdrawnfromfinancial
10statementswhichincludesthebalancesheet,incomestatement,charitycareandbaddebtand
11chargesbypayer,preparedinaccordancewithgenerallyacceptedaccountingprinciples;
12 (5)"Healthcareprovider",hospitalsasdefinedinsection197.020andambulatory
13surgicalcenters[andabortionfacilities] asdefinedinsection197.200;
14 (6)"Nosocomialinfection",asdefinedbythefederalCentersforDiseaseControland
15Preventionandappliedtoinfectionswithinhospitals,ambulatorysurgicalcenters,[abortion
16facilities,] andotherfacilities;
17 (7)"Nosocomialinfectionincidencerate",arisk-adjustedmeasurementofnewcases
18ofnosocomialinfectionsbyprocedureordevicewithinapopulationoveragivenperiodof
19time,withsuchmeasurementsdefinedbyruleofthedepartmentpursuanttosubsection3of
20section192.667forusebyallhospitals,ambulatorysurgicalcenters,[abortionfacilities,] and
21otherfacilitiesincomplyingwiththerequirementsoftheMissourinosocomialinfection
22controlactof2004;
23 (8)"Otherfacility",atypeoffacilitydeterminedtobeasourceofinfectionsand
24designatedbyruleofthedepartmentpursuanttosubsection11ofsection192.667;
25 (9)"Patientabstractdata",datasubmittedbyhospitalswhichincludesbutisnot
26limitedtodateofbirth,sex,race,zipcode,countyofresidence,admissiondate,discharge
27date,principalandotherdiagnoses,includingexternalcauses,principalandotherprocedures,
28proceduredates,totalbilledcharges,dispositionofthepatientandexpectedsourceof
29paymentwithsourcescategorizedaccordingtoMedicare,Medicaid,othergovernment,
30workers'compensation,allcommercialpayorscodedwithacommoncode,self-pay,no
31chargeandother.
192.667.1.Allhealthcareprovidersshallatleastannuallyprovidetothedepartment
2chargedataasrequiredbythedepartment.Allhospitalsshallatleastannuallyprovidepatient
3abstractdataandfinancialdataasrequiredbythedepartment.Hospitalsasdefinedinsection
4197.020shallreportpatientabstractdataforoutpatientsandinpatients.Ambulatorysurgical
HB1304 3 5centers[andabortionfacilities] asdefinedinsection197.200shallprovidepatientabstract
6datatothedepartment.Thedepartmentshallspecifybyrulethetypesofinformationwhich
7shallbesubmittedandthemethodofsubmission.
8 2.Thedepartmentshallcollectdataontheincidenceofhealthcare-associated
9infectionsfromhospitals,ambulatorysurgicalcenters,[abortionfacilities,] andotherfacilities
10asnecessarytogeneratethereportsrequiredbythissection.Hospitals,ambulatorysurgical
11centers,[abortionfacilities,] andotherfacilitiesshallprovidesuchdataincompliancewith
12thissection.Inordertostreamlinegovernmentandtoeliminateduplicativereporting
13requirements,iftheCentersforMedicareandMedicaidServices,oritssuccessorentity,
14requireshospitalstosubmithealthcare-associatedinfectiondata,thenhospitalsandthe
15departmentshallnotberequiredtocomplywiththehealthcare-associatedinfectiondata
16reportingrequirementsofsubsections2to17ofthissectionapplicabletohospitals,except
17thatthedepartmentshallpostalinkonitswebsitetopubliclyreporteddatabyhospitalson
18theCentersforMedicareandMedicaidServices'HospitalComparewebsite,oritssuccessor.
19 3.Thedepartmentshallpromulgaterulesspecifyingthestandardsandproceduresfor
20thecollection,analysis,riskadjustment,andreportingoftheincidenceofhealthcare-
21associatedinfectionsandthetypesofinfectionsandprocedurestobemonitoredpursuantto
22subsection13ofthissection.Inpromulgatingsuchrules,thedepartmentshall:
23 (1)Usemethodologiesandsystemsfordatacollectionestablishedbythefederal
24CentersforDiseaseControlandPrevention'sNationalHealthcareSafetyNetwork,orits
25successor;and
26 (2)Considerthefindingsandrecommendationsoftheinfectioncontroladvisory
27panelestablishedpursuanttosection197.165.
28 4.ByJanuary1,2017,theinfectioncontroladvisorypanelcreatedbysection197.165
29shallmakerecommendationstothedepartmentregardingtheCentersforMedicareand
30MedicaidServices'healthcare-associatedinfectiondatacollection,analysis,andpublic
31reportingrequirementsforhospitals,ambulatorysurgicalcenters,andotherfacilitiesinthe
32federalCentersforDiseaseControlandPrevention'sNationalHealthcareSafetyNetwork,or
33itssuccessor,inlieuofallorpartofthedatacollection,analysis,andpublicreporting
34requirementsofthissection.Theadvisorypanelrecommendationsshalladdresswhich
35hospitalsshallberequiredasaconditionoflicensuretousetheNationalHealthcareSafety
36Networkfordatacollection;theuseoftheNationalHealthcareSafetyNetworkforrisk
37adjustmentandanalysisofhospitalsubmitteddata;andtheuseoftheCentersforMedicare
38andMedicaidServices'HospitalComparewebsite,oritssuccessor,forpublicreportingofthe
39incidenceofhealthcare-associatedinfectionmetrics.Theadvisorypanelshallconsiderthe
40followingfactorsindevelopingitsrecommendation:
HB1304 4 41 (1)Whetherthepublicisaffordedthesameorgreateraccesstofacility-specific
42infectioncontrolindicatorsandmetrics;
43 (2)Whetherthedataprovidedtothepublicissubjecttothesameorgreateraccuracy
44ofriskadjustment;
45 (3)Whetherthepublicisprovidedwiththesameorgreaterspecificityofreportingof
46infectionsbytypeoffacilityinfectionsandprocedures;
47 (4)Whetherthedataissubjecttothesameorgreaterlevelofconfidentialityofthe
48identityofanindividualpatient;
49 (5)WhethertheNationalHealthcareSafetyNetwork,oritssuccessor,hasthe
50capacitytoreceive,analyze,andreporttherequireddataforallfacilities;
51 (6)WhetherthecosttoimplementtheNationalHealthcareSafetyNetworkinfection
52datacollectionandreportingsystemisthesameorless.
53 5.Afterconsideringtherecommendationsoftheinfectioncontroladvisorypanel,and
54providedthattherequirementsofsubsection13ofthissectioncanbemet,thedepartment
55shallimplementguidelinesfromthefederalCentersforDiseaseControlandPrevention's
56NationalHealthcareSafetyNetwork,oritssuccessor.Itshallbeaconditionoflicensurefor
57hospitalsthatmeettheminimumpublicreportingrequirementsoftheNationalHealthcare
58SafetyNetworkandtheCentersforMedicareandMedicaidServicestoparticipateinthe
59NationalHealthcareSafetyNetwork,oritssuccessor.Suchhospitalsshallpermitthe
60NationalHealthcareSafetyNetwork,oritssuccessor,todisclosefacility-specificinfection
61datatothedepartmentasrequiredunderthissection,andasnecessarytoprovidethepublic
62reportsrequiredbythedepartment.Itshallbeaconditionoflicensureforanyambulatory
63surgicalcenter[orabortionfacility] whichdoesnotvoluntarilyparticipateintheNational
64HealthcareSafetyNetwork,oritssuccessor,tosubmitfacility-specificdatatothedepartment
65asrequiredunderthissection,andasnecessarytoprovidethepublicreportsrequiredbythe
66department.
67 6.Thedepartmentshallnotrequiretheresubmissionofdatawhichhasbeen
68submittedtothedepartmentofhealthandseniorservicesorthedepartmentofsocialservices
69underanyotherprovisionoflaw.Thedepartmentofhealthandseniorservicesshallaccept
70datasubmittedbyassociationsorrelatedorganizationsonbehalfofhealthcareprovidersby
71enteringintobindingagreementsnegotiatedwithsuchassociationsorrelatedorganizationsto
72obtaindatarequiredpursuanttosection192.665andthissection.Ahealthcareprovidershall
73submittherequiredinformationtothedepartmentofhealthandseniorservices:
74 (1)Iftheproviderdoesnotsubmittherequireddatathroughsuchassociationsor
75relatedorganizations;
HB1304 5 76 (2)IfnobindingagreementhasbeenreachedwithinninetydaysofAugust28,1992,
77betweenthedepartmentofhealthandseniorservicesandsuchassociationsorrelated
78organizations;or
79 (3)Ifabindingagreementhasexpiredformorethanninetydays.
80 7.Informationobtainedbythedepartmentundertheprovisionsofsection192.665
81andthissectionshallnotbepublicinformation.Reportsandstudiespreparedbythe
82departmentbaseduponsuchinformationshallbepublicinformationandmayidentify
83individualhealthcareproviders.Thedepartmentofhealthandseniorservicesmayauthorize
84theuseofthedatabyotherresearchorganizationspursuanttotheprovisionsofsection
85192.067.Thedepartmentshallnotuseorreleaseanyinformationprovidedundersection
86192.665andthissectionwhichwouldenableanypersontodetermineanyhealthcare
87provider'snegotiateddiscountswithspecificpreferredproviderorganizationsorother
88managedcareorganizations.Thedepartmentshallnotreleasedatainaformwhichcouldbe
89usedtoidentifyapatient.AnyviolationofthissubsectionisaclassAmisdemeanor.
90 8.Thedepartmentshallundertakeareasonablenumberofstudiesandpublish
91information,includingatleastanannualconsumerguide,incollaborationwithhealthcare
92providers,businesscoalitionsandconsumersbasedupontheinformationobtainedpursuantto
93theprovisionsofsection192.665andthissection.Thedepartmentshallallowallhealthcare
94providersandassociationsandrelatedorganizationswhohavesubmitteddatawhichwillbe
95usedinanypublicationtoreviewandcommentonthepublicationpriortoitspublicationor
96releaseforgeneraluse.Thepublicationshallbemadeavailabletothepublicforareasonable
97charge.
98 9.Anyhealthcareproviderwhichcontinuallyandsubstantially,asthesetermsare
99definedbyrule,failstocomplywiththeprovisionsofthissectionshallnotbeallowedto
100participateinanyprogramadministeredbythestateortoreceiveanymoneysfromthestate.
101 10.Ahospital,asdefinedinsection197.020,aggrievedbythedepartment's
102determinationofineligibilityforstatemoneyspursuanttosubsection9ofthissectionmay
103appealasprovidedinsection197.071.Anambulatorysurgicalcenter[orabortionfacility] as
104definedinsection197.200aggrievedbythedepartment'sdeterminationofineligibilityfor
105statemoneyspursuanttosubsection9ofthissectionmayappealasprovidedinsection
106197.221.
107 11.Thedepartmentofhealthmaypromulgaterulesprovidingforcollectionofdata
108andpublicationoftheincidenceofhealthcare-associatedinfectionsforothertypesofhealth
109facilitiesdeterminedtobesourcesofinfections;exceptthat,physicians'officesshallbe
110exemptfromreportinganddisclosureofsuchinfections.
HB1304 6 111 12.ByJanuary1,2017,theadvisorypanelshallrecommendandthedepartmentshall
112adoptinregulationwithaneffectivedateofnolaterthanJanuary1,2018,therequirements
113forthereportingofthefollowingtypesofinfectionsasspecifiedinthissubsection:
114 (1)Infectionsassociatedwithaminimumoffoursurgicalproceduresforhospitals
115andaminimumoftwosurgicalproceduresforambulatorysurgicalcentersthatmeetthe
116followingcriteria:
117 (a)Areusuallyassociatedwithanelectivesurgicalprocedure.An"electivesurgical
118procedure"isaplanned,nonemergencysurgicalprocedurethatmaybeeithermedically
119requiredsuchasahipreplacementoroptionalsuchasbreastaugmentation;
120 (b)Demonstrateahighpriorityaspectsuchasaffectingalargenumberofpatients,
121havingasubstantialimpactforasmallerpopulation,orbeingassociatedwithsubstantialcost,
122morbidity,ormortality;or
123 (c)AreinfectionsforwhichreportsarecollectedbytheNationalHealthcareSafety
124Networkoritssuccessor;
125 (2)Centralline-relatedbloodstreaminfections;
126 (3)Healthcare-associatedinfectionsspecifiedforreportingbyhospitals,ambulatory
127surgicalcenters,andotherhealthcarefacilitiesbytherulesoftheCentersforMedicareand
128MedicaidServicestothefederalCentersforDiseaseControlandPrevention'sNational
129HealthcareSafetyNetwork,oritssuccessor;and
130 (4)Othercategoriesofinfectionsthatmaybeestablishedbyrulebythedepartment.
131
132Thedepartment,inconsultationwiththeadvisorypanel,shallbeauthorizedtocollectand
133reportdataonsubsetsofeachtypeofinfectiondescribedinthissubsection.
134 13.Inconsultationwiththeinfectioncontroladvisorypanelestablishedpursuantto
135section197.165,thedepartmentshalldevelopanddisseminatetothepublicreportsbasedon
136datacompiledforaperiodoftwelvemonths.Suchreportsshallbeupdatedquarterlyand
137shallshowforeachhospital,ambulatorysurgicalcenter,[abortionfacility,]andotherfacility
138metricsonrisk-adjustedhealthcare-associatedinfectionsunderthissection.
139 14.Thetypesofinfectionsundersubsection12ofthissectiontobepubliclyreported
140shallbedeterminedbythedepartmentbyruleandshallbeconsistentwiththeinfections
141trackedbytheNationalHealthcareSafetyNetwork,oritssuccessor.
142 15.Reportspublishedpursuanttosubsection13ofthissectionshallbepublishedand
143readilyaccessibleonthedepartment'sinternetwebsite.Thereportsshallbedistributedat
144leastannuallytothegovernorandmembersofthegeneralassembly.Thedepartmentshall
145makesuchreportsavailabletothepublicforaperiodofatleasttwoyears.
146 16.TheHospitalIndustryDataInstituteshallpublishareportofMissourihospitals'[,]
147andambulatorysurgicalcenters'[, andabortionfacilities'] compliancewithstandardized
HB1304 7 148qualityofcaremeasuresestablishedbythefederalCentersforMedicareandMedicaid
149Servicesforpreventionofinfectionsrelatedtosurgicalprocedures.IftheHospitalIndustry
150DataInstitutefailstodosobyJuly31,2008,andannuallythereafter,thedepartmentshallbe
151authorizedtocollectinformationfromtheCentersforMedicareandMedicaidServicesor
152fromhospitals[,] andambulatorysurgicalcenters[, andabortionfacilities] andpublishsuch
153informationinaccordancewiththissection.
154 17.Thedatacollectedorpublishedpursuanttothissectionshallbeavailabletothe
155departmentforpurposesoflicensinghospitals[,] andambulatorysurgicalcenters[, and
156abortionfacilities] pursuanttochapter197.
157 18.Thedepartmentshallpromulgaterulestoimplementtheprovisionsofsection
158192.131andsections197.150to197.160.Anyruleorportionofarule,asthattermis
159definedinsection536.010,thatiscreatedundertheauthoritydelegatedinthissectionshall
160becomeeffectiveonlyifitcomplieswithandissubjecttoalloftheprovisionsofchapter536
161and,ifapplicable,section536.028.Thissectionandchapter536arenonseverableandifany
162ofthepowersvestedwiththegeneralassemblypursuanttochapter536toreview,todelaythe
163effectivedate,ortodisapproveandannularulearesubsequentlyheldunconstitutional,then
164thegrantofrulemakingauthorityandanyruleproposedoradoptedafterAugust28,2004,
165shallbeinvalidandvoid.
166 19.NolaterthanAugust28,2017,eachhospital,excludingmentalhealthfacilitiesas
167definedinsection632.005,andeachambulatorysurgicalcenter[andabortionfacility] as
168definedinsection197.200,shallinconsultationwithitsmedicalstaffestablishan
169antimicrobialstewardshipprogramforevaluatingthejudicioususeofantimicrobials,
170especiallyantibioticsthatarethelastlineofdefenseagainstresistantinfections.The
171hospital'sstewardshipprogramandtheresultsoftheprogramshallbemonitoredand
172evaluatedbyhospitalqualityimprovementdepartmentsandshallbeavailableupon
173inspectiontothedepartment.Ataminimum,theantimicrobialstewardshipprogramshallbe
174designedtoevaluatethathospitalizedpatientsreceive,inaccordancewithacceptedmedical
175standardsofpractice,theappropriateantimicrobial,attheappropriatedose,attheappropriate
176time,andfortheappropriateduration.
177 20.Hospitalsdescribedinsubsection19ofthissectionshallmeettheNational
178HealthcareSafetyNetworkrequirementsforreportingantimicrobialusageorresistanceby
179usingtheCentersforDiseaseControlandPrevention'sAntimicrobialUseandResistance
180(AUR)ModulewhenconditionsofparticipationpromulgatedbytheCentersforMedicare
181andMedicaidServicesrequiringtheelectronicreportingofantibioticuseorantibiotic
182resistancebyhospitalsbecomeeffective.Whensuchantimicrobialusageorresistance
183reportingtakeseffect,hospitalsshallauthorizetheNationalHealthcareSafetyNetwork,orits
184successor,todisclosetothedepartmentfacility-specificinformationreportedtotheAUR
HB1304 8 185Module.Facility-specificdataonantibioticusageandresistancecollectedunderthis
186subsectionshallnotbedisclosedtothepublic,butthedepartmentmayreleasecase-specific
187informationtootherfacilities,physicians,andthepublicifthedepartmentdeterminesona
188case-by-casebasisthatthereleaseofsuchinformationisnecessarytoprotectpersonsina
189publichealthemergency.Nothinginthissectionshallprohibitahospitalfromvoluntarily
190reportingantibioticuseorantibioticresistancedatathroughtheNationalHealthcareSafety
191Network,oritssuccessor,priortotheeffectivedateoftheconditionsofparticipation
192requiringthereporting.
193 21.ThedepartmentshallmakeareporttothegeneralassemblybeginningJanuary1,
1942018,andoneveryJanuaryfirstthereafterontheincidence,type,anddistributionof
195antimicrobial-resistantinfectionsidentifiedinthestateandwithinregionsofthestate.
197.150.Thedepartmentshallrequirethateachhospital,ambulatorysurgicalcenter,
2[abortionfacility,]andotherfacilityhaveinplaceproceduresformonitoringandenforcing
3compliancewithinfectioncontrolregulationsandstandards.Suchproceduresshallbe
4coordinatedwithadministrativestaff,personnelstaff,andthequalityimprovementprogram.
5Suchproceduresshallinclude,ataminimum,requirementsforthefacility'sinfectioncontrol
6programtoconductsurveillanceofpersonnelwithaportionofthesurveillancetobedonein
7suchmannerthatemployeesandmedicalstaffareobservedwithouttheirknowledgeofsuch
8observation,providedthatthisunobservedsurveillancerequirementshallnotbeconsideredto
9begroundsforlicensureenforcementactionbythedepartmentuntilthedepartment
10establishesclearandverifiablecriteriafordeterminingcompliance.Suchsurveillancealso
11mayincludemonitoringoftherateofuseofhandhygieneproducts.
197.152.1.Infectioncontrolofficersasdefinedinfederalregulationandother
2hospital[,] andambulatorysurgicalcenter[, andabortionfacility] employeesshallbe
3protectedagainstretaliationbythehospital[,] orambulatorysurgicalcenter[, orabortion
4facility] forreportinginfectioncontrolconcernspursuanttosection197.285andshallbe
5entitledtothefullbenefitsofthatsection.Suchinfectioncontrolofficersshallreportany
6interferenceintheperformanceoftheirdutiesbytheirsupervisorstothehospital[,] or
7ambulatorysurgicalcenter[, orabortionfacility] complianceofficerestablishedbyand
8empoweredtoactpursuanttosection197.285.
9 2.Infectioncontrolofficersasdefinedinfederalregulationshallalsohavethe
10authoritytoorderthecessationofapracticethatfallsoutsideacceptedpracticesasdefinedby
11appropriatestateandfederalregulatoryagencies,accreditationorganizations,orthestandards
12adoptedbytheCentersforDiseaseControlandPreventionortheAssociationof
13ProfessionalsinInfectionControlandEpidemiology.Thehospital[,] orambulatory
14surgicalcenter[, orabortionfacility] mayrequirethatsuchacessationorderofaninfection
15controlofficerbeendorsedbythehospital[,] orambulatorysurgicalcenter[, orabortion
HB1304 9 16facility] chiefexecutiveofficerorhisorherdesigneebeforetakingeffect.Thehospital[,] or
17ambulatorysurgicalcenter[, orabortionfacility] infectioncontrolcommitteeshallconveneas
18soonaspossibletoreviewsuchcessationorderandmayoverruleorsustainthedirectiveof
19theinfectioncontrolofficer.Thedepartmentshallpromulgaterulesgoverningdocumentation
20ofsuchevents.
21 3.Membersofthemedicalstaffwhoreportingoodfaithinfectioncontrolconcernsto
22thehospital[,] orambulatorysurgicalcenter[, orabortionfacility] administrationormedical
23staffleadershipshallnotbesubjecttoretaliationordiscriminationfordoingso.Nothingin
24thissectionshallpreventorshieldmedicalstaffmembersfrombeingsubjecttoprofessional
25reviewactionsforsubstandardcareorbreachofstandardsestablishedinhospitalpolicy,
26rules,ormedicalstaffbylaws.
197.158.Everyhospital[,] andambulatorysurgerycenter[, andabortionfacility]
2shall,beginningJune1,2006,provideeachpatientanopportunitytosubmittothehospital[,]
3orambulatorysurgicalcenter[, orabortionfacility] administrationcomplaints,comments,
4andsuggestionsrelatedtothecaretheyreceivedortheirpersonalobservationsrelatedtothe
5qualityofcareprovided.Thedepartmentshallpromulgaterulestoimplementthissection.
197.160.Thedepartmentofhealthandseniorservicesshallhaveaccesstoalldata
2andinformationheldbyhospitals,ambulatorysurgicalcenters,[abortionfacilities,] andother
3facilitiesrelatedtotheirinfectioncontrolpractices,rates,ortreatmentsofinfections.Failure
4toprovidesuchaccessshallbegroundsforfullorpartiallicensuresuspensionorrevocation
5pursuanttosection197.293,sections197.010to197.100,orsections197.200to197.240.If
6thedepartmentdeterminesthatthehospital,ambulatorysurgicalcenter,[abortionfacility,]or
7otherfacilityiswillfullyimpedingaccesstosuchinformation,thedepartmentshallbe
8authorizedtodirectallstateagenciestosuspendalloraportionofstatepaymentstosuch
9entityuntilsuchtimeasthedesiredinformationisobtainedbythedepartment.
197.162.Thedepartmentshallinitslicensureofhospitals[,] andambulatorysurgical
2centers[, andabortionfacilities] givespecialattentiontoinfectioncontrolpracticesandshall
3directhospitals[,] andambulatorysurgicalcenters[, andabortionfacilities] tosetquantifiable
4measuresofperformanceforreducingtheincidenceofnosocomialinfectionsinMissouri.
5Thedepartmentshallprepareanannualreportoninfectioncontrolstandardsandcompliance,
6whichshallbesharedwiththegovernorandthegeneralassembly.
197.165.1.Thedepartmentshallappointan"InfectionControlAdvisoryPanel"for
2thepurposesofimplementingsections192.131and192.667.
3 2.Membersoftheinfectioncontroladvisorypanelshallinclude:
4 (1)Twopublicmembers;
5 (2)Threeboard-certifiedorboard-eligiblephysicianslicensedpursuanttochapter
6334whoareaffiliatedwithaMissourihospitalormedicalschool,activemembersofthe
HB1304 10 7SocietyforHealthCareEpidemiologyofAmerica,andhavedemonstratedinterestand
8expertiseinhealthfacilityinfectioncontrol;
9 (3)Onephysicianlicensedpursuanttochapter334whoisactiveinthepracticeof
10medicineinMissouriandwhoholdsmedicalstaffprivilegesataMissourihospital;
11 (4)Fourinfectioncontrolpractitionerscertifiedbythecertificationboardofinfection
12controlandepidemiology,atleasttwoofwhomshallbepracticinginaruralhospitalor
13settingandatleasttwoofwhomshallberegisteredprofessionalnurseslicensedunderchapter
14335;
15 (5)Amedicalstatisticianwithanadvanceddegreeinsuchspecialty;
16 (6)Aclinicalmicrobiologistwithanadvanceddegreeinsuchspecialty;
17 (7)Threeemployeesofthedepartment,representingthefunctionsofhospital[,] and
18ambulatorysurgicalcenter[, andabortionfacility] licensure,epidemiologyandhealthdata
19analysis,whoshallserveasexofficiononvotingmembersofthepanel.
20 3.Reasonableexpensesofthepanelshallbepaidfromprivatedonationsmade
21specificallyforthatpurposetothe"InfectionControlAdvisoryPanelFund",whichishereby
22createdinthestatetreasury.Ifsuchdonationsarenotreceivedfromprivatesources,thenthe
23provisionsofthisactshallbeimplementedwithouttheadvisorypanel.
197.200.Asusedinsections197.200to197.240,unlessthecontextclearlyindicates
2otherwise,thefollowingtermsmean:
3 (1)["Abortionfacility",assuchtermisdefinedinsection188.015;
4 (2)]"Ambulatorysurgicalcenter",anypublicorprivateestablishmentoperated
5primarilyforthepurposeofperformingsurgicalproceduresorprimarilyforthepurposeof
6performingchildbirths,andwhichdoesnotprovideservicesorotheraccommodationsfor
7patientstostaymorethantwenty-threehourswithintheestablishment,provided,however,
8thatnothinginthisdefinitionshallbeconstruedtoincludetheofficesofdentistscurrently
9licensedpursuanttochapter332;
10 [(3)](2)"Dentist",anypersoncurrentlylicensedtopracticedentistrypursuantto
11chapter332;
12 [(4)](3)"Department",thedepartmentofhealthandseniorservices;
13 [(5)](4)"Governmentalunit",anycity,countyorotherpoliticalsubdivisionofthis
14state,oranydepartment,division,boardorotheragencyofanypoliticalsubdivisionofthis
15state;
16 [(6)](5)"Person",anyindividual,firm,partnership,corporation,company,or
17associationandthelegalsuccessorsthereof;
18 [(7)](6)"Physician",anypersoncurrentlylicensedtopracticemedicinepursuantto
19chapter334;
HB1304 11 20 [(8)](7)"Podiatrist",anypersoncurrentlylicensedtopracticepodiatrypursuantto
21chapter330.
197.205.1.Nopersonorgovernmentalunitactingseverallyorjointlywithanyother
2personorgovernmentalunitshallestablish,conductormaintainanambulatorysurgical
3center[orabortionfacility] inthisstatewithoutalicenseundersections197.200to197.240
4issuedbythedepartmentofhealthandseniorservices.
5 2.Nothinginsections197.200to197.240shallbeconstruedtoimpairorabridgethe
6authorityofagovernmentalunittolicenseambulatorysurgicalcenters[orabortionfacilities],
7providedthatanyordinanceofagovernmentalunitshallrequirecompliancewithallrules,
8regulations,andstandardsadoptedbythedepartmenttoimplementtheprovisionsofsections
9197.200to197.240.
197.215.1.Uponreceiptofanapplicationforalicense,thedepartmentofhealthand
2seniorservicesshallissuealicenseiftheapplicantandambulatorysurgicalcenterfacilities
3[orabortionfacilities] meettherequirementsestablishedundersections197.200to197.240,
4andhaveprovidedaffirmativeevidencethat:
5 (1)Eachmemberofthesurgicalstaffisaphysician,dentistorpodiatristcurrently
6licensedtopracticeinMissouri[, andeachpersonauthorizedtoperformorinduceabortionsis
7aphysiciancurrentlylicensedtopracticeinMissouri];
8 (2)Surgicalproceduresinambulatorysurgicalcentersshallbeperformedonlyby
9physicians,dentistsorpodiatrists,whoatthetimeareprivilegedtoperformsurgical
10proceduresinatleastonelicensedhospitalinthecommunityinwhichtheambulatory
11surgicalcenterislocated,thusprovidingassurancetothepublicthatpatientstreatedinthe
12centershallreceivecontinuityofcareshouldtheservicesofahospitalberequired;
13alternatively,applicantshallsubmitacopyofacurrentworkingagreementwithatleastone
14licensedhospitalinthecommunityinwhichtheambulatorysurgicalcenterislocated,
15guaranteeingthetransferandadmittanceofpatientsforemergencytreatmentwhenever
16necessary;
17 (3)Continuousphysicianservicesorregisteredprofessionalnursingservicesare
18providedwheneverapatientisinthefacility;
19 (4)Adequatemedicalrecordsforeachpatientaretobemaintained.
20 2.Uponreceiptofanapplicationforalicense,ortherenewalthereof,thedepartment
21shallissueorrenewthelicenseiftheapplicantandprogrammeettherequirements
22establishedundersections197.200to197.240.Eachlicenseshallbeissuedonlyforthe
23personsandpremisesnamedintheapplication.Alicense,unlesssoonersuspendedor
24revoked,shallbeissuedforaperiodofoneyear.
25 3.Eachlicenseshallbeissuedonlyforthepremisesandpersonsorgovernmental
26unitsnamedintheapplication,andshallnotbetransferableorassignableexceptwiththe
HB1304 12 27writtenconsentofthedepartment.Licensesshallbepostedinaconspicuousplaceonthe
28licensedpremises.
29 4.If,duringtheperiodinwhichanambulatorysurgicalcenterlicense[oranabortion
30facilitylicense] isineffect,thelicenseholderoroperatorlegallytransfersoperational
31responsibilitiesbyanyprocesstoanotherpersonasdefinedinsection197.200,anapplication
32shallbemadefortheissuanceofanewlicensetobecomeeffectiveonthetransferdate.
197.220.Thedepartmentofhealthandseniorservicesmaydeny,suspendorrevokea
2licenseinanycaseinwhichthedepartmentfindsthattherehasbeenasubstantialfailureto
3complywiththerequirementsofsections197.200to197.240,orinanycaseinwhichthe
4directorofthedepartmentmakesafindingthat:
5 (1)Theapplicant,oriftheapplicantisafirm,partnershiporassociation,anyofits
6members,orifacorporation,anyofitsofficersordirectors,orthepersondesignatedto
7manageorsupervisethefacility,hasbeenfinallyadjudicatedandfoundguilty,orentereda
8pleaofguiltyornolocontendere,inacriminalprosecutionunderthelawsofanystateorof
9theUnitedStates,foranyoffensereasonablyrelatedtothequalifications,functions,orduties
10ofanambulatorysurgicalcenter[orofanabortionfacility], orforanyoffenseanessential
11elementofwhichisfraud,dishonesty,oranactofviolence,orforanyoffenseinvolving
12moralturpitude,whetherornotsentenceisimposed;
13 (2)Thelicensurestatusorrecordoftheapplicant,oriftheapplicantisafirm,
14partnershiporassociation,ofanyofitsmembers,orifacorporation,ofanyofitsofficersor
15directors,orofthepersondesignatedtomanageorsupervisethefacility,fromanyotherstate,
16federaldistrictorland,territoryorcommonwealthoftheUnitedStates,orofanyforeign
17countrywheretheapplicanthasdonebusinessinasimilarcapacityindicatesthatgrantinga
18licensetotheapplicantwouldbedetrimentaltotheinterestsofthepublic.
197.225.1.Thedepartmentofhealthandseniorservicesmayadoptsuchreasonable
2rules,regulations,andstandardsforthetypesofservicesprovidedasarenecessarytocarry
3outtheprovisionsofsections197.200to197.240,andtoassurequalitypatientcareand
4patientsafety,whichshallinclude,butnotbelimitedto:
5 (1)Constructionofthefacilityincluding,butnotlimitedto,plumbing,heating,
6lighting,andventilationwhichshouldinsurethehealth,safety,comfort,andprivacyof
7patientsandprotectionfromfirehazard;
8 (2)Number,qualifications,andorganizationofallpersonnel,havingresponsibility
9foranypartofthecareprovidedtothepatients;
10 (3)Equipmentessentialtothehealth,welfare,andsafetyofthepatients;
11 (4)Facilities,programs,andservicestobeprovidedinconnectionwiththecareof
12patientsinambulatorysurgicalcenters;and
HB1304 13 13 (5)Proceduresforpeerreviewandforreceivingandinvestigatingcomplaints
14regardinganyambulatorysurgicalcenteroranyphysician,dentist,podiatrist,nurse,assistant,
15manager,supervisor,oremployeepracticingorworkinginanysuchfacility.
16 2.Thedepartmentofhealthandseniorservicesmayadoptseparaterules,regulations,
17orstandardstoapplytoambulatorysurgicalcenters[andtoapplytoabortionfacilities].
18 [3.Abortionfacilitiesshallberequiredtomaintainawrittenprotocolformanaging
19medicalemergenciesandthetransferofpatientsrequiringfurtheremergencycaretoa
20hospitalwithinareasonabledistancefromtheabortionfacility.]
197.230.1.Thedepartmentofhealthandseniorservicesshallmake,orcausetobe
2made,suchinspectionsandinvestigationsasitdeemsnecessary.Thedepartmentmay
3delegateitspowersanddutiestoinvestigateandinspectambulatorysurgicalcenters[or
4abortionfacilities] toanofficialofapoliticalsubdivisionhavingapopulationofatleastfour
5hundredfiftythousandifsuchpoliticalsubdivisionisdeemedqualifiedbythedepartmentto
6inspectandinvestigateambulatorysurgicalcenters.Theofficialsodesignatedshallsubmita
7writtenreportofhisorherfindingstothedepartmentandthedepartmentmayacceptthe
8recommendationsofsuchofficialifitdeterminesthatthefacilityinspectedmeetsminimum
9standardsestablishedpursuanttosections197.200to197.240.
10 2.[Inthecaseofanyabortionfacility,thedepartmentshallmakeorcausetobemade
11anunannouncedon-siteinspectionandinvestigationatleastannually.Suchon-site
12inspectionandinvestigationshallinclude,butnotbelimitedto,thefollowingareas:
13 (1)Compliancewithallstatutoryandregulatoryrequirementsforanabortionfacility,
14includingrequirementsthatthefacilitymaintainadequatestaffingandequipmenttorespond
15tomedicalemergencies;
16 (2)Compliancewiththeprovisionsofchapter188;and
17 (3)Compliancewiththerequirementinsection197.215thatcontinuousphysician
18servicesorregisteredprofessionalnursingservicesbeprovidedwheneverapatientisinthe
19facility.
20 3.]Inspection,investigation,andqualityassurancereportsshallbemadeavailableto
21thepublic.Anyportionofareportmayberedactedwhenmadepubliclyavailableifsuch
22portionwoulddiscloseinformationthatisnotsubjecttodisclosureunderthelaw.
197.235.1.Anypersonoperating,conducting,managing,orestablishingan
2ambulatorysurgicalcenter[orabortionfacility] withoutalicenserequiredbysections
3197.200to197.240isguiltyofaclassAmisdemeanorand,uponconviction,shallbesubject
4toafineofnotmorethanfivehundreddollars.Eachdayofcontinuingviolationshall
5constituteaseparateoffense.
6 2.Theattorneygeneralshallrepresentthedepartmentofhealthandseniorservices
7andshallinstituteanactioninthenameofthestateforinjunctiveorotherreliefagainstany
HB1304 14 8personorgovernmentalunittorestrainorpreventtheestablishment,conduct,management,
9oroperationofanambulatorysurgicalcenter[orabortionfacility] withoutalicenseissued
10pursuanttotheprovisionsofsections197.200to197.240.
11 3.Anypersonoperating,conducting,managing,orestablishinganambulatory
12surgicalcenter[orabortionfacility] who,inthecourseofadvertising,promoting,or
13otherwisepublicizingtheactivities,business,location,oranyothermatterconcerningthe
14operationsofsaidambulatorysurgicalcenter[orabortionfacility], usesoremploysinany
15mannerthewords"State,Missouri,StateofMissouri,DepartmentofHealthandSenior
16Services,theinitials'Mo.',"oranyemblemofthestateofMissouriorthedepartmentof
17healthandseniorservices,forthepurposeofconveyingorinanymannerreasonably
18calculatedtoconveythefalseimpressionthatthestateofMissourioranydepartment,agency,
19bureau,orinstrumentalitythereofisinvolvedinthebusinessofsaidambulatorysurgical
20center[orabortionfacility], ortookpartinsaidadvertisement,promotion,publicity,orother
21statement,shallbesubjecttoafineofonehundreddollarsperdayforeachdayduringthe
22periodbeginningwiththedaysaidadvertisement,promotion,publication,orstatementfirst
23appearsandendingonthedayonwhichitiswithdrawn.
197.240.AfterSeptember28,1975,noindividualorgrouphealthinsurancepolicyof
2insuranceprovidingcoverageonanexpenseincurredbasis,norindividualorgroupserviceor
3indemnitytypecontractissuedbyanonprofitcorporation,noranyself-insuredgrouphealth
4benefitplanortrust,ofanykindordescription,shallbeissuedorpaymentacceptedtherefor
5inrenewalorcontinuationthereofunlesscoverageforanyserviceperformedinan
6ambulatorysurgicalcenter[orabortionfacility] isprovidedforthereinifsuchservicewould
7havebeencoveredunderthetermsofthepolicyorcontractasaneligibleinpatientservice,
8exceptasprovidedinsection376.805.Nothinginthissectionshallapplytoagroupcontract,
9planortrustwhichprovideshealthcareandsurgicalcaredirectlytoitsmembersandtheir
10dependents.Nothinginthissectionshallbeconstruedtomandatecoverageunderan
11individualorgrouphealthinsurancepolicyofinsuranceprovidingcoverageonanexpense-
12incurredbasis,oranindividualorgroupserviceorindemnitytypecontractissuedbya
13nonprofitcorporation,oranyself-insuredgrouphealthbenefitplanortrust,ofanykindor
14description,toprovidehealthinsuranceforserviceswhichareusuallyperformedina
15physician'soffice.
197.285.1.Hospitals[,] andambulatorysurgicalcenters[, andabortionfacilities]
2shallestablishandimplementawrittenpolicyadoptedbyeachhospital[,] andambulatory
3surgicalcenter[, andabortionfacility] relatingtotheprotectionsforemployeeswhodisclose
4informationpursuanttosubsection2ofthissection.Thispolicyshallincludeatimeframe
5forcompletionofinvestigationsrelatedtocomplaints,nottoexceedthirtydays,andamethod
6fornotifyingthecomplainantofthedispositionoftheinvestigation.Thispolicyshallbe
HB1304 15 7submittedtothedepartmentofhealthandseniorservicestoverifyimplementation.Ata
8minimum,suchpolicyshallincludethefollowingprovisions:
9 (1)Nosupervisororindividualwithauthoritytohireorfireinahospital[,] or
10ambulatorysurgicalcenter[, orabortionfacility] shallprohibitemployeesfromdisclosing
11informationpursuanttosubsection2ofthissection;
12 (2)Nosupervisororindividualwithauthoritytohireorfireinahospital[,] or
13ambulatorysurgicalcenter[, orabortionfacility] shalluseorthreatentousehisorher
14supervisoryauthoritytoknowinglydiscriminateagainst,dismiss,penalizeorinanyway
15retaliateagainstorharassanemployeebecausetheemployeeingoodfaithreportedor
16disclosedanyinformationpursuanttosubsection2ofthissection,orinanywayattemptto
17dissuade,preventorinterferewithanemployeewhowishestoreportordisclosesuch
18information;
19 (3)Establishaprogramtoidentifyacomplianceofficerwhoisadesignatedperson
20responsibleforadministeringthereportingandinvestigationprocessandanalternateperson
21shouldtheprimarydesigneebeimplicatedinthereport.
22 2.Thissectionshallapplytoinformationdisclosedorreportedingoodfaithbyan
23employeeconcerning:
24 (1)Allegedfacilitymismanagementorfraudulentactivity;
25 (2)Allegedviolationsofapplicablefederalorstatelawsoradministrativerules
26concerningpatientcare,patientsafetyorfacilitysafety;or
27 (3)Theabilityofemployeestosuccessfullyperformtheirassignedduties.
28
29Allinformationdisclosed,collectedandmaintainedpursuanttothissubsectionandpursuant
30tothewrittenpolicyrequirementsofthissectionshallbeaccessibletothedepartmentof
31healthandseniorservicesatalltimesandshallbereviewedbythedepartmentofhealthand
32seniorservicesatleastannually.Complainantsshallbenotifiedofthedepartmentofhealth
33andseniorservices'accesstosuchinformationandofthecomplainant'srighttonotifythe
34departmentofhealthandseniorservicesofanyinformationconcerningallegedviolationsof
35applicablefederalorstatelawsoradministrativerulesconcerningpatientcare,patientsafety
36orfacilitysafety.
37 3.Priortoanydisclosuretoindividualsoragenciesotherthanthedepartmentof
38healthandseniorservices,employeeswishingtomakeadisclosurepursuanttotheprovisions
39ofthissectionshallfirstreporttotheindividualorindividualsdesignatedbythehospital[,] or
40ambulatorysurgicalcenter[, orabortionfacility] pursuanttosubsection1ofthissection.
41 4.Ifthecomplianceofficer,compliancecommitteeormanagementofficialdiscovers
42credibleevidenceofmisconductfromanysourceand,afterareasonableinquiry,hasreason
43tobelievethatthemisconductmayviolatecriminal,civiloradministrativelaw,thenthe
HB1304 16 44hospital[,] orambulatorysurgicalcenter[, orabortionfacility] shallreporttheexistenceof
45misconducttotheappropriategovernmentalauthoritywithinareasonableperiod,butnot
46morethansevendaysafterdeterminingthatthereiscredibleevidenceofaviolation.
47 5.Reportsmadetothedepartmentofhealthandseniorservicesshallbesubjecttothe
48provisionsofsection197.477,providedthattherestrictionsofsection197.477shallnotbe
49construedtolimittheemployee'sabilitytosubpoenafromtheoriginalsourcetheinformation
50reportedtothedepartmentpursuanttothissection.
51 6.Eachwrittenpolicyshallallowemployeesmakingareportwhowishtoremain
52anonymoustodoso,andshallincludesafeguardstoprotecttheconfidentialityofthe
53employeemakingthereport,theconfidentialityofpatientsandtheintegrityofdata,
54informationandmedicalrecords.
55 7.Eachhospital[,] andambulatorysurgicalcenter[, andabortionfacility] shall,
56withinforty-eighthoursofthereceiptofareport,notifytheemployeethathisorherreport
57hasbeenreceivedandisbeingreviewed.
197.287.ByJuly1,2001,allhospitalsandambulatorysurgicalcenters[, andbyJuly
21,2018,allabortionfacilities] shallprovidetrainingprograms,withmeasurableminimal
3trainingoutcomesrelatingtoqualityofpatientcareandpatientsafety,toallunlicensedstaff
4providingpatientcareintheirfacilitywithinninetydaysofthebeginningdateof
5employment.Standardsforsuchtrainingshallbeestablishedbythedepartmentofhealthand
6seniorservicesbyrule.Itshallbearequirementofhospital[,] andambulatorysurgicalcenter
7[,andabortionfacility] licensurepursuanttothischapterthatallhospitals[,] andambulatory
8surgicalcenters[, andabortionfacilities] submitdocumentationtothedepartmentofhealth
9andseniorservicesonthetrainingprogramused.
197.289.1.Allhospitals[,] andambulatorysurgicalcenters[, andabortionfacilities]
2shalldevelopandimplementamethodologywhichensuresadequatenursestaffingthatwill
3meettheneedsofpatients.Ataminimum,thereshallbeondutyatalltimesasufficient
4numberoflicensedregisterednursestoprovidepatientcarerequiringthejudgmentandskills
5ofalicensedregisterednurseandtooverseetheactivitiesofallnursingpersonnel.
6 2.Thereshallbesufficientlicensedandancillarynursingpersonnelondutyoneach
7nursingunittomeettheneedsofeachpatientinaccordancewithacceptedstandardsof
8qualitypatientcare.
197.293.1.Inadditiontothepowersestablishedinsections197.070and197.220,
2thedepartmentofhealthandseniorservicesshallusethefollowingstandardsforenforcing
3hospital[,] andambulatorysurgicalcenter[, andabortionfacility] licensureregulations
4promulgatedtoenforcetheprovisionsofsections197.010to197.120,sections197.150to
5197.165,andsections197.200to197.240:
HB1304 17 6 (1)Uponnotificationofadeficiencyinmeetingregulatorystandards,thehospital[,]
7orambulatorysurgicalcenter[, orabortionfacility] shalldevelopandimplementaplanof
8correctionapprovedbythedepartmentwhichincludes,butisnotlimitedto,thespecifictype
9ofcorrectiveactiontobetakenandanestimatedtimetocompletesuchaction;
10 (2)Iftheplanasimplementeddoesnotcorrectthedeficiency,thedepartmentmay
11either:
12 (a)Directthehospital[,] orambulatorysurgicalcenter[, orabortionfacility] to
13developandimplementaplanofcorrectionpursuanttosubdivision(1)ofthissubsection;or
14 (b)Requirethehospital[,] orambulatorysurgicalcenter[, orabortionfacility] to
15implementaplanofcorrectiondevelopedbythedepartment;
16 (3)Ifthereisacontinuingdeficiencyafterimplementationoftheplanofcorrection
17pursuanttosubdivision(2)ofthissubsectionandthehospital[,] orambulatorysurgicalcenter
18[,orabortionfacility] hashadanopportunitytocorrectsuchdeficiency,thedepartmentmay
19restrictnewinpatientadmissionsoroutpatiententrantstotheserviceorservicesaffectedby
20suchdeficiency;
21 (4)Ifthereisacontinuingdeficiencyafterthedepartmentrestrictsnewinpatient
22admissionsoroutpatiententrantstotheserviceorservicespursuanttosubdivision(3)ofthis
23subsectionandthehospital[,] orambulatorysurgicalcenter[, orabortionfacility] hashadan
24opportunitytocorrectsuchdeficiency,thedepartmentmaysuspendoperationsinallorpartof
25theserviceorservicesaffectedbysuchdeficiency;
26 (5)Ifthereisacontinuingdeficiencyaftersuspensionofoperationspursuantto
27subdivision(4)ofthissubsection,thedepartmentmaydeny,suspendorrevokethehospital's
28[,]orambulatorysurgicalcenter's[, orabortionfacility's] licensepursuanttosection197.070
29orsection197.220.
30 2.Notwithstandingtheprovisionsofsubsection1ofthissectiontothecontrary,ifa
31deficiencyinmeetinglicensurestandardspresentsanimmediateandseriousthreattothe
32patients'healthandsafety,thedepartmentmay,basedonthescopeandseverityofthe
33deficiency,restrictaccesstotheserviceorservicesaffectedbythedeficiencyuntilthe
34hospital[,] orambulatorysurgicalcenter[, orabortionfacility] hasdevelopedand
35implementedanapprovedplanofcorrection.Decisionsastowhetheradeficiency
36constitutesanimmediateandseriousthreattothepatients'healthandsafetyshallbemadein
37accordancewithguidelinesestablishedpursuanttoregulationofthedepartmentofhealthand
38seniorservicesandsuchdecisionsshallbeapprovedbythebureauofhealthfacilitylicensing
39inthedepartmentofhealthandseniorservices,oritssuccessoragency,orbyaperson
40authorizedbytheregulationstoapprovesuchdecisionsintheabsenceofthedirector.
197.295.1.Ahospital[,] orambulatorysurgicalcenter[, orabortionfacility]
2aggrievedbyadecisionofthedepartmentpursuanttotheprovisionsofparagraph(b)of
HB1304 18 3subdivision(2)andsubdivisions(3),(4)and(5)ofsubsection1ofsection197.293may
4appealsuchdecisiontotheadministrativehearingcommissionpursuanttosection197.071or
5section197.221,andseekjudicialreviewpursuanttosection621.145.Anappealofanaction
6torestrictnewinpatientadmissionsoroutpatiententrants,suspendoperationsorrevokea
7licenseshallbeheardonanexpeditedbasisbytheadministrativehearingcommission.The
8hospital[,] orambulatorysurgicalcenter[, orabortionfacility] mayapplytothe
9administrativehearingcommissionforanordertostayorsuspendanysuchdepartmental
10actionpendingthecommission'sfindingsandrulingasauthorizedbysection621.035.
11 2.Ifboththedepartmentandthehospital[,] orambulatorysurgicalcenter[, or
12abortionfacility] agreetodoso,priortoanappealtotheadministrativehearingcommission
13pursuanttosection197.071orsection197.221,anofficialactionofthedepartmentmade
14pursuanttosections197.010to197.120orsections197.200to197.240maybeappealedtoa
15departmentalhearingofficer.Thedepartmentofhealthandseniorservicesshallpromulgate
16rulesspecifyingthequalificationsofsuchahearingofficer,establishprocedurestoensure
17impartialdecisionsandprovideforcomparableappealremedieswhenadepartmentalhearing
18officerisunavailable.
334.100.1.Theboardmayrefusetoissueorrenewanycertificateofregistrationor
2authority,permitorlicenserequiredpursuanttothischapterforoneoranycombinationof
3causesstatedinsubsection2ofthissection.Theboardshallnotifytheapplicantinwritingof
4thereasonsfortherefusalandshalladvisetheapplicantoftheapplicant'srighttofilea
5complaintwiththeadministrativehearingcommissionasprovidedbychapter621.Asan
6alternativetoarefusaltoissueorrenewanycertificate,registrationorauthority,theboard
7may,atitsdiscretion,issuealicensewhichissubjecttoprobation,restrictionorlimitationto
8anapplicantforlicensureforanyoneoranycombinationofcausesstatedinsubsection2of
9thissection.Theboard'sorderofprobation,limitationorrestrictionshallcontainastatement
10ofthedisciplineimposed,thebasistherefor,thedatesuchactionshallbecomeeffective,anda
11statementthattheapplicanthasthirtydaystorequestinwritingahearingbeforethe
12administrativehearingcommission.Iftheboardissuesaprobationary,limitedorrestricted
13licensetoanapplicantforlicensure,eitherpartymayfileawrittenpetitionwiththe
14administrativehearingcommissionwithinthirtydaysoftheeffectivedateoftheprobationary,
15limitedorrestrictedlicenseseekingreviewoftheboard'sdetermination.Ifnowrittenrequest
16forahearingisreceivedbytheadministrativehearingcommissionwithinthethirty-day
17period,therighttoseekreviewoftheboard'sdecisionshallbeconsideredaswaived.
18 2.Theboardmaycauseacomplainttobefiledwiththeadministrativehearing
19commissionasprovidedbychapter621againstanyholderofanycertificateofregistrationor
20authority,permitorlicenserequiredbythischapteroranypersonwhohasfailedtorenewor
HB1304 19 21hassurrenderedtheperson'scertificateofregistrationorauthority,permitorlicenseforany
22oneoranycombinationofthefollowingcauses:
23 (1)Useofanycontrolledsubstance,asdefinedinchapter195,oralcoholicbeverage
24toanextentthatsuchuseimpairsaperson'sabilitytoperformtheworkofanyprofession
25licensedorregulatedbythischapter;
26 (2)Thepersonhasbeenfinallyadjudicatedandfoundguilty,orenteredapleaof
27guiltyornolocontendere,inacriminalprosecutionunderthelawsofanystateorofthe
28UnitedStates,foranyoffensereasonablyrelatedtothequalifications,functionsordutiesof
29anyprofessionlicensedorregulatedpursuanttothischapter,foranyoffenseinvolvingfraud,
30dishonestyoranactofviolence,orforanyoffenseinvolvingmoralturpitude,whetherornot
31sentenceisimposed;
32 (3)Useoffraud,deception,misrepresentationorbriberyinsecuringanycertificateof
33registrationorauthority,permitorlicenseissuedpursuanttothischapterorinobtaining
34permissiontotakeanyexaminationgivenorrequiredpursuanttothischapter;
35 (4)Misconduct,fraud,misrepresentation,dishonesty,unethicalconductor
36unprofessionalconductintheperformanceofthefunctionsordutiesofanyprofession
37licensedorregulatedbythischapter,including,butnotlimitedto,thefollowing:
38 (a)Obtainingorattemptingtoobtainanyfee,charge,tuitionorothercompensation
39byfraud,deceptionormisrepresentation;willfullyandcontinuallyoverchargingor
40overtreatingpatients;orchargingforvisitstothephysician'sofficewhichdidnotoccur
41unlesstheserviceswerecontractedforinadvance,orforserviceswhichwerenotrenderedor
42documentedinthepatient'srecords;
43 (b)Attempting,directlyorindirectly,bywayofintimidation,coercionordeception,
44toobtainorretainapatientordiscouragetheuseofasecondopinionorconsultation;
45 (c)Willfullyandcontinuallyperforminginappropriateorunnecessarytreatment,
46diagnostictestsormedicalorsurgicalservices;
47 (d)Delegatingprofessionalresponsibilitiestoapersonwhoisnotqualifiedby
48training,skill,competency,age,experienceorlicensuretoperformsuchresponsibilities;
49 (e)Misrepresentingthatanydisease,ailmentorinfirmitycanbecuredbyamethod,
50procedure,treatment,medicineordevice;
51 (f)Performingorprescribingmedicalserviceswhichhavebeendeclaredbyboard
52ruletobeofnomedicalorosteopathicvalue;
53 (g)Finaldisciplinaryactionbyanyprofessionalmedicalorosteopathicassociationor
54societyorlicensedhospitalormedicalstaffofsuchhospitalinthisoranyotherstateor
55territory,whetheragreedtovoluntarilyornot,andincluding,butnotlimitedto,anyremoval,
56suspension,limitation,orrestrictionoftheperson'slicenseorstafforhospitalprivileges,
57failuretorenewsuchprivilegesorlicenseforcause,orotherfinaldisciplinaryaction,ifthe
HB1304 20 58actionwasinanywayrelatedtounprofessionalconduct,professionalincompetence,
59malpracticeoranyotherviolationofanyprovisionofthischapter;
60 (h)Signingablankprescriptionform;ordispensing,prescribing,administeringor
61otherwisedistributinganydrug,controlledsubstanceorothertreatmentwithoutsufficient
62examinationincludingfailingtoestablishavalidphysician-patientrelationshippursuantto
63section334.108,orforotherthanmedicallyacceptedtherapeuticorexperimentalor
64investigativepurposesdulyauthorizedbyastateorfederalagency,ornotinthecourseof
65professionalpractice,ornotingoodfaithtorelievepainandsuffering,ornottocurean
66ailment,physicalinfirmityordisease,exceptasauthorizedinsection334.104;
67 (i)Exercisinginfluencewithinaphysician-patientrelationshipforpurposesof
68engagingapatientinsexualactivity;
69 (j)Beinglistedonanystateorfederalsexualoffenderregistry;
70 (k)Terminatingthemedicalcareofapatientwithoutadequatenoticeorwithout
71makingotherarrangementsforthecontinuedcareofthepatient;
72 (l)Failingtofurnishdetailsofapatient'smedicalrecordstoothertreatingphysicians
73orhospitalsuponproperrequest;orfailingtocomplywithanyotherlawrelatingtomedical
74records;
75 (m)Failureofanyapplicantorlicenseetocooperatewiththeboardduringany
76investigation;
77 (n)Failuretocomplywithanysubpoenaorsubpoenaducestecumfromtheboardor
78anorderoftheboard;
79 (o)Failuretotimelypaylicenserenewalfeesspecifiedinthischapter;
80 (p)Violatingaprobationagreement,order,orothersettlementagreementwiththis
81boardoranyotherlicensingagency;
82 (q)Failingtoinformtheboardofthephysician'scurrentresidenceandbusiness
83address;
84 (r)Advertisingbyanapplicantorlicenseewhichisfalseormisleading,orwhich
85violatesanyruleoftheboard,orwhichclaimswithoutsubstantiationthepositivecureofany
86disease,orprofessionalsuperioritytoorgreaterskillthanthatpossessedbyanyother
87physician.Anapplicantorlicenseeshallalsobeinviolationofthisprovisioniftheapplicant
88orlicenseehasafinancialinterestinanyorganization,corporationorassociationwhichissues
89orconductssuchadvertising;
90 (s)Anyotherconductthatisunethicalorunprofessionalinvolvingaminor;
91 (5)Anyconductorpracticewhichisormightbeharmfulordangeroustothemental
92orphysicalhealthofapatientorthepublic;orincompetency,grossnegligenceorrepeated
93negligenceintheperformanceofthefunctionsordutiesofanyprofessionlicensedor
94regulatedbythischapter.Forthepurposesofthissubdivision,"repeatednegligence"means
HB1304 21 95thefailure,onmorethanoneoccasion,tousethatdegreeofskillandlearningordinarilyused
96underthesameorsimilarcircumstancesbythememberoftheapplicant'sorlicensee's
97profession;
98 (6)Violationof,orattemptingtoviolate,directlyorindirectly,orassistingor
99enablinganypersontoviolate,anyprovisionofthischapterorchapter324,orofanylawful
100ruleorregulationadoptedpursuanttothischapterorchapter324;
101 (7)Impersonationofanypersonholdingacertificateofregistrationorauthority,
102permitorlicenseorallowinganypersontousehisorhercertificateofregistrationor
103authority,permit,licenseordiplomafromanyschool;
104 (8)Revocation,suspension,restriction,modification,limitation,reprimand,warning,
105censure,probationorotherfinaldisciplinaryactionagainsttheholderoforapplicantfora
106licenseorotherrighttopracticeanyprofessionregulatedbythischapterbyanotherstate,
107territory,federalagencyorcountry,whetherornotvoluntarilyagreedtobythelicenseeor
108applicant,including,butnotlimitedto,thedenialoflicensure,surrenderofthelicense,
109allowingthelicensetoexpireorlapse,ordiscontinuingorlimitingthepracticeofmedicine
110whilesubjecttoaninvestigationorwhileactuallyunderinvestigationbyanylicensing
111authority,medicalfacility,branchoftheArmedForcesoftheUnitedStatesofAmerica,
112insurancecompany,court,agencyofthestateorfederalgovernment,oremployer;
113 (9)Apersonisfinallyadjudgedincapacitatedordisabledbyacourtofcompetent
114jurisdiction;
115 (10)Assistingorenablinganypersontopracticeoroffertopracticeanyprofession
116licensedorregulatedbythischapterwhoisnotregisteredandcurrentlyeligibletopractice
117pursuanttothischapter;orknowinglyperforminganyactwhichinanywayaids,assists,
118procures,advises,orencouragesanypersontopracticemedicinewhoisnotregisteredand
119currentlyeligibletopracticepursuanttothischapter.Aphysicianwhoworksinaccordance
120withstandingordersorprotocolsorinaccordancewiththeprovisionsofsection334.104
121shallnotbeinviolationofthissubdivision;
122 (11)Issuanceofacertificateofregistrationorauthority,permitorlicensebasedupon
123amaterialmistakeoffact;
124 (12)Failuretodisplayavalidcertificateorlicenseifsorequiredbythischapteror
125anyrulepromulgatedpursuanttothischapter;
126 (13)Violationofthedruglawsorrulesandregulationsofthisstate,includingbutnot
127limitedtoanyprovisionofchapter195,anyotherstate,orthefederalgovernment;
128 (14)Knowinglymaking,orcausingtobemade,oraiding,orabettinginthemaking
129of,afalsestatementinanybirth,deathorothercertificateordocumentexecutedin
130connectionwiththepracticeoftheperson'sprofession;
131 (15)Knowinglymakingafalsestatement,orallyorinwritingtotheboard;
HB1304 22 132 (16)Solicitingpatronageinpersonorbyagentsorrepresentatives,orbyanyother
133meansormanner,undertheperson'sownnameorunderthenameofanotherpersonor
134concern,actualorpretended,insuchamannerastoconfuse,deceive,ormisleadthepublicas
135totheneedornecessityfororappropriatenessofhealthcareservicesforallpatients,orthe
136qualificationsofanindividualpersonorpersonstodiagnose,render,orperformhealthcare
137services;
138 (17)Using,orpermittingtheuseof,theperson'snameunderthedesignationof
139"Doctor","Dr.","M.D.",or"D.O.",oranysimilardesignationwithreferencetothe
140commercialexploitationofanygoods,waresormerchandise;
141 (18)Knowinglymakingorcausingtobemadeafalsestatementormisrepresentation
142ofamaterialfact,withintenttodefraud,forpaymentpursuanttotheprovisionsofchapter
143208orchapter630orforpaymentfromTitleXVIIIorTitleXIXoftheSocialSecurityAct;
144 (19)Failureorrefusaltoproperlyguardagainstcontagious,infectiousor
145communicablediseasesorthespreadthereof;maintaininganunsanitaryofficeor
146performingprofessionalservicesunderunsanitaryconditions;orfailuretoreportthe
147existenceofanunsanitaryconditionintheofficeofaphysicianorinanyhealthcarefacility
148totheboard,inwriting,withinthirtydaysafterthediscoverythereof;
149 (20)Anycandidateforlicensureorpersonlicensedtopracticeasaphysicaltherapist,
150payingorofferingtopayareferralfeeorevaluatingortreatingapatientinamanner
151inconsistentwithsection334.506;
152 (21)Anycandidateforlicensureorpersonlicensedtopracticeasaphysicaltherapist,
153treatingorattemptingtotreatailmentsorotherhealthconditionsofhumanbeingsotherthan
154byprofessionalphysicaltherapyandasauthorizedbysections334.500to334.620;
155 (22)Anypersonlicensedtopracticeasaphysicianorsurgeon,requiring,asa
156conditionofthephysician-patientrelationship,thatthepatientreceiveprescribeddrugs,
157devicesorotherprofessionalservicesdirectlyfromfacilitiesofthatphysician'sofficeorother
158entitiesunderthatphysician'sownershiporcontrol.Aphysicianshallprovidethepatient
159withaprescriptionwhichmaybetakentothefacilityselectedbythepatientandaphysician
160knowinglyfailingtodisclosetoapatientonaformapprovedbytheadvisorycommissionfor
161professionalphysicaltherapistsasestablishedbysection334.625whichisdatedandsigned
162byapatientorguardianacknowledgingthatthepatientorguardianhasreadandunderstands
163thatthephysicianhasapecuniaryinterestinaphysicaltherapyorrehabilitationservice
164providingprescribedtreatmentandthattheprescribedtreatmentisavailableonacompetitive
165basis.Thissubdivisionshallnotapplytoareferralbyonephysiciantoanotherphysician
166withinagroupofphysicianspracticingtogether;
167 (23)Apatternofpersonaluseorconsumptionofanycontrolledsubstanceunlessitis
168prescribed,dispensedoradministeredbyanotherphysicianwhoisauthorizedbylawtodoso;
HB1304 23 169 (24)Habitualintoxicationordependenceonalcohol,evidenceofwhichmayinclude
170morethanonealcohol-relatedenforcementcontactasdefinedbysection302.525;
171 (25)Failuretocomplywithatreatmentprogramoranaftercareprogramenteredinto
172aspartofaboardorder,settlementagreementorlicensee'sprofessionalhealthprogram;
173 (26)Revocation,suspension,limitation,probation,orrestrictionofanykind
174whatsoeverofanycontrolledsubstanceauthority,whetheragreedtovoluntarilyornot,or
175voluntaryterminationofacontrolledsubstanceauthoritywhileunderinvestigation[;
176 (27)Foraphysiciantooperate,conduct,manage,orestablishanabortionfacility,or
177foraphysiciantoperformanabortioninanabortionfacility,ifsuchfacilitycomesunderthe
178definitionofanambulatorysurgicalcenterpursuanttosections197.200to197.240,andsuch
179facilityhasfailedtoobtainorrenewalicenseasanambulatorysurgicalcenter].
180 3.Collaborativepracticearrangements,protocolsandstandingordersshallbein
181writingandsignedanddatedbyaphysicianpriortotheirimplementation.
182 4.Afterthefilingofsuchcomplaintbeforetheadministrativehearingcommission,
183theproceedingsshallbeconductedinaccordancewiththeprovisionsofchapter621.Upona
184findingbytheadministrativehearingcommissionthatthegrounds,providedinsubsection2
185ofthissection,fordisciplinaryactionaremet,theboardmay,singlyorincombination,warn,
186censureorplacethepersonnamedinthecomplaintonprobationonsuchtermsand
187conditionsastheboarddeemsappropriateforaperiodnottoexceedtenyears,ormay
188suspendtheperson'slicense,certificateorpermitforaperiodnottoexceedthreeyears,or
189restrictorlimittheperson'slicense,certificateorpermitforanindefiniteperiodoftime,or
190revoketheperson'slicense,certificate,orpermit,oradministerapublicorprivatereprimand,
191ordenytheperson'sapplicationforalicense,orpermanentlywithholdissuanceofalicenseor
192requirethepersontosubmittothecare,counselingortreatmentofphysiciansdesignatedby
193theboardattheexpenseoftheindividualtobeexamined,orrequirethepersontoattendsuch
194continuingeducationalcoursesandpasssuchexaminationsastheboardmaydirect.
195 5.Inanyorderofrevocation,theboardmayprovidethatthepersonmaynotapplyfor
196reinstatementoftheperson'slicenseforaperiodoftimerangingfromtwotosevenyears
197followingthedateoftheorderofrevocation.Allstayordersshalltollthistimeperiod.
198 6.Beforerestoringtogoodstandingalicense,certificateorpermitissuedpursuantto
199thischapterwhichhasbeeninarevoked,suspendedorinactivestateforanycauseformore
200thantwoyears,theboardmayrequiretheapplicanttoattendsuchcontinuingmedical
201educationcoursesandpasssuchexaminationsastheboardmaydirect.
202 7.Inanyinvestigation,hearingorotherproceedingtodeterminealicensee'sor
203applicant'sfitnesstopractice,anyrecordrelatingtoanypatientofthelicenseeorapplicant
204shallbediscoverablebytheboardandadmissibleintoevidence,regardlessofanystatutoryor
205commonlawprivilegewhichsuchlicensee,applicant,recordcustodianorpatientmight
HB1304 24 206otherwiseinvoke.Inaddition,nosuchlicensee,applicant,orrecordcustodianmaywithhold
207recordsortestimonybearinguponalicensee'sorapplicant'sfitnesstopracticeontheground
208ofprivilegebetweensuchlicensee,applicantorrecordcustodianandapatient.
209 8.Theactoflawfullydispensing,prescribing,administering,orotherwise
210distributingivermectintabletsorhydroxychloroquinesulfatetabletsforhumanuseshall
211notbegroundsfordenial,suspension,revocation,orotherdisciplinaryactionbytheboard.
334.735.1.Asusedinsections334.735to334.749,thefollowingtermsmean:
2 (1)"Applicant",anyindividualwhoseekstobecomelicensedasaphysician
3assistant;
4 (2)"Certification"or"registration",aprocessbyacertifyingentitythatgrants
5recognitiontoapplicantsmeetingpredeterminedqualificationsspecifiedbysuchcertifying
6entity;
7 (3)"Certifyingentity",thenongovernmentalagencyorassociationwhichcertifiesor
8registersindividualswhohavecompletedacademicandtrainingrequirements;
9 (4)"Collaborativepracticearrangement",writtenagreements,jointlyagreedupon
10protocols,orstandingorders,allofwhichshallbeinwriting,forthedeliveryofhealthcare
11services;
12 (5)"Department",thedepartmentofcommerceandinsuranceoradesignatedagency
13thereof;
14 (6)"License",adocumentissuedtoanapplicantbytheboardacknowledgingthatthe
15applicantisentitledtopracticeasaphysicianassistant;
16 (7)"Physicianassistant",apersonwhohasgraduatedfromaphysicianassistant
17programaccreditedbytheAccreditationReviewCommissiononEducationforthePhysician
18Assistantoritssuccessoragency,priorto2001,ortheCommitteeonAlliedHealthEducation
19andAccreditationortheCommissiononAccreditationofAlliedHealthEducationPrograms,
20whohaspassedthecertifyingexaminationadministeredbytheNationalCommissionon
21CertificationofPhysicianAssistantsandhasactivecertificationbytheNationalCommission
22onCertificationofPhysicianAssistantswhoprovideshealthcareservicesdelegatedbya
23licensedphysician.Apersonwhohasbeenemployedasaphysicianassistantforthreeyears
24priortoAugust28,1989,whohaspassedtheNationalCommissiononCertificationof
25PhysicianAssistantsexamination,andhasactivecertificationoftheNationalCommissionon
26CertificationofPhysicianAssistants;
27 (8)"Recognition",theformalprocessofbecomingacertifyingentityasrequiredby
28theprovisionsofsections334.735to334.749.
29 2.Thescopeofpracticeofaphysicianassistantshallconsistonlyofthefollowing
30servicesandprocedures:
31 (1)Takingpatienthistories;
HB1304 25 32 (2)Performingphysicalexaminationsofapatient;
33 (3)Performingorassistingintheperformanceofroutineofficelaboratoryandpatient
34screeningprocedures;
35 (4)Performingroutinetherapeuticprocedures;
36 (5)Recordingdiagnosticimpressionsandevaluatingsituationscallingforattentionof
37aphysiciantoinstitutetreatmentprocedures;
38 (6)Instructingandcounselingpatientsregardingmentalandphysicalhealthusing
39proceduresreviewedandapprovedbyacollaboratingphysician;
40 (7)Assistingthesupervisingphysicianininstitutionalsettings,includingreviewing
41oftreatmentplans,orderingoftestsanddiagnosticlaboratoryandradiologicalservices,and
42orderingoftherapies,usingproceduresreviewedandapprovedbyalicensedphysician;
43 (8)Assistinginsurgery;and
44 (9)Performingsuchothertasksnotprohibitedbylawunderthecollaborativepractice
45arrangementwithalicensedphysicianasthephysicianassistanthasbeentrainedandis
46proficienttoperform.
47 3.[Physicianassistantsshallnotperformorprescribeabortions.
48 4.]Physicianassistantsshallnotprescribeanydrug,medicine,deviceortherapy
49unlesspursuanttoacollaborativepracticearrangementinaccordancewiththelaw,nor
50prescribelenses,prismsorcontactlensesfortheaid,relieforcorrectionofvisionorthe
51measurementofvisualpowerorvisualefficiencyofthehumaneye,noradministerormonitor
52generalorregionalblockanesthesiaduringdiagnostictests,surgeryorobstetricprocedures.
53Prescribingofdrugs,medications,devicesortherapiesbyaphysicianassistantshallbe
54pursuanttoacollaborativepracticearrangementwhichisspecifictotheclinicalconditions
55treatedbythesupervisingphysicianandthephysicianassistantshallbesubjecttothe
56following:
57 (1)Aphysicianassistantshallonlyprescribecontrolledsubstancesinaccordance
58withsection334.747;
59 (2)Thetypesofdrugs,medications,devicesortherapiesprescribedbyaphysician
60assistantshallbeconsistentwiththescopesofpracticeofthephysicianassistantandthe
61collaboratingphysician;
62 (3)Allprescriptionsshallconformwithstateandfederallawsandregulationsand
63shallincludethename,addressandtelephonenumberofthephysicianassistant;
64 (4)Aphysicianassistant,oradvancedpracticeregisterednurseasdefinedinsection
65335.016mayrequest,receiveandsignfornoncontrolledprofessionalsamplesandmay
66distributeprofessionalsamplestopatients;and
67 (5)Aphysicianassistantshallnotprescribeanydrugs,medicines,devicesor
68therapiesthecollaboratingphysicianisnotqualifiedorauthorizedtoprescribe.
HB1304 26 69 [5.]4.Aphysicianassistantshallclearlyidentifyhimselforherselfasaphysician
70assistantandshallnotuseorpermittobeusedinthephysicianassistant'sbehalftheterms
71"doctor","Dr."or"doc"norholdhimselforherselfoutinanywaytobeaphysicianor
72surgeon.Nophysicianassistantshallpracticeorattempttopracticewithoutphysician
73collaborationorinanylocationwherethecollaboratingphysicianisnotimmediately
74availableforconsultation,assistanceandintervention,exceptasotherwiseprovidedinthis
75section,andinanemergencysituation,norshallanyphysicianassistantbillapatient
76independentlyordirectlyforanyservicesorprocedurebythephysicianassistant;exceptthat,
77nothinginthissubsectionshallbeconstruedtoprohibitaphysicianassistantfromenrolling
78withathird-partyplanorthedepartmentofsocialservicesasaMOHealthNetorMedicaid
79providerwhileactingunderacollaborativepracticearrangementbetweenthephysicianand
80physicianassistant.
81 [6.]5.Thelicensingofphysicianassistantsshalltakeplacewithinprocesses
82establishedbythestateboardofregistrationforthehealingartsthroughruleandregulation.
83Theboardofhealingartsisauthorizedtoestablishrulespursuanttochapter536establishing
84licensingandrenewalprocedures,collaboration,collaborativepracticearrangements,fees,
85andaddressingsuchothermattersasarenecessarytoprotectthepublicanddisciplinethe
86profession.Anapplicationforlicensingmaybedeniedorthelicenseofaphysicianassistant
87maybesuspendedorrevokedbytheboardinthesamemannerandforviolationofthe
88standardsassetforthbysection334.100,orsuchotherstandardsofconductsetbytheboard
89byruleorregulation.Personslicensedpursuanttotheprovisionsofchapter335shallnotbe
90requiredtobelicensedasphysicianassistants.Allapplicantsforphysicianassistantlicensure
91whocompleteaphysicianassistanttrainingprogramafterJanuary1,2008,shallhavea
92master'sdegreefromaphysicianassistantprogram.
93 [7.]6.Atalltimesthephysicianisresponsiblefortheoversightoftheactivitiesof,
94andacceptsresponsibilityfor,healthcareservicesrenderedbythephysicianassistant.
95 [8.]7.(1)Aphysicianmayenterintocollaborativepracticearrangementswith
96physicianassistants.Collaborativepracticearrangements,whichshallbeinwriting,may
97delegatetoaphysicianassistanttheauthoritytoprescribe,administer,ordispensedrugsand
98providetreatmentwhichiswithintheskill,training,andcompetenceofthephysician
99assistant.Collaborativepracticearrangementsmaydelegatetoaphysicianassistant,as
100definedinsection334.735,theauthoritytoadminister,dispense,orprescribecontrolled
101substanceslistedinSchedulesIII,IV,andVofsection195.017,andScheduleII-
102hydrocodone.ScheduleIIInarcoticcontrolledsubstancesandScheduleII-hydrocodone
103prescriptionsshallbelimitedtoaonehundredtwenty-hoursupplywithoutrefill.Such
104collaborativepracticearrangementsshallbeintheformofawrittenarrangement,jointly
105agreed-uponprotocols,orstandingordersforthedeliveryofhealthcareservices.
HB1304 27 106 (2)Notwithstandinganyotherprovisionofthissectiontothecontrary,acollaborative
107practicearrangementmaydelegatetoaphysicianassistanttheauthoritytoadminister,
108dispense,orprescribeScheduleIIcontrolledsubstancesforhospicepatients;provided,that
109thephysicianassistantisemployedbyahospiceprovidercertifiedpursuanttochapter197
110andthephysicianassistantisprovidingcaretohospicepatientspursuanttoacollaborative
111practicearrangementthatdesignatesthecertifiedhospiceasalocationwherethephysician
112assistantisauthorizedtopracticeandprescribe.
113 [9.]8.Thewrittencollaborativepracticearrangementshallcontainatleastthe
114followingprovisions:
115 (1)Completenames,homeandbusinessaddresses,zipcodes,andtelephonenumbers
116ofthecollaboratingphysicianandthephysicianassistant;
117 (2)Alistofallotherofficesorlocations,otherthanthoselistedinsubdivision(1)of
118thissubsection,wherethecollaboratingphysicianhasauthorizedthephysicianassistantto
119prescribe;
120 (3)Arequirementthatthereshallbepostedateveryofficewherethephysician
121assistantisauthorizedtoprescribe,incollaborationwithaphysician,aprominentlydisplayed
122disclosurestatementinformingpatientsthattheymaybeseenbyaphysicianassistantand
123havetherighttoseethecollaboratingphysician;
124 (4)Allspecialtyorboardcertificationsofthecollaboratingphysicianandall
125certificationsofthephysicianassistant;
126 (5)Themannerofcollaborationbetweenthecollaboratingphysicianandthe
127physicianassistant,includinghowthecollaboratingphysicianandthephysicianassistant
128will:
129 (a)Engageincollaborativepracticeconsistentwitheachprofessional'sskill,training,
130education,andcompetence;
131 (b)Maintaingeographicproximity,asdeterminedbytheboardofregistrationforthe
132healingarts;and
133 (c)Providecoverageduringabsence,incapacity,infirmity,oremergencyofthe
134collaboratingphysician;
135 (6)Alistofallotherwrittencollaborativepracticearrangementsofthecollaborating
136physicianandthephysicianassistant;
137 (7)Thedurationofthewrittenpracticearrangementbetweenthecollaborating
138physicianandthephysicianassistant;
139 (8)Adescriptionofthetimeandmannerofthecollaboratingphysician'sreviewof
140thephysicianassistant'sdeliveryofhealthcareservices.Thedescriptionshallinclude
141provisionsthatthephysicianassistantshallsubmitaminimumoftenpercentofthecharts
142documentingthephysicianassistant'sdeliveryofhealthcareservicestothecollaborating
HB1304 28 143physicianforreviewbythecollaboratingphysician,oranyotherphysiciandesignatedinthe
144collaborativepracticearrangement,everyfourteendays.Reviewsmaybeconducted
145electronically;
146 (9)Thecollaboratingphysician,oranyotherphysiciandesignatedinthe
147collaborativepracticearrangement,shallrevieweveryfourteendaysaminimumoftwenty
148percentofthechartsinwhichthephysicianassistantprescribescontrolledsubstances.The
149chartsreviewedunderthissubdivisionmaybecountedinthenumberofchartsrequiredtobe
150reviewedundersubdivision(8)ofthissubsection;
151 (10)Astatementthatnocollaborationrequirementsinadditiontothefederallaw
152shallberequiredforaphysician-physicianassistantteamworkinginacertifiedcommunity
153behavioralhealthclinicasdefinedbyPub.L.113-93,oraruralhealthclinicunderthefederal
154RuralHealthServicesAct,Pub.L.95-210,asamended,orafederallyqualifiedhealthcenter
155asdefinedin42U.S.C.Section1395x,asamended;and
156 (11)Ifacollaborativepracticearrangementisusedinclinicalsituationswherea
157collaboratingphysicianassistantprovideshealthcareservicesthatincludethediagnosisand
158initiationoftreatmentforacutelyorchronicallyillorinjuredpersons,thenthecollaborating
159physicianoranyotherphysiciandesignatedinthecollaborativepracticearrangementshallbe
160presentforsufficientperiodsoftime,atleastonceeverytwoweeks,exceptinextraordinary
161circumstancesthatshallbedocumented,toparticipateinachartreviewandtoprovide
162necessarymedicaldirection,medicalservices,consultations,andsupervisionofthehealth
163carestaff.
164 [10.]9.Thestateboardofregistrationforthehealingartsundersection334.125may
165promulgaterulesregulatingtheuseofcollaborativepracticearrangements.
166 [11.]10.Thestateboardofregistrationforthehealingartsshallnotdeny,revoke,
167suspend,orotherwisetakedisciplinaryactionagainstacollaboratingphysicianforhealthcare
168servicesdelegatedtoaphysicianassistant,providedthattheprovisionsofthissectionandthe
169rulespromulgatedthereunderaresatisfied.
170 [12.]11.Withinthirtydaysofanychangeandoneachrenewal,thestateboardof
171registrationforthehealingartsshallrequireeveryphysiciantoidentifywhetherthephysician
172isengagedinanycollaborativepracticearrangement,includingcollaborativepractice
173arrangementsdelegatingtheauthoritytoprescribecontrolledsubstances,andalsoreportto
174theboardthenameofeachphysicianassistantwithwhomthephysicianhasenteredintosuch
175arrangement.Theboardmaymakesuchinformationavailabletothepublic.Theboardshall
176trackthereportedinformationandmayroutinelyconductrandomreviewsofsuch
177arrangementstoensurethatthearrangementsarecarriedoutincompliancewiththischapter.
178 [13.]12.Thecollaboratingphysicianshalldetermineanddocumentthecompletionof
179aperiodoftimeduringwhichthephysicianassistantshallpracticewiththecollaborating
HB1304 29 180physiciancontinuouslypresentbeforepracticinginasettingwherethecollaborating
181physicianisnotcontinuouslypresent.Thislimitationshallnotapplytocollaborative
182arrangementsofprovidersofpopulation-basedpublichealthservicesasdefinedby20CSR
1832150-5.100asofApril30,2009.
184 [14.]13.Nocontractorotherarrangementshallrequireaphysiciantoactasa
185collaboratingphysicianforaphysicianassistantagainstthephysician'swill.Aphysician
186shallhavetherighttorefusetoactasasupervisingphysician,withoutpenalty,foraparticular
187physicianassistant.Nocontractorotheragreementshalllimitthecollaboratingphysician's
188ultimateauthorityoveranyprotocolsorstandingordersorinthedelegationofthephysician's
189authoritytoanyphysicianassistant.Nocontractorotherarrangementshallrequireany
190physicianassistanttocollaboratewithanyphysicianagainstthephysicianassistant'swill.A
191physicianassistantshallhavetherighttorefusetocollaborate,withoutpenalty,witha
192particularphysician.
193 [15.]14.Physicianassistantsshallfilewiththeboardacopyoftheircollaborating
194physicianform.
195 [16.]15.Nophysicianshallbedesignatedtoserveasacollaboratingphysicianfor
196morethansixfull-timeequivalentlicensedphysicianassistants,full-timeequivalent
197advancedpracticeregisterednurses,orfull-timeequivalentassistantphysicians,orany
198combinationthereof.Thislimitationshallnotapplytophysicianassistantcollaborative
199practicearrangementsofhospitalemployeesprovidinginpatientcareserviceinhospitalsas
200definedinchapter197,ortoacertifiedregisterednurseanesthetistprovidinganesthesia
201servicesunderthesupervisionofananesthesiologistorotherphysician,dentist,orpodiatrist
202whoisimmediatelyavailableifneededassetoutinsubsection7ofsection334.104.
203 [17.]16.Noarrangementmadeunderthissectionshallsupercedecurrenthospital
204licensingregulationsgoverninghospitalmedicationordersunderprotocolsorstandingorders
205forthepurposeofdeliveringinpatientoremergencycarewithinahospital,asdefinedin
206section197.020,ifsuchprotocolsorstandingordershavebeenapprovedbythehospital's
207medicalstaffandpharmaceuticaltherapeuticscommittee.
595.027.1.Uponrequestbythedepartmentforverificationofinjuriesofvictims,
2medicalprovidersshallsubmittheinformationrequestedbythedepartmentwithintwenty
3workingdaysoftherequestatnocosttothefund.
4 2.Forpurposesofthissection,"medicalproviders"meansphysicians,dentists,
5clinicalpsychologists,optometrists,podiatrists,registerednurses,physician'sassistants,
6chiropractors,physicaltherapists,hospitals,ambulatorysurgicalcenters,[abortionfacilities,]
7andnursinghomes.
8 3.Failuretosubmittheinformationasrequiredbythissectionshallbeaninfraction.
HB1304 30 [188.017.1.Thissectionshallbeknownandmaybecitedasthe
2 "RighttoLifeoftheUnbornChildAct".
3 2.Notwithstandinganyotherprovisionoflawtothecontrary,no
4 abortionshallbeperformedorinduceduponawoman,exceptincasesof
5 medicalemergency.Anypersonwhoknowinglyperformsorinducesan
6 abortionofanunbornchildinviolationofthissubsectionshallbeguiltyofa
7 classBfelony,aswellassubjecttosuspensionorrevocationofhisorher
8 professionallicensebyhisorherprofessionallicensingboard.Awomanupon
9 whomanabortionisperformedorinducedinviolationofthissubsectionshall
10 notbeprosecutedforaconspiracytoviolatetheprovisionsofthissubsection.
11 3.Itshallbeanaffirmativedefenseforanypersonallegedtohave
12 violatedtheprovisionsofsubsection2ofthissectionthattheperson
13 performedorinducedanabortionbecauseofamedicalemergency.The
14 defendantshallhavetheburdenofpersuasionthatthedefenseismore
15 probablytruethannot.
16 4.Theenactmentofthissectionshallonlybecomeeffectiveupon
17 notificationtotherevisorofstatutesbyanopinionbytheattorneygeneralof
18 Missouri,aproclamationbythegovernorofMissouri,ortheadoptionofa
19 concurrentresolutionbytheMissourigeneralassemblythat:
20 (1)TheUnitedStatesSupremeCourthasoverruled,inwholeorin
21 part,Roev.Wade,410U.S.113(1973),restoringorgrantingtothestateof
22 Missouritheauthoritytoregulateabortiontotheextentsetforthinthis
23 section,andthatasaresult,itisreasonablyprobablethatthissectionwouldbe
24 upheldbythecourtasconstitutional;
25 (2)AnamendmenttotheConstitutionoftheUnitedStateshasbeen
26 adoptedthathastheeffectofrestoringorgrantingtothestateofMissourithe
27 authoritytoregulateabortiontotheextentsetforthinthissection;or
28 (3)TheUnitedStatesCongresshasenactedalawthathastheeffectof
29 restoringorgrantingtothestateofMissouritheauthoritytoregulateabortion
30 totheextentsetforthinthissection.]
[188.020.Nopersonshallperformorinduceanabortionexcepta
2 physician.]
[188.021.1.WhenRU-486(mifepristone)oranydrugorchemicalis
2 usedforthepurposeofinducinganabortion,theinitialdoseofthedrugor
3 chemicalshallbeadministeredinthesameroomandinthephysicalpresence
4 ofthephysicianwhoprescribed,dispensed,orotherwiseprovidedthedrugor
5 chemicaltothepatient.Thephysicianinducingtheabortion,oraperson
6 actingonsuchphysician'sbehalf,shallmakeallreasonableeffortstoensure
7 thatthepatientreturnsaftertheadministrationoruseofRU-486oranydrugor
8 chemicalforafollow-upvisitunlesssuchterminationofthepregnancyhas
9 alreadybeenconfirmedandthepatient'smedicalconditionhasbeenassessed
10 byalicensedphysicianpriortodischarge.
11 2.WhentheFoodandDrugAdministrationlabelofanydrugor
12 chemicalusedforthepurposeofinducinganabortionincludesanyclinical
13 studyinwhichmorethanonepercentofthoseadministeredthedrugor
14 chemicalrequiredsurgicalinterventionafteritsadministration,nophysician
HB1304 31 15 mayprescribeoradministersuchdrugorchemicaltoanypatientwithoutfirst
16 obtainingapprovalfromthedepartmentofhealthandseniorservicesofa
17 complicationplanfromthephysicianforadministrationofthedrugor
18 chemicaltoanypatient.Thecomplicationplanshallincludeanyinformation
19 deemednecessarybythedepartmenttoensurethesafetyofanypatient
20 sufferingcomplicationsasaresultoftheadministrationofthedrugor
21 chemicalinquestion.Nocomplicationplanshallberequiredwherethe
22 patientisadministeredthedruginamedicalemergencyatahospitalandis
23 thentreatedasaninpatientatahospitalundermedicalmonitoringbythe
24 hospitaluntiltheabortioniscompleted.
25 3.Thedepartmentmayadoptrules,regulations,andstandards
26 governingcomplicationplanstoensurethatpatientsundergoingabortions
27 inducedbydrugsorchemicalshaveaccesstosafeandreliablecare.Anyrule
28 orportionofarule,asthattermisdefinedinsection536.010,thatiscreated
29 undertheauthoritydelegatedinthissectionshallbecomeeffectiveonlyifit
30 complieswithandissubjecttoalloftheprovisionsofchapter536and,if
31 applicable,section536.028.Thissectionandchapter536arenonseverable
32 andifanyofthepowersvestedwiththegeneralassemblypursuanttochapter
33 536toreview,todelaytheeffectivedate,ortodisapproveandannularuleare
34 subsequentlyheldunconstitutional,thenthegrantofrulemakingauthorityand
35 anyruleproposedoradoptedafterOctober24,2017,shallbeinvalidand
36 void.]
[188.027.1.Exceptincasesofmedicalemergency,noabortionshall
2 beperformedorinducedonawomanwithouthervoluntaryandinformed
3 consent,givenfreelyandwithoutcoercion.Consenttoanabortionis
4 voluntaryandinformedandgivenfreelyandwithoutcoercionif,andonlyif,
5 atleastseventy-twohourspriortotheabortion:
6 (1)Thephysicianwhoistoperformorinducetheabortion,aqualified
7 professional,orthereferringphysicianhasinformedthewomanorally,
8 reducedtowriting,andinperson,ofthefollowing:
9 (a)Thenameofthephysicianwhowillperformorinducethe
10 abortion;
11 (b)Medicallyaccurateinformationthatareasonablepatientwould
12 considermaterialtothedecisionofwhetherornottoundergotheabortion,
13 including:
14 a.Adescriptionoftheproposedabortionmethod;
15 b.Theimmediateandlong-termmedicalriskstothewoman
16 associatedwiththeproposedabortionmethodincluding,butnotlimitedto,
17 infection,hemorrhage,cervicaltearoruterineperforation,harmtosubsequent
18 pregnanciesortheabilitytocarryasubsequentchildtoterm,andpossible
19 adversepsychologicaleffectsassociatedwiththeabortion;and
20 c.Theimmediateandlong-termmedicalriskstothewoman,inlight
21 oftheanesthesiaandmedicationthatistobeadministered,theunbornchild's
22 gestationalage,andthewoman'smedicalhistoryandmedicalcondition;
23 (c)Alternativestotheabortionwhichshallincludemakingthewoman
24 awarethatinformationandmaterialsshallbeprovidedtoherdetailingsuch
25 alternativestotheabortion;
HB1304 32 26 (d)Astatementthatthephysicianperformingorinducingtheabortion
27 isavailableforanyquestionsconcerningtheabortion,togetherwiththe
28 telephonenumberthatthephysicianmaybelaterreachedtoanswerany
29 questionsthatthewomanmayhave;
30 (e)Thelocationofthehospitalthatoffersobstetricalorgynecological
31 carelocatedwithinthirtymilesofthelocationwheretheabortionisperformed
32 orinducedandatwhichthephysicianperformingorinducingtheabortionhas
33 clinicalprivilegesandwherethewomanmayreceivefollow-upcarebythe
34 physicianifcomplicationsarise;
35 (f)Thegestationalageoftheunbornchildatthetimetheabortionisto
36 beperformedorinduced;and
37 (g)Theanatomicalandphysiologicalcharacteristicsoftheunborn
38 childatthetimetheabortionistobeperformedorinduced;
39 (2)Thephysicianwhoistoperformorinducetheabortionora
40 qualifiedprofessionalhaspresentedthewoman,inperson,printedmaterials
41 providedbythedepartment,whichdescribetheprobableanatomicaland
42 physiologicalcharacteristicsoftheunbornchildattwo-weekgestational
43 incrementsfromconceptiontofullterm,includingcolorphotographsor
44 imagesofthedevelopingunbornchildattwo-weekgestationalincrements.
45 Suchdescriptionsshallincludeinformationaboutbrainandheartfunctions,
46 thepresenceofexternalmembersandinternalorgansduringtheapplicable
47 stagesofdevelopmentandinformationonwhentheunbornchildisviable.
48 Theprintedmaterialsshallprominentlydisplaythefollowingstatement:"The
49 lifeofeachhumanbeingbeginsatconception.Abortionwillterminatethelife
50 ofaseparate,unique,livinghumanbeing.";
51 (3)Thephysicianwhoistoperformorinducetheabortion,aqualified
52 professional,orthereferringphysicianhaspresentedthewoman,inperson,
53 printedmaterialsprovidedbythedepartment,whichdescribethevarious
54 surgicalanddrug-inducedmethodsofabortionrelevanttothestageof
55 pregnancy,aswellastheimmediateandlong-termmedicalriskscommonly
56 associatedwitheachabortionmethodincluding,butnotlimitedto,infection,
57 hemorrhage,cervicaltearoruterineperforation,harmtosubsequent
58 pregnanciesortheabilitytocarryasubsequentchildtoterm,andthe
59 possibleadversepsychologicaleffectsassociatedwithanabortion;
60 (4)Thephysicianwhoistoperformorinducetheabortionora
61 qualifiedprofessionalshallprovidethewomanwiththeopportunitytoviewat
62 leastseventy-twohourspriortotheabortionanactiveultrasoundoftheunborn
63 childandheartheheartbeatoftheunbornchildiftheheartbeatisaudible.The
64 womanshallbeprovidedwithageographicallyindexedlistmaintainedbythe
65 departmentofhealthcareproviders,facilities,andclinicsthatperform
66 ultrasounds,includingthosethatofferultrasoundservicesfreeofcharge.Such
67 materialsshallprovidecontactinformationforeachprovider,facility,orclinic
68 includingtelephonenumbersand,ifavailable,websiteaddresses.Shouldthe
69 womandecidetoobtainanultrasoundfromaprovider,facility,orclinicother
70 thantheabortionfacility,thewomanshallbeofferedareasonabletimeto
71 obtaintheultrasoundexaminationbeforethedateandtimesetforperforming
72 orinducinganabortion.Thepersonconductingtheultrasoundshallensure
73 thattheactiveultrasoundimageisofaqualityconsistentwithstandard
HB1304 33 74 medicalpracticeinthecommunity,containsthedimensionsoftheunborn
75 child,andaccuratelyportraysthepresenceofexternalmembersandinternal
76 organs,ifpresentorviewable,oftheunbornchild.Theauscultationoffetal
77 hearttonemustalsobeofaqualityconsistentwithstandardmedicalpractice
78 inthecommunity.Ifthewomanchoosestoviewtheultrasoundorhearthe
79 heartbeatorbothattheabortionfacility,theviewingorhearingorbothshall
80 beprovidedtoherattheabortionfacilityatleastseventy-twohourspriorto
81 theabortionbeingperformedorinduced;
82 (5)Theprintedmaterialsprovidedbythedepartmentshallinclude
83 informationonthepossibilityofanabortioncausingpainintheunbornchild.
84 Thisinformationshallinclude,butneednotbelimitedto,thefollowing:
85 (a)Unbornchildrenasearlyaseightweeksgestationalagestartto
86 showspontaneousmovementsandunbornchildrenatthisstageinpregnancy
87 showreflexresponsestotouch;
88 (b)Intheunbornchild,theareaaroundhisorhermouthandlipsisthe
89 firstpartoftheunbornchild'sbodytorespondtotouchandbyfourteenweeks
90 gestationalagemostoftheunbornchild'sbodyisresponsivetotouch;
91 (c)Painreceptorsontheunbornchild'sskindeveloparoundhisorher
92 mouthataroundseventoeightweeksgestationalage,aroundthepalmsofhis
93 orherhandsattentotenandahalfweeks,ontheabdominalwallatfifteen
94 weeks,andoverallofhisorherbodyatsixteenweeksgestationalage;
95 (d)Beginningatsixteenweeksgestationalageandlater,itispossible
96 forpaintobetransmittedfromreceptorstothecortexoftheunbornchild's
97 brain,wherethinkingandperceivingoccur;
98 (e)Whenaphysicianperformsalife-savingsurgery,heorshe
99 providesanesthesiatounbornchildrenasyoungassixteenweeksgestational
100 ageinordertoalleviatetheunbornchild'spain;and
101 (f)Adescriptionoftheactualstepsintheabortionproceduretobe
102 performedorinducedandatwhichstepstheabortionprocedurecouldbe
103 painfultotheunbornchild;
104 (6)Thephysicianwhoistoperformorinducetheabortionora
105 qualifiedprofessionalhaspresentedthewoman,inperson,printedmaterials
106 providedbythedepartmentexplainingtothewomanalternativestoabortion
107 shemaywishtoconsider.Suchmaterialsshall:
108 (a)Identifyonageographicalbasispublicandprivateagencies
109 availabletoassistawomanincarryingherunbornchildtoterm,andtoassist
110 herincaringforherdependentchildorplacingherchildforadoption,
111 includingagenciescommonlyknownandgenerallyreferredtoaspregnancy
112 resourcecenters,crisispregnancycenters,maternityhomes,andadoption
113 agencies.Suchmaterialsshallprovideacomprehensivelistbygeographical
114 areaoftheagencies,adescriptionoftheservicestheyoffer,andthetelephone
115 numbersandaddressesoftheagencies;providedthatsuchmaterialsshallnot
116 includeanyprograms,services,organizations,oraffiliatesoforganizations
117 thatperformorinduce,orassistintheperformingorinducingof,abortionsor
118 thatreferforabortions;
119 (b)ExplaintheMissourialternativestoabortionservicesprogram
120 undersection188.325,andanyotherprogramsandservicesavailableto
121 pregnantwomenandmothersofnewbornchildrenofferedbypublicorprivate
HB1304 34 122 agencieswhichassistawomanincarryingherunbornchildtotermandassist
123 herincaringforherdependentchildorplacingherchildforadoption,
124 includingbutnotlimitedtoprenatalcare;maternalhealthcare;newbornor
125 infantcare;mentalhealthservices;professionalcounselingservices;housing
126 programs;utilityassistance;transportationservices;food,clothing,and
127 suppliesrelatedtopregnancy;parentingskills;educationalprograms;job
128 trainingandplacementservices;drugandalcoholtestingandtreatment;and
129 adoptionassistance;
130 (c)IdentifythestatewebsitefortheMissourialternativestoabortion
131 servicesprogramundersection188.325,andanytoll-freenumberestablished
132 bythestateoperatedinconjunctionwiththeprogram;
133 (d)Prominentlydisplaythestatement:"Therearepublicandprivate
134 agencieswillingandabletohelpyoucarryyourchildtoterm,andtoassist
135 youandyourchildafteryourchildisborn,whetheryouchoosetokeepyour
136 childorplacehimorherforadoption.ThestateofMissouriencouragesyou
137 tocontactthoseagenciesbeforemakingafinaldecisionaboutabortion.State
138 lawrequiresthatyourphysicianoraqualifiedprofessionalgiveyouthe
139 opportunitytocallagencieslikethesebeforeyouundergoanabortion.";
140 (7)Thephysicianwhoistoperformorinducetheabortionora
141 qualifiedprofessionalhaspresentedthewoman,inperson,printedmaterials
142 providedbythedepartmentexplainingthatthefatheroftheunbornchildis
143 liabletoassistinthesupportofthechild,evenininstanceswherehehas
144 offeredtopayfortheabortion.Suchmaterialsshallincludeinformationon
145 thelegaldutiesandsupportobligationsofthefatherofachild,including,but
146 notlimitedto,childsupportpayments,andthefactthatpaternitymaybe
147 establishedbythefather'snameonabirthcertificateorstatementofpaternity,
148 orbycourtaction.Suchprintedmaterialsshallalsostatethatmore
149 informationconcerningpaternityestablishmentandchildsupportservicesand
150 enforcementmaybeobtainedbycallingthefamilysupportdivisionwithinthe
151 Missouridepartmentofsocialservices;and
152 (8)Thephysicianwhoistoperformorinducetheabortionora
153 qualifiedprofessionalshallinformthewomanthatsheisfreetowithholdor
154 withdrawherconsenttotheabortionatanytimewithoutaffectingherrightto
155 futurecareortreatmentandwithoutthelossofanystateorfederallyfunded
156 benefitstowhichshemightotherwisebeentitled.
157 2.Allinformationrequiredtobeprovidedtoawomanconsidering
158 abortionbysubsection1ofthissectionshallbepresentedtothewoman
159 individually,inthephysicalpresenceofthewomanandinaprivateroom,to
160 protectherprivacy,tomaintaintheconfidentialityofherdecision,toensure
161 thattheinformationfocusesonherindividualcircumstances,toensureshehas
162 anadequateopportunitytoaskquestions,andtoensurethatsheisnotavictim
163 ofcoercedabortion.Shouldawomanbeunabletoreadmaterialsprovidedto
164 her,theyshallbereadtoher.Shouldawomanneedaninterpreterto
165 understandtheinformationpresentedinthewrittenmaterials,aninterpreter
166 shallbeprovidedtoher.Shouldawomanaskquestionsconcerninganyofthe
167 informationormaterials,answersshallbeprovidedinalanguageshecan
168 understand.
HB1304 35 169 3.Noabortionshallbeperformedorinducedunlessanduntilthe
170 womanuponwhomtheabortionistobeperformedorinducedcertifiesin
171 writingonachecklistformprovidedbythedepartmentthatshehasbeen
172 presentedalltheinformationrequiredinsubsection1ofthissection,thatshe
173 hasbeenprovidedtheopportunitytoviewanactiveultrasoundimageofthe
174 unbornchildandheartheheartbeatoftheunbornchildifitisaudible,andthat
175 shefurthercertifiesthatshegiveshervoluntaryandinformedconsent,freely
176 andwithoutcoercion,totheabortionprocedure.
177 4.Nophysicianshallperformorinduceanabortionunlessanduntil
178 thephysicianhasobtainedfromthewomanhervoluntaryandinformed
179 consentgivenfreelyandwithoutcoercion.Ifthephysicianhasreasonto
180 believethatthewomanisbeingcoercedintohavinganabortion,thephysician
181 orqualifiedprofessionalshallinformthewomanthatservicesareavailablefor
182 herandshallprovideherwithprivateaccesstoatelephoneandinformation
183 aboutsuchservices,includingbutnotlimitedtothefollowing:
184 (1)Rapecrisiscenters,asdefinedinsection455.003;
185 (2)Sheltersforvictimsofdomesticviolence,asdefinedinsection
186 455.200;and
187 (3)Ordersofprotection,pursuanttochapter455.
188 5.Thephysicianwhoistoperformorinducetheabortionshall,at
189 leastseventy-twohourspriortosuchprocedure,informthewomanorallyand
190 inpersonof:
191 (1)Theimmediateandlong-termmedicalriskstothewoman
192 associatedwiththeproposedabortionmethodincluding,butnotlimitedto,
193 infection,hemorrhage,cervicaltearoruterineperforation,harmtosubsequent
194 pregnanciesortheabilitytocarryasubsequentchildtoterm,andpossible
195 adversepsychologicaleffectsassociatedwiththeabortion;and
196 (2)Theimmediateandlong-termmedicalriskstothewoman,inlight
197 oftheanesthesiaandmedicationthatistobeadministered,theunbornchild's
198 gestationalage,andthewoman'smedicalhistoryandmedicalconditions.
199 6.Nophysicianshallperformorinduceanabortionunlessanduntil
200 thephysicianhasreceivedandsignedacopyoftheformprescribedin
201 subsection3ofthissection.Thephysicianshallretainacopyoftheformin
202 thepatient'smedicalrecord.
203 7.Intheeventofamedicalemergency,thephysicianwhoperformed
204 orinducedtheabortionshallclearlycertifyinwritingthenatureand
205 circumstancesofthemedicalemergency.Thiscertificationshallbesignedby
206 thephysicianwhoperformedorinducedtheabortion,andshallbemaintained
207 undersection188.060.
208 8.Nopersonorentityshallrequire,obtain,oracceptpaymentforan
209 abortionfromoronbehalfofapatientuntilatleastseventy-twohourshave
210 passedsincethetimethattheinformationrequiredbysubsection1ofthis
211 sectionhasbeenprovidedtothepatient.Nothinginthissubsectionshall
212 prohibitapersonorentityfromnotifyingthepatientthatpaymentforthe
213 abortionwillberequiredaftertheseventy-two-hourperiodhasexpiredifshe
214 voluntarilychoosestohavetheabortion.
215 9.Theterm"qualifiedprofessional"asusedinthissectionshallrefer
216 toaphysician,physicianassistant,registerednurse,licensedpracticalnurse,
HB1304 36 217 psychologist,licensedprofessionalcounselor,orlicensedsocialworker,
218 licensedorregisteredunderchapter334,335,or337,actingunderthe
219 supervisionofthephysicianperformingorinducingtheabortion,andacting
220 withinthecourseandscopeofhisorherauthorityprovidedbylaw.The
221 provisionsofthissectionshallnotbeconstruedtoinanywayexpandthe
222 authorityotherwiseprovidedbylawrelatingtothelicensure,registration,or
223 scopeofpracticeofanysuchqualifiedprofessional.
224 10.ByNovember30,2010,thedepartmentshallproducethewritten
225 materialsandformsdescribedinthissection.Anywrittenmaterialsproduced
226 shallbeprintedinatypefacelargeenoughtobeclearlylegible.All
227 informationshallbepresentedinanobjective,unbiasedmannerdesignedto
228 conveyonlyaccuratescientificandmedicalinformation.Thedepartment
229 shallfurnishthewrittenmaterialsandformsatnocostandinsufficient
230 quantitytoanypersonwhoperformsorinducesabortions,ortoanyhospitalor
231 facilitythatprovidesabortions.Thedepartmentshallmakeallinformation
232 requiredbysubsection1ofthissectionavailabletothepublicthroughits
233 departmentwebsite.Thedepartmentshallmaintainatoll-free,twenty-four-
234 hourhotlinetelephonenumberwhereacallercanobtaininformationona
235 regionalbasisconcerningtheagenciesandservicesdescribedinsubsection1
236 ofthissection.Noidentifyinginformationregardingpersonswhousethe
237 websiteshallbecollectedormaintained.Thedepartmentshallmonitorthe
238 websiteonaregularbasistopreventtamperingandcorrectanyoperational
239 deficiencies.
240 11.Inordertopreservethecompellinginterestofthestatetoensure
241 thatthechoicetoconsenttoanabortionisvoluntaryandinformed,andgiven
242 freelyandwithoutcoercion,thedepartmentshallusetheproceduresfor
243 adoptionofemergencyrulesundersection536.025inordertopromulgateall
244 necessaryrules,forms,andothernecessarymaterialtoimplementthissection
245 byNovember30,2010.
246 12.Iftheprovisionsinsubsections1and8ofthissectionrequiringa
247 seventy-two-hourwaitingperiodforanabortionareevertemporarilyor
248 permanentlyrestrainedorenjoinedbyjudicialorder,thenthewaitingperiod
249 foranabortionshallbetwenty-fourhours;provided,however,thatifsuch
250 temporaryorpermanentrestrainingorderorinjunctionisstayedordissolved,
251 orotherwiseceasestohaveeffect,thewaitingperiodforanabortionshallbe
252 seventy-twohours.]
[188.030.1.Exceptinthecaseofamedicalemergency,noabortion
2 ofaviableunbornchildshallbeperformedorinducedunlesstheabortionis
3 necessarytopreservethelifeofthepregnantwomanwhoselifeisendangered
4 byaphysicaldisorder,physicalillness,orphysicalinjury,includingalife-
5 endangeringphysicalconditioncausedbyorarisingfromthepregnancyitself,
6 orwhencontinuationofthepregnancywillcreateaseriousriskofsubstantial
7 andirreversiblephysicalimpairmentofamajorbodilyfunctionofthe
8 pregnantwoman.Forpurposesofthissection,"majorbodilyfunction"
9 includes,butisnotlimitedto,functionsoftheimmunesystem,normalcell
10 growth,digestive,bowel,bladder,neurological,brain,respiratory,circulatory,
11 endocrine,andreproductivefunctions.
HB1304 37 12 2.Exceptinthecaseofamedicalemergency:
13 (1)Priortoperformingorinducinganabortionuponawoman,the
14 physicianshalldeterminethegestationalageoftheunbornchildinamanner
15 consistentwithacceptedobstetricalandneonatalpracticesandstandards.In
16 makingsuchdetermination,thephysicianshallmakesuchinquiriesofthe
17 pregnantwomanandperformorcausetobeperformedsuchmedical
18 examinations,imagingstudies,andtestsasareasonablyprudentphysician,
19 knowledgeableaboutthemedicalfactsandconditionsofboththewomanand
20 theunbornchildinvolved,wouldconsidernecessarytoperformandconsider
21 inmakinganaccuratediagnosiswithrespecttogestationalage;
22 (2)Ifthephysiciandeterminesthatthegestationalageoftheunborn
23 childistwentyweeksormore,priortoperformingorinducinganabortion
24 uponthewoman,thephysicianshalldetermineiftheunbornchildisviableby
25 usingandexercisingthatdegreeofcare,skill,andproficiencycommonly
26 exercisedbyaskillful,careful,andprudentphysician.Inmakingthis
27 determinationofviability,thephysicianshallperformorcausetobe
28 performedsuchmedicalexaminationsandtestsasarenecessarytomakea
29 findingofthegestationalage,weight,andlungmaturityoftheunbornchild
30 andshallentersuchfindingsanddeterminationofviabilityinthemedical
31 recordofthewoman;
32 (3)Ifthephysiciandeterminesthatthegestationalageoftheunborn
33 childistwentyweeksormore,andfurtherdeterminesthattheunbornchildis
34 notviableandperformsorinducesanabortionuponthewoman,thephysician
35 shallreportsuchfindingsanddeterminationsandthereasonsforsuch
36 determinationstothehealthcarefacilityinwhichtheabortionisperformed
37 andtothestateboardofregistrationforthehealingarts,andshallentersuch
38 findingsanddeterminationsinthemedicalrecordsofthewomanandinthe
39 individualabortionreportsubmittedtothedepartmentundersection188.052;
40 (4)(a)Ifthephysiciandeterminesthattheunbornchildisviable,the
41 physicianshallnotperformorinduceanabortionuponthewomanunlessthe
42 abortionisnecessarytopreservethelifeofthepregnantwomanorthata
43 continuationofthepregnancywillcreateaseriousriskofsubstantialand
44 irreversiblephysicalimpairmentofamajorbodilyfunctionofthewoman.
45 (b)Beforeaphysicianmayproceedwithperformingorinducingan
46 abortionuponawomanwhenithasbeendeterminedthattheunbornchildis
47 viable,thephysicianshallfirstcertifyinwritingthemedicalthreatposedto
48 thelifeofthepregnantwoman,orthemedicalreasonsthatcontinuationofthe
49 pregnancywouldcauseaseriousriskofsubstantialandirreversiblephysical
50 impairmentofamajorbodilyfunctionofthepregnantwoman.Upon
51 completionoftheabortion,thephysicianshallreportthereasonsand
52 determinationsfortheabortionofaviableunbornchildtothehealthcare
53 facilityinwhichtheabortionisperformedandtothestateboardofregistration
54 forthehealingarts,andshallentersuchfindingsanddeterminationsinthe
55 medicalrecordofthewomanandintheindividualabortionreportsubmittedto
56 thedepartmentundersection188.052.
57 (c)Beforeaphysicianmayproceedwithperformingorinducingan
58 abortionuponawomanwhenithasbeendeterminedthattheunbornchildis
59 viable,thephysicianwhoistoperformtheabortionshallobtaintheagreement
HB1304 38 60 ofasecondphysicianwithknowledgeofacceptedobstetricalandneonatal
61 practicesandstandardswhoshallconcurthattheabortionisnecessaryto
62 preservethelifeofthepregnantwoman,orthatcontinuationofthepregnancy
63 wouldcauseaseriousriskofsubstantialandirreversiblephysicalimpairment
64 ofamajorbodilyfunctionofthepregnantwoman.Thissecondphysician
65 shallalsoreportsuchreasonsanddeterminationstothehealthcarefacilityin
66 whichtheabortionistobeperformedandtothestateboardofregistrationfor
67 thehealingarts,andshallentersuchfindingsanddeterminationsinthe
68 medicalrecordofthewomanandtheindividualabortionreportsubmittedto
69 thedepartmentundersection188.052.Thesecondphysicianshallnothave
70 anylegalorfinancialaffiliationorrelationshipwiththephysicianperforming
71 orinducingtheabortion,exceptthatsuchprohibitionshallnotapplyto
72 physicianswhoselegalorfinancialaffiliationorrelationshipisaresultof
73 beingemployedbyorhavingstaffprivilegesatthesamehospitalastheterm
74 "hospital"isdefinedinsection197.020.
75 (d)Anyphysicianwhoperformsorinducesanabortionuponawoman
76 whenithasbeendeterminedthattheunbornchildisviableshallutilizethe
77 availablemethodortechniqueofabortionmostlikelytopreservethelifeor
78 healthoftheunbornchild.Incaseswherethemethodortechniqueofabortion
79 mostlikelytopreservethelifeorhealthoftheunbornchildwouldpresenta
80 greaterrisktothelifeorhealthofthewomanthananotherlegallypermitted
81 andavailablemethodortechnique,thephysicianmayutilizesuchother
82 methodortechnique.Inallcaseswherethephysicianperformsanabortion
83 uponaviableunbornchild,thephysicianshallcertifyinwritingtheavailable
84 methodortechniquesconsideredandthereasonsforchoosingthemethodor
85 techniqueemployed.
86 (e)Nophysicianshallperformorinduceanabortionuponawoman
87 whenithasbeendeterminedthattheunbornchildisviableunlessthereisin
88 attendanceaphysicianotherthanthephysicianperformingorinducingthe
89 abortionwhoshalltakecontrolofandprovideimmediatemedicalcarefora
90 childbornasaresultoftheabortion.Duringtheperformanceoftheabortion,
91 thephysicianperformingit,andsubsequenttotheabortion,thephysician
92 requiredtobeinattendance,shalltakeallreasonablestepsinkeepingwith
93 goodmedicalpractice,consistentwiththeprocedureused,topreservethelife
94 orhealthoftheviableunbornchild;providedthatitdoesnotposeanincreased
95 risktothelifeofthewomanordoesnotposeanincreasedriskofsubstantial
96 andirreversiblephysicalimpairmentofamajorbodilyfunctionofthewoman.
97 3.Anypersonwhoknowinglyperformsorinducesanabortionofan
98 unbornchildinviolationoftheprovisionsofthissectionisguiltyofaclassD
99 felony,and,uponafindingofguiltorpleaofguilty,shallbeimprisonedfora
100 termofnotlessthanoneyear,and,notwithstandingtheprovisionsofsection
101 558.002,shallbefinednotlessthantenthousandnormorethanfiftythousand
102 dollars.
103 4.Anyphysicianwhopleadsguiltytoorisfoundguiltyofperforming
104 orinducinganabortionofanunbornchildinviolationofthissectionshallbe
105 subjecttosuspensionorrevocationofhisorherlicensetopracticemedicinein
106 thestateofMissouribythestateboardofregistrationforthehealingartsunder
107 theprovisionsofsections334.100and334.103.
HB1304 39 108 5.AnyhospitallicensedinthestateofMissourithatknowinglyallows
109 anabortionofanunbornchildtobeperformedorinducedinviolationofthis
110 sectionmaybesubjecttosuspensionorrevocationofitslicenseunderthe
111 provisionsofsection197.070.
112 6.AnyabortionfacilitylicensedinthestateofMissourithat
113 knowinglyallowsanabortionofanunbornchildtobeperformedorinducedin
114 violationofthissectionmaybesubjecttosuspensionorrevocationofits
115 licenseundertheprovisionsofsection197.220.
116 7.Awomanuponwhomanabortionisperformedorinducedin
117 violationofthissectionshallnotbeprosecutedforaconspiracytoviolatethe
118 provisionsofthissection.
119 8.Nothinginthissectionshallbeconstruedascreatingorrecognizing
120 arighttoabortion,norisittheintentionofthissectiontomakelawfulany
121 abortionthatiscurrentlyunlawful.
122 9.Itistheintentofthelegislaturethatthissectionbeseverableas
123 notedinsection1.140.Intheeventthatanysection,subsection,subdivision,
124 paragraph,sentence,orclauseofthissectionbedeclaredinvalidunderthe
125 ConstitutionoftheUnitedStatesortheConstitutionoftheStateofMissouri,it
126 istheintentofthelegislaturethattheremainingprovisionsofthissection
127 remaininforceandeffectasfarascapableofbeingcarriedintoexecutionas
128 intendedbythelegislature.
129 10.Thegeneralassemblymay,byconcurrentresolution,appointone
130 ormoreofitsmemberswhosponsoredorco-sponsoredthisactinhisorher
131 officialcapacitytointerveneasamatterofrightinanycaseinwhichthe
132 constitutionalityofthislawischallenged.]
[188.033.Wheneveranabortionfacilityorafamilyplanningagency
2 locatedinthisstate,oranyofitsagentsoremployeesactingwithinthescope
3 ofhisorherauthorityoremployment,providestoawomanconsideringan
4 abortionthename,address,telephonenumber,orwebsiteofanabortion
5 providerthatislocatedoutsideofthestate,suchabortionfacilityorfamily
6 planningagencyoritsagentsoremployeesshallalsoprovidetosuchwoman
7 theprintedmaterialsproducedbythedepartmentundersection188.027.Ifthe
8 name,address,telephonenumber,orwebsiteofsuchabortionproviderisnot
9 providedtosuchwomaninperson,suchprintedmaterialsshallbeofferedto
10 her,andifshechooses,senttosuchwomanatnocosttoherthesamedayoras
11 soonaspossibleeitherelectronicallyorbyU.S.mailovernightdelivery
12 serviceorbyotherovernightorsame-daydeliveryservicetoanaddressof
13 suchwoman'schoosing.Thedepartmentshallfurnishsuchprintedmaterials
14 atnocostandinsufficientquantitiestoabortionfacilitiesandfamilyplanning
15 agencieslocatedwithinthestate.]
[188.038.1.Thegeneralassemblyofthisstatefindsthat:
2 (1)Removingvestigesofanypastbiasordiscriminationagainst
3 pregnantwomen,theirpartners,andtheirfamilymembers,includingtheir
4 unbornchildren,isanimportanttaskforthoseinthelegal,medical,social
5 services,andhumanservicesprofessions;
HB1304 40 6 (2)Endinganycurrentbiasordiscriminationagainstpregnantwomen,
7 theirpartners,andtheirfamilymembers,includingtheirunbornchildren,isa
8 legitimatepurposeofgovernmentinordertoguaranteethatthosewho"are
9 endowedbytheirCreatorwithcertainunalienableRights"canenjoy"Life,
10 LibertyandthepursuitofHappiness";
11 (3)Thehistoricalrelationshipofbiasordiscriminationbysome
12 familyplanningprogramsandpoliciestowardspoorandminoritypopulations,
13 including,butnotlimitedto,thenonconsensualsterilizationofmentallyill,
14 poor,minority,andimmigrantwomenandothercoercivefamilyplanning
15 programsandpolicies,mustberejected;
16 (4)AmongMissouriresidents,therateofblackorAfrican-American
17 womenwhoundergoabortionsissignificantlyhigher,aboutthreeandone-half
18 timeshigher,thantherateofwhitewomenwhoundergoabortions.Among
19 Missouriresidents,therateofblackorAfrican-Americanwomenwho
20 undergorepeatabortionsissignificantlyhigher,aboutoneandone-halftimes
21 higher,thantherateofwhitewomenwhoundergorepeatabortions;
22 (5)Performingorinducinganabortionbecauseofthesexofthe
23 unbornchildisrepugnanttothevaluesofequalityoffemalesandmalesand
24 thesameopportunitiesforgirlsandboys,andfurthersafalsemindsetof
25 femaleinferiority;
26 (6)Governmenthasalegitimateinterestinpreventingtheabortionof
27 unbornchildrenwithDownSyndromebecauseitisaformofbiasordisability
28 discriminationandvictimizesthedisabledunbornchildathisorhermost
29 vulnerablestage.EliminatingunbornchildrenwithDownSyndromeraises
30 graveconcernsforthelivesofthosewhodolivewithdisabilities.Itsendsa
31 messageofdwindlingsupportfortheiruniquechallenges,fostersafalsesense
32 thatdisabilityissomethingthatcouldhavebeenavoidable,andislikelyto
33 increasethestigmaassociatedwithdisability.
34 2.Nopersonshallperformorinduceanabortiononawomanifthe
35 personknowsthatthewomanisseekingtheabortionsolelybecauseofa
36 prenataldiagnosis,test,orscreeningindicatingDownSyndromeorthe
37 potentialofDownSyndromeinanunbornchild.
38 3.Nopersonshallperformorinduceanabortiononawomanifthe
39 personknowsthatthewomanisseekingtheabortionsolelybecauseofthesex
40 orraceoftheunbornchild.
41 4.Anyphysicianorotherpersonwhoperformsorinducesorattempts
42 toperformorinduceanabortionprohibitedbythissectionshallbesubjectto
43 allapplicablecivilpenaltiesunderthischapterincluding,butnotlimitedto,
44 sections188.065and188.085.]
[188.039.1.Forpurposesofthissection,"medicalemergency"means
2 aconditionwhich,onthebasisofthephysician'sgoodfaithclinicaljudgment,
3 socomplicatesthemedicalconditionofapregnantwomanastonecessitate
4 theimmediateabortionofherpregnancytoavertherdeathorforwhicha
5 delaywillcreateaseriousriskofsubstantialandirreversibleimpairmentofa
6 majorbodilyfunction.
7 2.Exceptinthecaseofmedicalemergency,nopersonshallperformor
8 induceanabortionunlessatleastseventy-twohourspriortheretothephysician
HB1304 41 9 whoistoperformorinducetheabortion,aqualifiedprofessional,orthe
10 referringphysicianhasconferredwiththepatientanddiscussedwithherthe
11 indicatorsandcontraindicators,andriskfactorsincludinganyphysical,
12 psychological,orsituationalfactorsfortheproposedprocedureandtheuseof
13 medications,includingbutnotlimitedtomifepristone,inlightofhermedical
14 historyandmedicalcondition.Foranabortionperformedoranabortion
15 inducedbyadrugordrugs,suchconferenceshalltakeplaceatleastseventy-
16 twohourspriortothewritingorcommunicationofthefirstprescriptionfor
17 suchdrugordrugsinconnectionwithinducinganabortion.Onlyonesuch
18 conferenceshallberequiredforeachabortion.
19 3.Thepatientshallbeevaluatedbythephysicianwhoistoperformor
20 inducetheabortion,aqualifiedprofessional,orthereferringphysicianduring
21 theconferenceforindicatorsandcontraindicators,riskfactorsincludingany
22 physical,psychological,orsituationalfactorswhichwouldpredisposethe
23 patienttoorincreasetheriskofexperiencingoneormoreadversephysical,
24 emotional,orotherhealthreactionstotheproposedprocedureordrugordrugs
25 ineithertheshortorlongtermascomparedwithwomenwhodonotpossess
26 suchriskfactors.
27 4.Attheendoftheconference,andifthewomanchoosestoproceed
28 withtheabortion,thephysicianwhoistoperformorinducetheabortion,a
29 qualifiedprofessional,orthereferringphysicianshallsignandshallcausethe
30 patienttosignawrittenstatementthatthewomangaveherinformedconsent
31 freelyandwithoutcoercionafterthephysicianorqualifiedprofessionalhad
32 discussedwithhertheindicatorsandcontraindicators,andriskfactors,
33 includinganyphysical,psychological,orsituationalfactors.Allsuch
34 executedstatementsshallbemaintainedaspartofthepatient'smedicalfile,
35 subjecttotheconfidentialitylawsandrulesofthisstate.
36 5.Thedirectorofthedepartmentofhealthandseniorservicesshall
37 disseminateamodelformthatphysiciansorqualifiedprofessionalsmayuseas
38 thewrittenstatementrequiredbythissection,butanylackorunavailabilityof
39 suchamodelformshallnotaffectthedutiesofthephysicianorqualified
40 professionalsetforthinsubsections2to4ofthissection.
41 6.Asusedinthissection,theterm"qualifiedprofessional"shallrefer
42 toaphysician,physicianassistant,registerednurse,licensedpracticalnurse,
43 psychologist,licensedprofessionalcounselor,orlicensedsocialworker,
44 licensedorregisteredunderchapter334,335,or337,actingunderthe
45 supervisionofthephysicianperformingorinducingtheabortion,andacting
46 withinthecourseandscopeofhisorherauthorityprovidedbylaw.The
47 provisionsofthissectionshallnotbeconstruedtoinanywayexpandthe
48 authorityotherwiseprovidedbylawrelatingtothelicensure,registration,or
49 scopeofpracticeofanysuchqualifiedprofessional.
50 7.Iftheprovisionsinsubsection2ofthissectionrequiringaseventy-
51 two-hourwaitingperiodforanabortionareevertemporarilyorpermanently
52 restrainedorenjoinedbyjudicialorder,thenthewaitingperiodforanabortion
53 shallbetwenty-fourhours;provided,however,thatifsuchtemporaryor
54 permanentrestrainingorderorinjunctionisstayedordissolved,orotherwise
55 ceasestohaveeffect,thewaitingperiodforanabortionshallbeseventy-two
56 hours.]
HB1304 42 [188.047.1.Alltissue,exceptthattissueneededforpurposes
2 describedinsubsection5ofthissection,removedatthetimeofabortionshall
3 besubmittedwithinfivedaystoaboard-eligibleorcertifiedpathologistfor
4 grossandhistopathologicalexamination.Thepathologistshallfileacopyof
5 thetissuereportwiththestatedepartmentofhealthandseniorservices,and
6 shallprovidewithinseventy-twohoursacopyofthereporttotheabortion
7 facilityorhospitalinwhichtheabortionwasperformedorinduced.The
8 pathologist'sreportshallbemadeapartofthepatient'spermanentrecord.If
9 thepathologicalexaminationfailstoidentifyevidenceofacompleted
10 abortion,thepathologistshallnotifytheabortionfacilityorhospitalwithin
11 twenty-fourhours.
12 2.Thedepartmentshallreconcileeachnoticeofabortionwithits
13 correspondingtissuereport.Ifthedepartmentdoesnotreceivethenoticeof
14 abortionorthetissuereport,thedepartmentshallmakeaninquiryofthe
15 abortionfacilityorhospital.Aftersuchinquiry,ifthehospitalorabortion
16 facilityhasnotsatisfactorilyrespondedtosaidinquiryandthedepartment
17 findsthattheabortionfacilityorhospitalwheretheabortionwasperformedor
18 inducedwasnotincompliancewiththeprovisionsofthissection,the
19 departmentshallconsidersuchnoncomplianceadeficiencyrequiringan
20 unscheduledinspectionofthefacilitytoensurethedeficiencyisremedied,
21 subjecttotheprovisionsofchapter197regardinglicensesuspensions,
22 reviews,andappeals.
23 3.BeginningJanuary1,2018,thedepartmentshallmakeanannual
24 reporttothegeneralassembly.Thereportshallincludethenumberofany
25 deficienciesandinquiriesbythedepartmentofeachabortionfacilityinthe
26 calendaryearandwhetheranydeficiencieswereremediedand,foreach
27 abortionfacility,aggregatedde-identifieddataaboutthetotalnumberof
28 abortionsperformedatthefacility,theterminationproceduresused,the
29 numberandtypeofcomplicationsreportedforeachtypeoftermination
30 procedure,whetherthedepartmentreceivedthetissuereportforeachabortion,
31 andtheexistenceandnature,ifany,ofanyinconsistenciesorconcerns
32 betweentheabortionreportssubmittedundersection188.052andthetissue
33 reportsubmittedunderthissection.Thereportshallnotcontainanypersonal
34 patientinformationthedisclosureofwhichisprohibitedbystateorfederal
35 law.
36 4.Allreportsprovidedbythedepartmenttothegeneralassembly
37 underthissectionshallmaintainconfidentialityofallpersonalinformationof
38 patients,facilitypersonnel,andfacilityphysicians.
39 5.Nothinginthissectionshallprohibittheutilizationoffetalorgans
40 ortissueresultingfromanabortionformedicalorscientificpurposesto
41 determinethecauseorcausesofanyanomaly,illness,death,orgenetic
42 conditionofthefetus,thepaternityofthefetus,orforlawenforcement
43 purposes.
44 6.Thedepartmentmayadoptrules,regulations,andstandards
45 governingthereportsrequiredunderthissection.Indoingso,thedepartment
46 shallensurethatthesereportscontainallinformationnecessarytoensure
47 compliancewithallapplicablelawsandregulations.Anyruleorportionofa
HB1304 43 48 rule,asthattermisdefinedinsection536.010,thatiscreatedunderthe
49 authoritydelegatedinthissectionshallbecomeeffectiveonlyifitcomplies
50 withandissubjecttoalloftheprovisionsofchapter536and,ifapplicable,
51 section536.028.Thissectionandchapter536arenonseverableandifanyof
52 thepowersvestedwiththegeneralassemblypursuanttochapter536toreview,
53 todelaytheeffectivedate,ortodisapproveandannularulearesubsequently
54 heldunconstitutional,thenthegrantofrulemakingauthorityandanyrule
55 proposedoradoptedafterOctober24,2017,shallbeinvalidandvoid.]
[188.052.1.Anindividualabortionreportforeachabortion
2 performedorinduceduponawomanshallbecompletedbythephysicianwho
3 performedorinducedtheabortion.Abortionreportsshallinclude,butnotbe
4 limitedto,acertificationthatthephysiciandoesnothaveanyknowledgethat
5 thewomansoughttheabortionsolelybecauseofaprenataldiagnosis,test,or
6 screeningindicatingDownSyndromeorthepotentialofDownSyndromein
7 theunbornchildandacertificationthatthephysiciandoesnothaveany
8 knowledgethatthewomansoughttheabortionsolelybecauseofthesexor
9 raceoftheunbornchild.
10 2.Anindividualcomplicationreportforanypost-abortioncare
11 performeduponawomanshallbecompletedbythephysicianprovidingsuch
12 post-abortioncare.Thisreportshallinclude:
13 (1)Thedateoftheabortion;
14 (2)Thenameandaddressoftheabortionfacilityorhospitalwherethe
15 abortionwasperformedorinduced;
16 (3)Thenatureoftheabortioncomplicationdiagnosedortreated.
17 3.Allabortionreportsshallbesignedbytheattendingphysicianwho
18 performedorinducedtheabortionandsubmittedtothedepartmentwithin
19 forty-fivedaysfromthedateoftheabortion.Allcomplicationreportsshallbe
20 signedbythephysicianprovidingthepost-abortioncareandsubmittedtothe
21 departmentwithinforty-fivedaysfromthedateofthepost-abortioncare.
22 4.Acopyoftheabortionreportshallbemadeapartofthemedical
23 recordofthepatientoftheabortionfacilityorhospitalinwhichtheabortion
24 wasperformedorinduced.
25 5.Thedepartmentshallberesponsibleforcollectingallabortion
26 reportsandcomplicationreportsandcollatingandevaluatingalldatagathered
27 therefromandshallannuallypublishastatisticalreportbasedonsuchdata
28 fromabortionsperformedorinducedinthepreviouscalendaryear.]
[188.056.1.Notwithstandinganyotherprovisionoflawtothe
2 contrary,noabortionshallbeperformedorinduceduponawomanateight
3 weeksgestationalageorlater,exceptincasesofmedicalemergency.Any
4 personwhoknowinglyperformsorinducesanabortionofanunbornchildin
5 violationofthissubsectionshallbeguiltyofaclassBfelony,aswellas
6 subjecttosuspensionorrevocationofhisorherprofessionallicensebyhisor
7 herprofessionallicensingboard.Awomanuponwhomanabortionis
8 performedorinducedinviolationofthissubsectionshallnotbeprosecutedfor
9 aconspiracytoviolatetheprovisionsofthissection.
HB1304 44 10 2.Itshallbeanaffirmativedefenseforanypersonallegedtohave
11 violatedtheprovisionsofsubsection1ofthissectionthattheperson
12 performedorinducedanabortionbecauseofamedicalemergency.The
13 defendantshallhavetheburdenofpersuasionthatthedefenseismore
14 probablytruethannot.
15 3.Prosecutionunderthissectionshallbarprosecutionundersection
16 188.057,188.058,or188.375ifprosecutionundersuchsectionswouldviolate
17 theprovisionsofAmendmentVtotheConstitutionoftheUnitedStatesor
18 ArticleI,Section19oftheConstitutionofMissouri.
19 4.Ifanyoneormoreprovisions,subsections,sentences,clauses,
20 phrases,orwordsofthissectionortheapplicationthereoftoanyperson,
21 circumstance,orperiodofgestationalageisfoundtobeunenforceable,
22 unconstitutional,orinvalidbyacourtofcompetentjurisdiction,thesameis
23 herebydeclaredtobeseverableandthebalanceofthesectionshallremain
24 effectivenotwithstandingsuchunenforceability,unconstitutionality,or
25 invalidity.Thegeneralassemblyherebydeclaresthatitwouldhavepassed
26 thissection,andeachprovision,subsection,sentence,clause,phrase,orword
27 thereof,irrespectiveofthefactthatanyoneormoreprovisions,subsections,
28 sentences,clauses,phrases,orwordsofthesection,ortheapplicationofthe
29 sectiontoanyperson,circumstance,orperiodofgestationalage,wouldbe
30 declaredunenforceable,unconstitutional,orinvalid.]
[188.057.1.Notwithstandinganyotherprovisionoflawtothe
2 contrary,noabortionshallbeperformedorinduceduponawomanatfourteen
3 weeksgestationalageorlater,exceptincasesofmedicalemergency.Any
4 personwhoknowinglyperformsorinducesanabortionofanunbornchildin
5 violationofthissubsectionshallbeguiltyofaclassBfelony,aswellas
6 subjecttosuspensionorrevocationofhisorherprofessionallicensebyhisor
7 herprofessionallicensingboard.Awomanuponwhomanabortionis
8 performedorinducedinviolationofthissubsectionshallnotbeprosecutedfor
9 aconspiracytoviolatetheprovisionsofthissection.
10 2.Itshallbeanaffirmativedefenseforanypersonallegedtohave
11 violatedtheprovisionsofsubsection1ofthissectionthattheperson
12 performedorinducedanabortionbecauseofamedicalemergency.The
13 defendantshallhavetheburdenofpersuasionthatthedefenseismore
14 probablytruethannot.
15 3.Prosecutionunderthissectionshallbarprosecutionunder
16 section188.056,188.058,or188.375ifprosecutionundersuchsections
17 wouldviolatetheprovisionsofAmendmentVtotheConstitutionofthe
18 UnitedStatesorArticleI,Section19oftheConstitutionofMissouri.
19 4.Ifanyoneormoreprovisions,subsections,sentences,clauses,
20 phrases,orwordsofthissectionortheapplicationthereoftoanyperson,
21 circumstance,orperiodofgestationalageisfoundtobeunenforceable,
22 unconstitutional,orinvalidbyacourtofcompetentjurisdiction,thesameis
23 herebydeclaredtobeseverableandthebalanceofthesectionshallremain
24 effectivenotwithstandingsuchunenforceability,unconstitutionality,or
25 invalidity.Thegeneralassemblyherebydeclaresthatitwouldhavepassed
26 thissection,andeachprovision,subsection,sentence,clause,phrase,orword
HB1304 45 27 thereof,irrespectiveofthefactthatanyoneormoreprovisions,subsections,
28 sentences,clauses,phrases,orwordsofthesection,ortheapplicationofthe
29 sectiontoanyperson,circumstance,orperiodofgestationalage,wouldbe
30 declaredunenforceable,unconstitutional,orinvalid.]
[188.058.1.Notwithstandinganyotherprovisionoflawtothe
2 contrary,noabortionshallbeperformedorinduceduponawomanateighteen
3 weeksgestationalageorlater,exceptincasesofmedicalemergency.Any
4 personwhoknowinglyperformsorinducesanabortionofanunbornchildin
5 violationofthissubsectionshallbeguiltyofaclassBfelony,aswellas
6 subjecttosuspensionorrevocationofhisorherprofessionallicensebyhisor
7 herprofessionallicensingboard.Awomanuponwhomanabortionis
8 performedorinducedinviolationofthissectionshallnotbeprosecutedfora
9 conspiracytoviolatetheprovisionsofthissection.
10 2.Itshallbeanaffirmativedefenseforanypersonallegedtohave
11 violatedtheprovisionsofsubsection1ofthissectionthattheperson
12 performedorinducedanabortionbecauseofamedicalemergency.The
13 defendantshallhavetheburdenofpersuasionthatthedefenseismore
14 probablytruethannot.
15 3.Prosecutionunderthissectionshallbarprosecutionundersection
16 188.056,188.057,or188.375ifprosecutionundersuchsectionswouldviolate
17 theprovisionsofAmendmentVtotheConstitutionoftheUnitedStatesor
18 ArticleI,Section19oftheConstitutionofMissouri.
19 4.Ifanyoneormoreprovisions,subsections,sentences,clauses,
20 phrases,orwordsofthissectionortheapplicationthereoftoanyperson,
21 circumstance,orperiodofgestationalageisfoundtobeunenforceable,
22 unconstitutional,orinvalidbyacourtofcompetentjurisdiction,thesameis
23 herebydeclaredtobeseverableandthebalanceofthesectionshallremain
24 effectivenotwithstandingsuchunenforceability,unconstitutionality,or
25 invalidity.Thegeneralassemblyherebydeclaresthatitwouldhavepassed
26 thissection,andeachprovision,subsection,sentence,clause,phrase,orword
27 thereof,irrespectiveofthefactthatanyoneormoreprovisions,subsections,
28 sentences,clauses,phrases,orwordsofthesection,ortheapplicationofthe
29 sectiontoanyperson,circumstance,orperiodofgestationalage,wouldbe
30 declaredunenforceable,unconstitutional,orinvalid.]
[188.075.1.Anypersonwhocontrarytotheprovisionsofsections
2 188.010to188.085knowinglyperforms,induces,oraidsintheperformance
3 orinducingofanyabortionorknowinglyfailstoperformanyactionrequired
4 bysections188.010to188.085shallbeguiltyofaclassAmisdemeanor,
5 unlessadifferentpenaltyisprovidedforinstatelaw,and,uponconviction,
6 shallbepunishedasprovidedbylaw.
7 2.Itshallbeanaffirmativedefenseforanypersonallegedtohave
8 violatedanyprovisionofthischapterthatthepersonperformedanactionor
9 didnotperformanactionbecauseofamedicalemergency.Thisaffirmative
10 defenseshallbeavailableincriminal,civil,andadministrativeactionsor
11 proceedings.Thedefendantshallhavetheburdenofpersuasionthatthe
12 defenseismoreprobablytruethannot.
HB1304 46 13 3.Theattorneygeneralshallhaveconcurrentoriginaljurisdiction
14 throughoutthestate,alongwitheachprosecutingattorneyandcircuitattorney
15 withintheirrespectivejurisdictions,tocommenceactionsforaviolationof
16 anyprovisionofthischapter,foraviolationofanystatelawontheuseof
17 publicfundsforanabortion,orforaviolationofanystatelawwhichregulates
18 anabortionfacilityorapersonwhoperformsorinducesanabortion.The
19 attorneygeneral,orprosecutingattorneyorcircuitattorneywithintheir
20 respectivejurisdictions,mayseekinjunctiveorotherreliefagainstanyperson
21 who,orentitywhich,isinviolationofanyprovisionofthischapter,misuses
22 publicfundsforanabortion,orviolatesanystatelawwhichregulatesan
23 abortionfacilityorapersonwhoperformsorinducesanabortion.]
[188.080.Anypersonwhoisnotaphysicianwhoperformsorinduces
2 orattemptstoperformorinduceanabortiononanotherisguiltyofaclassB
3 felony,and,uponconviction,shallbepunishedasprovidedbylaw.Any
4 physicianperformingorinducinganabortionwhodoesnothaveclinical
5 privilegesatahospitalwhichoffersobstetricalorgynecologicalcarelocated
6 withinthirtymilesofthelocationatwhichtheabortionisperformedor
7 inducedshallbeguiltyofaclassAmisdemeanor,and,uponconvictionshall
8 bepunishedasprovidedbylaw.]
[188.230.Nothinginthisactisintendedtoauthorizeanyoneother
2 thanaphysiciantoperformanabortion.]
[188.375.1.Thissectionshallbeknownandmaybecitedasthe
2 "Late-TermPain-CapableUnbornChildProtectionAct".
3 2.Asusedinthissection,thephrase"late-termpain-capableunborn
4 child"shallmeananunbornchildattwentyweeksgestationalageorlater.
5 3.Notwithstandinganyotherprovisionoflawtothecontrary,no
6 abortionshallbeperformedorinduceduponawomancarryingalate-term
7 pain-capableunbornchild,exceptincasesofmedicalemergency.Anyperson
8 whoknowinglyperformsorinducesanabortionofalate-termpain-capable
9 unbornchildinviolationofthissubsectionshallbeguiltyofaclassBfelony,
10 aswellassubjecttosuspensionorrevocationofhisorherprofessionallicense
11 byhisorherprofessionallicensingboard.Awomanuponwhomanabortion
12 isperformedorinducedinviolationofthissubsectionshallnotbeprosecuted
13 foraconspiracytoviolatetheprovisionsofthissubsection.
14 4.Itshallbeanaffirmativedefenseforanypersonallegedtohave
15 violatedtheprovisionsofsubsection3ofthissectionthattheperson
16 performedorinducedanabortionbecauseofamedicalemergency.The
17 defendantshallhavetheburdenofpersuasionthatthedefenseismore
18 probablytruethannot.
19 5.Prosecutionundersubsection3ofthissectionshallbarprosecution
20 undersection188.056,188.057,or188.058ifprosecutionundersuchsections
21 wouldviolatetheprovisionsofAmendmentVtotheConstitutionofthe
22 UnitedStatesorArticleI,Section19oftheConstitutionofMissouri.
23 6.Whenincasesofmedicalemergencyaphysicianperformsor
24 inducesanabortionuponawomaninherthirdtrimestercarryingalate-term
HB1304 47 25 pain-capableunbornchild,thephysicianshallutilizetheavailablemethodor
26 techniqueofabortionmostlikelytopreservethelifeorhealthoftheunborn
27 child.Incaseswherethemethodortechniqueofabortionmostlikelyto
28 preservethelifeorhealthoftheunbornchildwouldpresentagreaterriskto
29 thelifeorhealthofthewomanthananotherlegallypermittedandavailable
30 methodortechnique,thephysicianmayutilizesuchothermethodor
31 technique.Inallcaseswherethephysicianperformsorinducesanabortion
32 uponawomanduringherthirdtrimestercarryingalate-termpain-capable
33 unbornchild,thephysicianshallcertifyinwritingtheavailablemethodor
34 techniquesconsideredandthereasonsforchoosingthemethodortechnique
35 employed.
36 7.Whenincasesofmedicalemergencyaphysicianperformsor
37 inducesanabortionuponawomanduringherthirdtrimestercarryingalate-
38 termpain-capableunbornchild,thereshallbeinattendanceaphysicianother
39 thanthephysicianperformingorinducingtheabortionwhoshalltakecontrol
40 ofandprovideimmediatemedicalcareforachildbornasaresultofthe
41 abortion.
42 8.Anyphysicianwhoknowinglyviolatesanyoftheprovisionsof
43 subsection6or7ofthissectionshallbeguiltyofaclassDfelony,aswellas
44 subjecttosuspensionorrevocationofhisorherprofessionallicensebyhisor
45 herprofessionallicensingboard.Awomanuponwhomanabortionis
46 performedorinducedinviolationofsubsection6or7ofthissectionshallnot
47 beprosecutedforaconspiracytoviolatetheprovisionsofthosesubsections.
48 9.Ifanyoneormoreprovisions,subsections,sentences,clauses,
49 phrases,orwordsofthissectionortheapplicationthereoftoanyperson,
50 circumstance,orperiodofgestationalageisfoundtobeunenforceable,
51 unconstitutional,orinvalidbyacourtofcompetentjurisdiction,thesameis
52 herebydeclaredtobeseverableandthebalanceofthesectionshallremain
53 effectivenotwithstandingsuchunenforceability,unconstitutionality,or
54 invalidity.Thegeneralassemblyherebydeclaresthatitwouldhavepassed
55 thissection,andeachprovision,subsection,sentence,clause,phrase,orword
56 thereof,irrespectiveofthefactthatanyoneormoreprovisions,subsections,
57 sentences,clauses,phrases,orwordsofthesection,ortheapplicationofthe
58 sectiontoanyperson,circumstance,orperiodofgestationalage,wouldbe
59 declaredunenforceable,unconstitutional,orinvalid.]
[334.245.1.Notwithstandinganyotherprovisionoflawtothe
2 contrarythatmayallowapersontoprovideservicesrelatingtopregnancy,
3 includingprenatal,delivery,andpostpartumservices,nopersonotherthana
4 licensedphysicianisauthorizedtoperformorinduceanabortion.
5 2.Anypersonwhoviolatestheprovisionsofthissectionisguiltyofa
6 classBfelony.]
[574.200.1.Apersoncommitstheoffenseofinterferencewith
2 medicalassistanceifheorshe,whileservinginhisorhercapacityasan
3 employeeofanabortionfacility:
4 (1)Knowinglyordersorrequestsmedicalpersonneltodeviatefrom
5 anyapplicablestandardofcareorordinarypracticewhileprovidingmedical
HB1304 48 6 assistancetoapatientforreasonsunrelatedtothepatient'shealthorwelfare;
7 or
8 (2)Knowinglyattemptstopreventmedicalpersonnelfromproviding
9 medicalassistancetoapatientinaccordancewithallapplicablestandardsof
10 careorordinarypracticeforreasonsunrelatedtothepatient'shealthor
11 welfare.
12 2.TheoffenseofinterferencewithmedicalassistanceisaclassA
13 misdemeanor.
14 3.Forpurposesofthissection,theterm"medicalpersonnel"shall
15 include,butnotbelimitedto,thefollowing:
16 (1)Physiciansandsurgeonslicensedunderchapter334;
17 (2)Nurseslicensedunderchapter335;
18 (3)Emergencymedicalservicespersonnelasdefinedinsection
19 190.600;or
20 (4)Anypersonoperatingunderthesupervisionofsuchmedical
21 personnel.]
âś”
HB1304 49