FIRSTREGULARSESSION
HOUSECOMMITTEESUBSTITUTEFOR
HOUSEBILLNOS.35,1081,1038&
1016
103RDGENERALASSEMBLY
0225H.02C JOSEPHENGLER,ChiefClerk
ANACT
Torepealsection191.1720,RSMo,andtoenactinlieuthereofonenewsectionrelatingto
gendertransitionprocedures.
BeitenactedbytheGeneralAssemblyofthestateofMissouri,asfollows:
SectionA.Section191.1720,RSMo,isrepealedandonenewsectionenactedinlieu
2thereof,tobeknownassection191.1720,toreadasfollows:
191.1720.1.Thissectionshallbeknownandmaybecitedasthe"MissouriSave
2AdolescentsfromExperimentation(SAFE)Act".
3 2.Forpurposesofthissection,thefollowingtermsmean:
4 (1)"Biologicalsex",thebiologicalindicationofmaleorfemaleinthecontextof
5reproductivepotentialorcapacity,suchassexchromosomes,naturallyoccurringsex
6hormones,gonads,andnonambiguousinternalandexternalgenitaliapresentatbirth,without
7regardtoanindividual'spsychological,chosen,orsubjectiveexperienceofgender;
8 (2)"Cross-sexhormones",testosterone,estrogen,orotherandrogensgiventoan
9individualinamountsthataregreaterormorepotentthanwouldnormallyoccurnaturallyina
10healthyindividualofthesameageandsex;
11 (3)"Gender",thepsychological,behavioral,social,andculturalaspectsofbeingmale
12orfemale;
13 (4)"Gendertransition",theprocessinwhichanindividualtransitionsfrom
14identifyingwithandlivingasagenderthatcorrespondstohisorherbiologicalsexto
15identifyingwithandlivingasagenderdifferentfromhisorherbiologicalsex,andmay
16involvesocial,legal,orphysicalchanges;
EXPLANATION—Matterenclosedinbold-facedbrackets[thus] intheabovebillisnotenactedandis
intendedtobeomittedfromthelaw.Matterinbold-facetypeintheabovebillisproposedlanguage. 17 (5)"Gendertransitionsurgery",asurgicalprocedureperformedforthepurposeof
18assistinganindividualwithagendertransition,including,butnotlimitedto:
19 (a)Surgicalproceduresthatsterilize,including,butnotlimitedto,castration,
20vasectomy,hysterectomy,oophorectomy,orchiectomy,orpenectomy;
21 (b)Surgicalproceduresthatartificiallyconstructtissuewiththeappearanceof
22genitaliathatdiffersfromtheindividual'sbiologicalsex,including,butnotlimitedto,
23metoidioplasty,phalloplasty,orvaginoplasty;or
24 (c)Augmentationmammoplastyorsubcutaneousmastectomy;
25 (6)"Healthcareprovider",anindividualwhoislicensed,certified,orotherwise
26authorizedbythelawsofthisstatetoadministerhealthcareintheordinarycourseofthe
27practiceofhisorherprofession;
28 (7)"Puberty-blockingdrugs",gonadotropin-releasinghormoneanaloguesorother
29syntheticdrugsusedtostopluteinizinghormonesecretionandfolliclestimulatinghormone
30secretion,syntheticantiandrogendrugstoblocktheandrogenreceptor,oranyotherdrugused
31todelayorsuppresspubertaldevelopmentinchildrenforthepurposeofassistingan
32individualwithagendertransition.
33 3.Ahealthcareprovidershallnotknowinglyperformagendertransitionsurgeryon
34anyindividualundereighteenyearsofage.
35 4.(1)Ahealthcareprovidershallnotknowinglyprescribeoradministercross-sex
36hormonesorpuberty-blockingdrugsforthepurposeofagendertransitionforanyindividual
37undereighteenyearsofage.
38 (2)UntilMarch1,2026,theprovisionsofthissubsectionshallnotapplytothe
39prescriptionoradministrationofcross-sexhormonesorpuberty-blockingdrugsforany
40individualundereighteenyearsofagewhowasprescribedoradministeredsuchhormonesor
41drugspriortoAugust28,2023,forthepurposeofassistingtheindividualwithagender
42transition.
43 [(3)TheprovisionsofthissubsectionshallexpireonAugust28,2027.]
44 5.Theperformanceofagendertransitionsurgeryortheprescriptionor
45administrationofcross-sexhormonesorpuberty-blockingdrugstoanindividualunder
46eighteenyearsofageinviolationofthissectionshallbeconsideredunprofessionalconduct
47andanyhealthcareproviderdoingsoshallhavehisorherlicensetopracticerevokedbythe
48appropriatelicensingentityordisciplinaryreviewboardwithcompetentjurisdictioninthis
49state.
50 6.(1)Theprescriptionoradministrationofcross-sexhormonesorpuberty-blocking
51drugstoanindividualundereighteenyearsofageforthepurposeofagendertransitionshall
52beconsideredgroundsforacauseofactionagainstthehealthcareprovider.Theprovisions
53ofchapter538shallnotapplytoanyactionbroughtunderthissubsection.
HCSHBs35,1081,1038&1016 2 54 (2)Anactionbroughtpursuanttothissubsectionshallbebroughtwithinfifteenyears
55oftheindividualinjuredattainingtheageoftwenty-oneorofthedatethetreatmentofthe
56injuryatissueintheactionbythedefendanthasceased,whicheverislater.
57 (3)Anindividualbringinganactionunderthissubsectionshallbeentitledtoa
58rebuttablepresumptionthattheindividualwasharmediftheindividualisinfertilefollowing
59theprescriptionoradministrationofcross-sexhormonesorpuberty-blockingdrugsandthat
60theharmwasadirectresultofthehormonesordrugsprescribedoradministeredbythehealth
61careprovider.Suchpresumptionmayberebuttedonlybyclearandconvincingevidence.
62 (4)Inanyactionbroughtpursuanttothissubsection,aplaintiffmayrecover
63economicandnoneconomicdamagesandpunitivedamages,withoutlimitationtotheamount
64andnolessthanfivehundredthousanddollarsintheaggregate.Thejudgmentagainsta
65defendantinanactionbroughtpursuanttothissubsectionshallbeinanamountofthreetimes
66theamountofanyeconomicandnoneconomicdamagesorpunitivedamagesassessed.Any
67awardofdamagesinanactionbroughtpursuanttothissubsectiontoaprevailingplaintiff
68shallincludeattorney'sfeesandcourtcosts.
69 (5)Anactionbroughtpursuanttothissubsectionmaybebroughtinanycircuitcourt
70ofthisstate.
71 (6)Nohealthcareprovidershallrequireawaiveroftherighttobringanaction
72pursuanttothissubsectionasaconditionofservices.Therighttobringanactionbyor
73throughanindividualundertheageofeighteenshallnotbewaivedbyaparentorlegal
74guardian.
75 (7)Aplaintifftoanactionbroughtunderthissubsectionmayenterintoavoluntary
76agreementofsettlementorcompromiseoftheaction,butnoagreementshallbevaliduntil
77approvedbythecourt.Noagreementallowedbythecourtshallincludeaprovisionregarding
78thenondisclosureorconfidentialityofthetermsofsuchagreementunlesssuchprovisionwas
79specificallyrequestedandagreedtobytheplaintiff.
80 (8)Ifrequestedbytheplaintiff,anypleadings,attachments,orexhibitsfiledwiththe
81courtinanyactionbroughtpursuanttothissubsection,aswellasanyjudgmentsissuedbythe
82courtinsuchactions,shallnotincludethepersonalidentifyinginformationoftheplaintiff.
83Suchinformationshallbeprovidedinaconfidentialinformationfilingsheet
84contemporaneouslyfiledwiththecourtorenteredbythecourt,whichshallnotbesubject
85topublicinspectionoravailability.
86 7.TheprovisionsofthissectionshallnotapplytoanyspeechprotectedbytheFirst
87AmendmentoftheUnitedStatesConstitution.
88 8.Theprovisionsofthissectionshallnotapplytothefollowing:
89 (1)Servicestoindividualsbornwithamedically-verifiabledisorderofsex
90development,including,butnotlimitedto,anindividualwithexternalbiologicalsex
HCSHBs35,1081,1038&1016 3 91characteristicsthatareirresolvablyambiguous,suchasthosebornwith46,XXchromosomes
92withvirilization,46,XYchromosomeswithundervirilization,orhavingbothovarianand
93testiculartissue;
94 (2)Servicesprovidedwhenaphysicianhasotherwisediagnosedanindividualwitha
95disorderofsexdevelopmentanddeterminedthroughgeneticorbiochemicaltestingthatthe
96individualdoesnothavenormalsexchromosomestructure,sexsteroidhormoneproduction,
97orsexsteroidhormoneaction;
98 (3)Thetreatmentofanyinfection,injury,disease,ordisorderthathasbeencausedby
99orexacerbatedbytheperformanceofgendertransitionsurgeryortheprescriptionor
100administrationofcross-sexhormonesorpuberty-blockingdrugsregardlessofwhetherthe
101surgerywasperformedorthehormonesordrugswereprescribedoradministeredin
102accordancewithstateandfederallaw;or
103 (4)Anyprocedureundertakenbecausetheindividualsuffersfromaphysicaldisorder,
104physicalinjury,orphysicalillnessthatwould,ascertifiedbyaphysician,placetheindividual
105inimminentdangerofdeathorimpairmentofamajorbodilyfunctionunlesssurgeryis
106performed.
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HCSHBs35,1081,1038&1016 4