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53	53	STATE OF OKLAHOMA
54	54
55	55	1st Session of the 59th Legislature (2023)
56	56
57	57	SENATE BILL 878 By: Jett
58	58
59	59
60	60
61	61	AS INTRODUCED
62	62
63	63	An Act relating to health care; creating the Oklahoma
64	64	Save Adolescents fro m Experimentation (SAFE) Act;
65	65	providing short title; defining terms; prohibiting
66	66	provision of or referral for gender transition
67	67	procedures; providing exceptions; pro hibiting certain
68	68	uses of public funds, public facilities , public
69	69	employees, and state Medicaid program; providing for
70	70	administrative and civil enforcement; authorizing
71	71	certain civil actions and relief; providing certain
72	72	construction; providing for codification; and
73	73	declaring an emergency.
74	74
75	75
76	76
77	77	BE IT ENACTED BY THE PEOPLE OF THE STATE OF OKLAHOMA:
78	78	SECTION 1. NEW LAW A new s ection of law to be codified
79	79	in the Oklahoma Statutes as Section 2607.1 of Title 63, unless there
80	80	is created a duplication in numbering, reads as follows:
81	81	This act shall be known and may be cited as the “Oklahoma Save
82	82	Adolescents from Experimentation (SAFE) Act ”.
83	83	SECTION 2. NEW LAW A new section of law to be codified
84	84	in the Oklahoma Statutes as Section 2607.2 of Title 63, unless there
85	85	is created a duplication in numbering, rea ds as follows:
86	86	As used in this act:
87	87	1. “Biological sex” means the biological indication of male and
88	88	female in the context of reproductive potential or capacity, such as
89	89
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140	140	sex chromosomes, naturally occurring sex hormones, gonads, and
141	141	nonambiguous internal a nd external genitalia present at birth,
142	142	without regard to an individual’s psychological, chosen, or
143	143	subjective experience of gender;
144	144	2. “Cross-sex hormones” means:
145	145	a. testosterone or other androgens given to biological
146	146	females in amounts that are larger o r more potent than
147	147	would normally occur naturally in healt hy biological
148	148	sex females, and
149	149	b. estrogen given to biological males in amounts that are
150	150	larger or more potent than would normally occur
151	151	naturally in healthy biological sex males;
152	152	3. “Gender” means the psychological, behavioral, social, and
153	153	cultural aspects of being male or female;
154	154	4. “Gender reassignment surgery ” means any medical or surgical
155	155	service that seeks to surgically alter or remove healthy physical or
156	156	anatomical characteristics or feature s that are typical for the
157	157	individual’s biological sex, in order to instill or create
158	158	physiological or anatomical characteristics that resemble a sex
159	159	different from the individual ’s biological sex, including but not
160	160	limited to genital or nongenital gender reassignment surgery
161	161	performed for the purpose of assisti ng an individual with a gender
162	162	transition;
163	163
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214	214	5. “Gender transition” means the process in which a person goes
215	215	from identifying with and living as a gender that corresponds to his
216	216	or her biological sex to identifying with and living as a gender
217	217	different from his or her biological sex, and may inv olve social,
218	218	legal, or physical changes;
219	219	6. a. “Gender transition procedures ” means any medical or
220	220	surgical service, including but not limited to
221	221	physician’s services, inpatient and outpatient
222	222	hospital services, or pr escribed drugs related to
223	223	gender transition that seeks to:
224	224	(1) alter or remove physica l or anatomical
225	225	characteristics or features that are typical for
226	226	the individual’s biological sex, or
227	227	(2) instill or create physiological or anatomical
228	228	characteristics that resemble a sex different
229	229	from the individual’s biological sex, including
230	230	but not limited to medical services that provide
231	231	puberty-blocking drugs, cross -sex hormones, or
232	232	other mechanisms to promot e the development of
233	233	feminizing or masculinizing features i n the
234	234	opposite biological sex, or gen ital or nongenital
235	235	gender reassignment surgery pe rformed for the
236	236	purpose of assisting an individual with a gender
237	237	transition.
238	238
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289	289	b. Gender transition procedures do not include:
290	290	(1) services to persons born with a medically
291	291	verifiable disorder of sex developme nt, including
292	292	a person with external biological s ex
293	293	characteristics that are irresolvably ambiguous,
294	294	such as those born with 46 XX chromosomes with
295	295	virilization, 46 XY chromosomes with
296	296	undervirilization, or having both ovarian and
297	297	testicular tissue,
298	298	(2) services provided when a physician has otherwise
299	299	diagnosed a disorder of sexual development that
300	300	the physician has determined through genetic or
301	301	biochemical testing that the person does not have
302	302	normal sex chromosome stru cture, sex steroid
303	303	hormone production, or sex steroid hormone
304	304	action,
305	305	(3) the treatment of any infection, injury, disease,
306	306	or disorder that has been caused by or
307	307	exacerbated by the performance of g ender
308	308	transition procedures, whether or not the gender
309	309	transition procedure was performed in acc ordance
310	310	with state and federal law, or
311	311	(4) any procedure undertaken because the individual
312	312	suffers from a physical disorder, physical
313	313
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364	364	injury, or physical illnes s that would, as
365	365	certified by a physician, place the indivi dual in
366	366	imminent danger of death or i mpairment of major
367	367	bodily function unless surgery is performed;
368	368	7. “Genital gender reassignment surgery ” means a medical
369	369	procedure performed for the purpose of assisting an individual with
370	370	a gender transition, includin g but not limited to:
371	371	a. surgical procedures such as penectomy, orchiectomy,
372	372	vaginoplasty, clitoroplasty, or vulvoplasty for
373	373	biologically male patients or hysterectomy or
374	374	oophorectomy for biologically female patients,
375	375	b. reconstruction of the fixed part of the urethra with
376	376	or without a metoidioplasty, or
377	377	c. phalloplasty, vaginectomy, scroto plasty, or
378	378	implantation of erection or testicular prostheses for
379	379	biologically female patients;
380	380	8. “Healthcare professional” means a person who is licensed,
381	381	certified, or otherwise authorized by the laws of this state to
382	382	administer health care in the ordin ary course of the practice of his
383	383	or her profession;
384	384	9. “Nongenital gender reassignment surgery ” means medical
385	385	procedures performed for the purpose of assisting an indiv idual with
386	386	a gender transition includ ing but not limited to:
387	387
388	388
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438	438	a. surgical procedures fo r biologically male patients,
439	439	such as augmentation mammoplasty, facial feminization
440	440	surgery, liposuction, lipof illing, voice surgery,
441	441	thyroid cartilage reduction, gluteal augmentation,
442	442	hair reconstruction, o r various aesthetic procedures,
443	443	or
444	444	b. surgical procedures for biologically female patients,
445	445	such as subcutaneous mastectomy, voice surgery,
446	446	liposuction, lipofil ling, pectoral implants, or
447	447	various aesthetic procedures;
448	448	10. “Physician” means a person who is licensed to practice
449	449	medicine in this state;
450	450	11. “Puberty-blocking drugs” means gonadotropin-releasing
451	451	hormone analogues or other synthetic drugs used in biol ogical males
452	452	to stop luteinizing hormone secretion and ther efore testosterone
453	453	secretion, or synthetic drugs used in biological females which stop
454	454	the production of estrogens and progesterone, when used to delay or
455	455	suppress pubertal development in children for the purpose of
456	456	assisting an individual with a gender tr ansition; and
457	457	12. “Public funds” means state, county, or local government
458	458	monies, in addition to any department, agency, or instrumentality
459	459	authorized or appropriated under state law or derived fr om any fund
460	460	in which such moneys are deposited.
461	461
462	462
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512	512	SECTION 3. NEW LAW A new section of law to be codified
513	513	in the Oklahoma Statutes as Section 2607. 3 of Title 63, unless there
514	514	is created a duplication in numbering, reads as follows:
515	515	A. A physician or other healthcare professional shall not
516	516	provide gender transition procedures to any individual under
517	517	eighteen (18) years of age.
518	518	B. A physician or other healthcare professional shall not refer
519	519	any individual under eighteen (18) years of age to any healthcare
520	520	professional for gender transition procedures.
521	521	C. A physician or other healthcare professional is not
522	522	prohibited from providing any of the following procedures which are
523	523	not gender transition procedures to an individual under eighteen
524	524	(18) years of age:
525	525	1. Services to persons born with a medically verifiable
526	526	disorder of sex development, including a person with exter nal
527	527	biological sex characteristics that are irresolvably ambiguous, such
528	528	as those born with 46 XX chromosomes with viriliz ation, 46 XY
529	529	chromosomes with undervirilization, or h aving both ovarian and
530	530	testicular tissue;
531	531	2. Services provided when a physician has otherwise diagnosed a
532	532	disorder of sexual development that the physician has determined
533	533	through genetic or biochemical testing that the person does not have
534	534	normal sex chromosome structure, sex steroid hormone production, or
535	535	sex steroid hormone action;
536	536
537	537
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587	587	3. The treatment of any infection, injury, disease, or disorder
588	588	that has been caused by or exacerbated by the performance of gender
589	589	transition procedures, whether or not the gender transition
590	590	procedure was performed in accordance with state and federal la w or
591	591	whether or not funding for the gender transition procedure is
592	592	permissible under Section 4 of this act; or
593	593	4. Any procedure undertaken because the individual suffers from
594	594	a physical disorder, physical injury , or physical illness that
595	595	would, as certified by a physician, place the individual in imminent
596	596	danger of death or impairment of major bodily function unless
597	597	surgery is performed.
598	598	SECTION 4. NEW LAW A new section of law to be codifi ed
599	599	in the Oklahoma Statutes as Section 2607.4 of Title 63, unless there
600	600	is created a duplication in numbering, reads as follows:
601	601	A. Public funds shall not be directl y or indirectly used,
602	602	granted, paid, or distributed to a ny entity, organization, or
603	603	individual that provides gender transition pr ocedures to an
604	604	individual under eighteen (18) years of age.
605	605	B. Healthcare services furnished in the following situations
606	606	shall not include gender transition procedures to an indivi dual
607	607	under eighteen (18) years of age:
608	608	1. By or in a healthcare facility o wned by the state or a
609	609	county or local government; or
610	610
611	611
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661	661	2. By a physician or other healthcare professional employed by
662	662	the state or a county or local government.
663	663	C. The state Medicaid program shall not reimburse or provide
664	664	coverage for gender transition procedures to an indi vidual under
665	665	eighteen (18) years of age.
666	666	SECTION 5. NEW LAW A new section of law to be codified
667	667	in the Oklahoma Statutes as Section 26 07.5 of Title 63, unless there
668	668	is created a duplication in numbering, reads as follows:
669	669	A. Any referral for or provision of gender transiti on
670	670	procedures to an individual u nder eighteen (18) years of age is
671	671	unprofessional conduct and shall, upon an adverse ruling by the
672	672	appropriate licensing board, result in immediate revocation of the
673	673	license or certificate of the physician or othe r healthcare
674	674	professional.
675	675	B. 1. A person may assert a n actual or threatene d violation of
676	676	this act as a claim or defense in a j udicial or administrative
677	677	proceeding and obtain compensatory damages, injunctive relief,
678	678	declaratory relief, or any other appropriate relief.
679	679	2. A person shall bring a claim for a vi olation of this act no
680	680	later than two (2) years after the day the cause of action accrues.
681	681	3. An individual under eighteen (18) years of age may bring an
682	682	action throughout their minority through a parent or next friend,
683	683	and may bring an action in their o wn name upon reaching majority at
684	684
685	685
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735	735	any time from that point until twenty (20) years after reaching the
736	736	age of majority.
737	737	4. Notwithstanding any other provision of law, an action under
738	738	this subsection may be commenced, and relief may be granted, in a
739	739	judicial proceeding without r egard to whether the person commencing
740	740	the action has sought or exhausted available administrative
741	741	remedies.
742	742	5. In any action or proceeding to enforce a provision of this
743	743	act, a prevailing party who establishes a violation of this act
744	744	shall recover reason able attorney fees.
745	745	C. 1. The Attorney General ma y bring an action to enforce
746	746	compliance with this act.
747	747	2. This act does not deny, impair, or otherwise affect any
748	748	right or authority of the Attorney General, this state, or any
749	749	agency, officer, or employe e of the state, acting under any law
750	750	other than this act, to institute or intervene in any proceeding.
751	751	SECTION 6. It being immediately necessary for the pr eservation
752	752	of the public peace, health or safety, an emergency is hereby
753	753	declared to exist, by reason whereof this act shall ta ke effect and
754	754	be in full force from and after i ts passage and approval.
755	755
756	756	59-1-1454 DC 1/19/2023 10:08:37 PM

Oklahoma 2024 Regular Session

Oklahoma Senate Bill SB878 Compare Versions