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Rhode Island Senate Bill S0270

Rhode Island 2025 Regular Session

Rhode Island Senate Bill S0270 Compare Versions

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99 S T A T E O F R H O D E I S L A N D
1010 IN GENERAL ASSEMBLY
1111 JANUARY SESSION, A.D. 2025
1212 ____________
1313
1414 A N A C T
1515 RELATING TO HEALTH AND SAFETY -- RHODE ISLAND'S CHILDREN DESERVE
1616 HELP NOT HARM ACT -- MINOR'S GENDER TRANSITION
1717 Introduced By: Senator E Morgan
1818 Date Introduced: February 13, 2025
1919 Referred To: Senate Health & Human Services
2020
2121
2222 It is enacted by the General Assembly as follows:
2323 SECTION 1. Legislative findings and purpose. 1
2424 The general assembly finds that: 2
2525 (1) Rhode Island has a compelling government interest protecting the health and safety of 3
2626 its citizens, especially vulnerable children; 4
2727 (2) Only a small percentage of the American population experiences distress identifying 5
2828 with their biological sex; 6
2929 (3) For the small percentage of children who are gender nonconforming or experience 7
3030 distress identifying with their biological sex, studies consistently demonstrate that the majority 8
3131 come to embrace their biological sex in adolescence or adulthood, thereby rendering most medical 9
3232 physiological interventions unnecessary; 10
3333 (4) Scientific studies show that individuals experiencing distress identifying with their 11
3434 biological sex have often experienced severe psychopathology preceding their gender dysphoria, 12
3535 which indicates these individuals could benefit greatly from access to mental healthcare services; 13
3636 (5) Even among individuals who have undergone inpatient gender reassignment 14
3737 procedures, suicide rates, psychiatric morbidities, and mortality rates remain markedly elevated 15
3838 above the background population; 16
3939 (6) Some healthcare professionals are prescribing puberty-blocking drugs such as 17
4040 gonadotropin-releasing hormone analogues, in order to delay the natural onset or progression of 18
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4444 puberty in children, who experience distress identifying with their biological sex: 1
4545 (i) Puberty-blocking drugs are being prescribed, despite the lack of any long-term 2
4646 longitudinal studies evaluating the risks and benefits of using these drugs for the treatment of such 3
4747 distress or gender dysphoria; and 4
4848 (ii) Puberty-blocking drugs are being prescribed in an off-label and experimental manner 5
4949 on children; 6
5050 (7) Some healthcare professionals are also prescribing cross-sex hormones for children 7
5151 who are experiencing distress identifying with their biological sex, despite the fact no randomized 8
5252 clinical trials have been conducted on the efficacy or safety of the use of cross-sex hormones in 9
5353 adults or children for the purpose of gender transition; 10
5454 (8) The use of cross-sex hormones comes with serious known risks: 11
5555 (i) For biological females, some risks may include; 12
5656 (A) Irreversible infertility; 13
5757 (B) Severe liver dysfunction; 14
5858 (C) Coronary artery disease, including heart attacks; 15
5959 (D) Increased risk of breast, cervical, and uterine cancers; 16
6060 (E) Cerebrovascular disease, including strokes; 17
6161 (F) Hypertension; 18
6262 (G) Erythrocytosis, which is an increase in red blood cells; 19
6363 (H) Sleep apnea; 20
6464 (I) Type 2 diabetes; 21
6565 (J) Loss of bone density; 22
6666 (K) Destabilization of psychiatric disorders; and 23
6767 (ii) For biological males, some risks may include: 24
6868 (A) Irreversible infertility; 25
6969 (B) Thromboembolic disease, including blood clots; 26
7070 (C) Cholelithiasis, including gallstones; 27
7171 (D) Coronary artery disease, including heart attacks; 28
7272 (E) Type 2 diabetes; 29
7373 (F) Breast cancer; 30
7474 (G) Macroprolactinoma, which is a tumor of the pituitary gland; 31
7575 (H) Cerebrovascular disease, including strokes; and 32
7676 (I) Hypertriglyceridemia, which is an elevated level of triglycerides in the blood; 33
7777 (9) Genital and non-genital gender reassignment surgeries are generally not recommended 34
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8181 for children, although evidence indicates referrals for children to have such surgeries are becoming 1
8282 more frequent; 2
8383 (10) Genital gender reassignment surgery includes several irreversible invasive procedures 3
8484 for males and females and involves the alteration of biologically healthy and functional body parts. 4
8585 These procedures are generally irreversible; 5
8686 (i) For biological males, surgery may involve: 6
8787 (A) Genital reconstruction, including a penectomy, which is the removal of the penis; 7
8888 (B) Orchiectomy, which is the removal of the testicles; 8
8989 (C) Vaginoplasty, which is the construction of a vagina-like structure, typically through a 9
9090 penile inversion procedure; 10
9191 (D) Clitoroplasty which is the construction of a clitoris-like structure; and 11
9292 (E) Vulvoplasty, which is the construction of a vulva-like structure; 12
9393 (ii) For biological females, surgery may involve: 13
9494 (A) Hysterectomy or oophorectomy; 14
9595 (B) Reconstruction of the urethra; 15
9696 (C) Genital reconstruction including metoidioplasty or phalloplasty, which is the 16
9797 construction of a penis-like structure; 17
9898 (D) Vaginectomy, which is the removal of the vagina; 18
9999 (E) Scrotoplasty, which is the construction of a scrotum-like structure; and 19
100100 (F) Implantation of erection and/or testicular prosthesis; 20
101101 (iii) The complications, risks, and long-term care concerns associated with genital sex 21
102102 reassignment surgery, for both males and females, are numerous and complex; 22
103103 (iv) Non-genital sex reassignment surgery includes various invasive procedures for males 23
104104 and females and also involves the alteration or removal of biologically health, and functional body 24
105105 parts: 25
106106 (A) For biological males, this surgery may involve: 26
107107 (I) Augmentation mammoplasty; 27
108108 (II) Facial feminization surgery; 28
109109 (III) Liposuction; 29
110110 (IV) Lipofilling; 30
111111 (V) Voice feminization surgery; 31
112112 (VI) Thyroid cartilage reduction; 32
113113 (VII) Gluteal augmentation; 33
114114 (VIII) Hair reconstruction; and 34
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118118 (IX) Other aesthetic procedures; 1
119119 (B) For biological females, this surgery may involve: 2
120120 (I) Subcutaneous mastectomy; 3
121121 (II) Voice masculinization surgery; 4
122122 (III) Liposuction; 5
123123 (IV) Lipofilling; 6
124124 (V) Pectoral implants; and 7
125125 (VI) Other aesthetic procedures; 8
126126 (11) It is an accepted principle of economics and public policy that when a service or 9
127127 product is subsidized or reimbursed, demand for that service or product increases; and 10
128128 (12) It is of grave concern to this general assembly that the medical community is allowing 11
129129 individuals, who experience distress identifying with their biological sex, to be subjects of 12
130130 irreversible and drastic non-genital gender reassignment surgery and irreversible, permanently 13
131131 sterilizing genital gender reassignment surgeries, despite the lack of studies showing that such 14
132132 extreme interventions have benefits that outweigh their risks or chances of cure. In fact, they may 15
133133 increase the risk of suicide. 16
134134 SECTION 2. Title 23 of the General Laws entitled "HEALTH AND SAFETY" is hereby 17
135135 amended by adding thereto the following chapter: 18
136136 CHAPTER 104 19
137137 RHODE ISLAND'S CHILDREN DESERVE HELP NOT HARM ACT 20
138138 23-104-1. Short title. 21
139139 This chapter shall be known and may be cited as the "Rhode Island's Children Deserve 22
140140 Help Not Harm Act". 23
141141 23-104-2. Definitions. 24
142142 The following definitions apply in the interpretation of the provisions of this chapter: 25
143143 (1) "Biological sex" means the biological indication of male and female in the context of 26
144144 reproductive potential or capacity, such as sex chromosomes, naturally occurring sex hormones, 27
145145 gonads, and nonambiguous internal and external genitalia, present at birth, including secondary sex 28
146146 characteristics. 29
147147 (2) "Cross-sex hormones" means: 30
148148 (i) Testosterone or other androgens given to biological females in amounts that create 31
149149 serum levels greater than would normally occur naturally in healthy biological females, which may 32
150150 include without limitation, the following risks: 33
151151 (A) Irreversible infertility; 34
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155155 (B) Severe liver dysfunction; 1
156156 (C) Coronary artery disease, including heart attacks; 2
157157 (D) Increased risk of breast, cervical, and uterine cancers; 3
158158 (E) Cerebrovascular disease, including strokes; 4
159159 (F) Hypertension; 5
160160 (G) Erythrocytosis, which is an increase in red blood cells; 6
161161 (H) Sleep apnea; 7
162162 (I) Type 2 diabetes; 8
163163 (J) Loss of bone density; and 9
164164 (K) Destabilization of psychiatric disorders; and 10
165165 (ii) Estrogen given to biological males, in amounts that create serum levels greater than 11
166166 would normally occur naturally in healthy biological males, which may include without limitation 12
167167 the following risks: 13
168168 (A) Irreversible infertility; 14
169169 (B) Thromboembolic disease, including blood clots; 15
170170 (C) Cholelithiasis, including gallstones; 16
171171 (D) Coronary artery disease, including heart attacks; 17
172172 (E) Type 2 diabetes; 18
173173 (F) Breast cancer; 19
174174 (G) Macroprolactinoma, which is a tumor of the pituitary gland; 20
175175 (H) Cerebrovascular disease, including strokes; and 21
176176 (I) Hypertriglyceridemia, which is an elevated level of triglycerides in the blood. 22
177177 (3) "Gender" means the psychological, behavioral, social and cultural aspects of being male 23
178178 and female. 24
179179 (4) "Gender reassignment surgery" means any surgical service that seeks to surgically alter 25
180180 or remove healthy physical or anatomical characteristics or features, that are typical for the 26
181181 individual's biological sex, in order to instill or create physiological or anatomical characteristics, 27
182182 that resemble a sex different from the individual's biological sex, including without limitation, 28
183183 genital or non-genital gender reassignment surgery performed for the purpose of assisting an 29
184184 individual with a gender transition. 30
185185 (5) "Gender transition" means the process in which a person goes from identifying with 31
186186 and living as a gender that corresponds to their biological sex, and may involve social, legal, or 32
187187 physical changes. 33
188188 (6) "Gender transition procedures" means any medical or surgical service provided or 34
189189
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192192 performed for the purpose of assisting an individual with a physical gender transition: 1
193193 (i) Gender transition procedures include, without limitation, physician's services, inpatient 2
194194 and outpatient hospital services, puberty-blocking drugs, cross-sex hormones, or genital or non-3
195195 genital gender reassignment surgery; 4
196196 (ii) Gender transition procedures do not include: 5
197197 (A) Services to persons born with a medically verifiable disorder of sex development, 6
198198 including a person with external biological sex characteristics that are irresolvably ambiguous, such 7
199199 as those born with 46 XX chromosomes with virilization, 46 XY chromosomes with 8
200200 undervirilization, or having both ovarian and testicular tissue; 9
201201 (B) Services provided when a physician has otherwise diagnosed a disorder of sexual 10
202202 development, that the physician has determined through genetic or biochemical testing that the 11
203203 person does not have normal sex chromosome structure, sex steroid production, or sex steroid 12
204204 hormone action; 13
205205 (C) The acute and chronic treatment of any infection, injury, disease, or disorder that has 14
206206 been caused by or exacerbated by the performance of gender transition procedures, whether or not 15
207207 the gender transition procedure, was performed in violation of state or federal law or whether or 16
208208 not funding for the gender transition procedure is prohibited pursuant to the provisions of this 17
209209 chapter; or 18
210210 (D) Any procedure undertaken because the individual suffers from a physical disorder, 19
211211 physical injury, or physical illness that would, as certified by a physician, place the individual in 20
212212 imminent danger of death or impairment of major bodily function, unless surgery is performed. 21
213213 (7) "Genital gender reassignment surgery" means a surgical procedure performed for the 22
214214 purpose of assisting an individual with a physical gender transition, including, without limitation: 23
215215 (i) Surgical procedures such as a penectomy, orchiectomy, vaginoplasty, clitoroplasty, or 24
216216 vulvoplasty for biologically male patients; or 25
217217 (ii) Surgical procedures such as hysterectomy, oophorectomy, reconstruction of the 26
218218 urethra, metoidioplasty or phalloplasty, vaginectomy, scrotoplasty, or implantation of erection 27
219219 and/or testicular protheses for biologically female patients. 28
220220 (8) "Non-genital gender reassignment surgery" means surgical procedures performed for 29
221221 the purpose of assisting an individual with a physical gender transition, including, without 30
222222 limitation: 31
223223 (i) Surgical procedures for biologically male patients, such as augmentation mammoplasty, 32
224224 facial feminization surgery, liposuction, lipofilling, voice feminization surgery, thyroid cartilage 33
225225 reduction, gluteal augmentation, hair reconstruction, or various aesthetic procedures; or 34
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229229 (ii) Surgical procedures for biologically female patients, such as subcutaneous mastectomy, 1
230230 voice masculinization surgery, liposuction, lipofilling, pectoral implants, or various aesthetic 2
231231 procedures. 3
232232 (9) "Physician" means a person who is licensed to practice medicine in this state. 4
233233 (10) "Puberty-blocking drugs" means gonadotropin-releasing hormone analogues or other 5
234234 synthetic drugs used in biological males to stop luteinizing hormone secretion and therefore 6
235235 testosterone production, or synthetic drugs used in biological females, which stop the production 7
236236 of estrogen and progesterone, when used to delay or suppress pubertal development in children, for 8
237237 the purpose of assisting an individual with a gender transition. 9
238238 (11) "Public funds" means state or local government monies, in addition to any department, 10
239239 agency, or instrumentality authorized or appropriated under state law or derived from any fund in 11
240240 which monies are deposited. 12
241241 23-104-3. Gender transition procedures for minors prohibited. 13
242242 (a) A physician or other healthcare professional shall not provide gender transition 14
243243 procedures to any individual under eighteen (18) years of age. 15
244244 (b) A healthcare institution or entity shall not facilitate the provision of gender transition 16
245245 procedures to any individual under eighteen (18) years of age. 17
246246 23-104-4. Insurance coverage for gender transition procedures for minors prohibited. 18
247247 (a) A health benefit plan under an insurance policy or other plan providing healthcare 19
248248 coverage in this state shall not include reimbursement for gender transition procedures for a person 20
249249 under eighteen (18) years of age. 21
250250 (b) A health benefit plan under an insurance policy or other plan providing healthcare 22
251251 coverage in this state is not required to provide coverage for gender transition procedures. 23
252252 (c) A federal health benefit plan under an insurance policy or other plan providing 24
253253 healthcare coverage, such as TRICare or Veterans Administration Healthcare, shall not include 25
254254 reimbursement for gender transition procedures for a person under eighteen (18) years of age in 26
255255 this state. 27
256256 23-104-5. Prohibition on aiding or abetting. 28
257257 (a) A person or entity shall not knowingly engage in conduct that aids or abets the 29
258258 performance or inducement of gender transition procedures, to any individual under eighteen (18) 30
259259 years of age, including employees of other state governments, the federal government, or foreign 31
260260 governments. 32
261261 (b) This provision shall not apply to any first amendment-protected speech. 33
262262 (c) No parent of a child victim shall be held liable under this section. 34
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266266 23-104-6. Prohibition on use of public funds for gender transition. 1
267267 (a) Public funds shall not be directly or indirectly used, granted, paid, or distributed to any 2
268268 entity, organization, or individual that provides gender transition procedures to an individual under 3
269269 eighteen (18) years of age. 4
270270 (b) Healthcare services furnished in the following situations shall not include gender 5
271271 transition procedures to an individual under eighteen (18) years of age: 6
272272 (1) By or in a facility owned by the state or a local government; or 7
273273 (2) By a physician or other healthcare professional employed by the state or local 8
274274 government. 9
275275 (c) An amount paid by an individual or an entity, during a taxable year, for provision of 10
276276 gender transition procedures or as premiums for healthcare coverage, that includes coverage for 11
277277 gender transition procedures, is not tax-deductible. 12
278278 (d) The state Medicaid program shall not reimburse or provide coverage for gender 13
279279 transition procedures to an individual under eighteen (18) years of age. 14
280280 23-104-7. Gender transition procedures on minors constitute unprofessional and 15
281281 reckless conduct. 16
282282 Any referral for or provision of gender transition procedures to an individual, under 17
283283 eighteen (18) years of age, is unprofessional conduct and is subject to discipline by the appropriate 18
284284 licensing entity or disciplinary review board, with competent jurisdiction in this state. 19
285285 23-104-8. Private cause of action. 20
286286 Every person who subjects or causes to be subjected any citizen of this state or other person 21
287287 within the jurisdiction to suffer injury by violating the provisions of this chapter shall be liable to 22
288288 the party injured in an action at law, suit in equity, or other appropriate proceedings for redress in 23
289289 the superior court of this state. The court may award attorney fees and costs to a prevailing plaintiff. 24
290290 23-104-9. Enforcement actions for recovery of damages suffered as a result of gender 25
291291 transition procedures on minors. 26
292292 (a) Statute of limitations: 27
293293 (1) Notwithstanding any other provision of law, an individual under eighteen (18) years of 28
294294 age may bring an action, throughout their minority, through a parent or next friend, and may bring 29
295295 an action in their own name, upon reaching the age of majority at any time from that point until 30
296296 thirty (30) years after reaching the age of majority. 31
297297 (2) Exceptions: 32
298298 (i) If at the time the person abused or suffering damages as a result of acts violating the 33
299299 provisions of this chapter, attains the age of eighteen (18) years and is under disability by reason 34
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303303 of mental incompetence or under other legal disability, the limitation period under subsection (a)(1) 1
304304 of this section does not begin to run until the removal of the disability; and 2
305305 (ii) The limitation period in subsection (a)(1) of this section does not run during a time 3
306306 period when the individual is subject to threats, intimidation, manipulation, fraudulent 4
307307 concealment, or fraud perpetrated by the physician or other healthcare professional, who prescribed 5
308308 or otherwise provided gender transition procedures or by any person, acting in the interest of the 6
309309 physician or other healthcare professional. 7
310310 (b) A person may assert an actual or threatened violation of this chapter, as a claim or 8
311311 defense in a judicial or administrative proceeding. 9
312312 (1) The following damages may be awarded to the claimant: 10
313313 (i) Compensatory damages, including, but not limited to: 11
314314 (A) Pain and suffering; 12
315315 (B) Loss of reputation; 13
316316 (C) Loss of income; and 14
317317 (D) Loss of consortium, including, but not limited to, the loss of expectation of sharing 15
318318 parenthood; 16
319319 (ii) Injunctive relief; 17
320320 (iii) Declaratory relief; 18
321321 (iv) Punitive damages; 19
322322 (v) Any other appropriate relief; and 20
323323 (vi) A prevailing party, who establishes a violation of this chapter shall recover reasonable 21
324324 attorneys' fees and cost. 22
325325 (c) Notwithstanding any other provision of law, an action under this chapter, may be 23
326326 commenced, and relief may be granted, in a judicial proceeding, without regard to whether the 24
327327 person commencing the action has sought or exhausted available administrative remedies. 25
328328 (d) The attorney general may bring an action to enforce compliance with this chapter. 26
329329 (e) This chapter does not deny, impair, or otherwise affect any right or authority of the 27
330330 attorney general, the State of Rhode Island, or any agency, officer, or employee of the state, acting 28
331331 under any law, other than this chapter, to institute or intervene in any proceeding. 29
332332 23-104-10. Right of intervention. 30
333333 The general assembly, by joint resolution, may appoint one or more of its members who 31
334334 sponsored or cosponsored this chapter in their official capacity, to intervene or defend the chapter 32
335335 as a matter of right, in any case in which the constitutionality or enforceability of this chapter, any 33
336336 portion thereof, or any rule or regulation adopted pursuant hereto, is challenged. 34
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340340 23-104-11. Severability. 1
341341 Any provision of this chapter held to be invalid or unenforceable by its terms, or as applied 2
342342 to any person or circumstance, shall be construed so as to give it the maximum effect, permitted by 3
343343 law, unless such holding, shall be one of utter invalidity or unenforceability, in which event such 4
344344 provision shall be deemed severable herefrom and shall not affect the remainder hereof or the 5
345345 application of such provision to other persons not similarly situated to or to other, dissimilar 6
346346 circumstances. 7
347347 23-104-12. Effective date. 8
348348 This act shall take effect on January 1, 2026, in order that minors in this state currently 9
349349 using puberty-blocking drugs or cross-sex hormones, shall have the time for appropriate medication 10
350350 tapering and discontinuation, under the care of their physician or other healthcare professional. 11
351351 SECTION 3. This act shall take effect on January 1, 2026. 12
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358358 EXPLANATION
359359 BY THE LEGISLATIVE COUNCIL
360360 OF
361361 A N A C T
362362 RELATING TO HEALTH AND SAFETY -- RHODE ISLAND'S CHILDREN DESERVE
363363 HELP NOT HARM ACT -- MINOR'S GENDER TRANSITION
364364 ***
365365 This act would prohibit gender transition procedures for all minors, use of public funds for 1
366366 that purpose, discipline for health care providers for providing same, a thirty (30) year statute of 2
367367 limitation, after reaching the age of majority, and right to a civil action for damages. 3
368368 This act would take effect on January 1, 2026. 4
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