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| 4 | 4 | | |
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| 5 | 5 | | 2025 -- S 0305 |
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| 6 | 6 | | ======== |
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| 7 | 7 | | LC000377 |
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| 8 | 8 | | ======== |
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| 9 | 9 | | S T A T E O F R H O D E I S L A N D |
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| 10 | 10 | | IN GENERAL ASSEMBLY |
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| 11 | 11 | | JANUARY SESSION, A.D. 2025 |
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| 12 | 12 | | ____________ |
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| 13 | 13 | | |
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| 14 | 14 | | A N A C T |
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| 15 | 15 | | RELATING TO HEALTH AND SAFETY -- MEDICAL ETHICS DEFENSE ACT |
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| 16 | 16 | | Introduced By: Senator E Morgan |
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| 17 | 17 | | Date Introduced: February 13, 2025 |
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| 18 | 18 | | Referred To: Senate Judiciary |
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| 19 | 19 | | |
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| 20 | 20 | | |
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| 21 | 21 | | It is enacted by the General Assembly as follows: |
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| 22 | 22 | | SECTION 1. Title 23 of the General Laws entitled "HEALTH AND SAFETY" is hereby 1 |
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| 23 | 23 | | amended by adding thereto the following chapter: 2 |
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| 24 | 24 | | CHAPTER 104 3 |
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| 25 | 25 | | MEDICAL ETHICS DEFENSE ACT 4 |
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| 26 | 26 | | 23-104-1. Short title. 5 |
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| 27 | 27 | | This chapter shall be known and may be cited as the "Medical Ethics Defense Act". 6 |
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| 28 | 28 | | 23-104-2. Definitions. 7 |
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| 29 | 29 | | As used in this chapter: 8 |
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| 30 | 30 | | (1) "Conscience" means the ethical, moral, or religious belief or principles held by any 9 |
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| 31 | 31 | | medical practitioner, healthcare institution, or healthcare payer. Conscience with respect to 10 |
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| 32 | 32 | | institutional entities or corporate bodies, as opposed to individual persons, is determined by 11 |
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| 33 | 33 | | reference to that entity or body’s governing documents, including, but not limited to, any published 12 |
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| 34 | 34 | | ethical, moral or religious guidelines or directives, mission statements, constitutions, articles of 13 |
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| 35 | 35 | | incorporation, bylaws, policies, or regulations. 14 |
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| 36 | 36 | | (2) "Disclosure" means a formal or informal communication or transmission, but does not 15 |
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| 37 | 37 | | include a communication or transmission concerning policy decisions that lawfully exercise 16 |
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| 38 | 38 | | discretionary authority unless the medical practitioner providing the disclosure or transmission 17 |
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| 39 | 39 | | reasonably believes that the disclosure or transmission evinces: 18 |
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| 40 | 40 | | (i) Any violation of any law, rule, or regulation; 19 |
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| 41 | 41 | | |
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| 42 | 42 | | |
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| 43 | 43 | | LC000377 - Page 2 of 7 |
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| 44 | 44 | | (ii) Any violation of any ethical guidelines for the provision of any medical procedure or 1 |
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| 45 | 45 | | service; or 2 |
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| 46 | 46 | | (iii) Gross mismanagement, a gross waste of funds, an abuse of authority, practices or 3 |
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| 47 | 47 | | methods of treatment that may put patient health at risk, or a substantial and specific danger to 4 |
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| 48 | 48 | | public health or safety. 5 |
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| 49 | 49 | | (3) "Discrimination" means any adverse action taken against, or any threat of adverse 6 |
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| 50 | 50 | | action communicated to, any medical practitioner, healthcare institution, or healthcare payer as a 7 |
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| 51 | 51 | | result of their decision to decline to participate in a medical procedure or service on the basis of 8 |
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| 52 | 52 | | conscience. Discrimination includes, but is not limited to, termination of employment; transfer from 9 |
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| 53 | 53 | | current position; demotion from current position; adverse administrative action; reassignment to a 10 |
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| 54 | 54 | | different shift or job title; increased administrative duties; refusal of staff privileges; refusal of 11 |
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| 55 | 55 | | board certification; loss of career specialty; reduction of wages, benefits or privileges; refusal to 12 |
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| 56 | 56 | | award a grant, contract or other program; refusal to provide residency training opportunities; denial, 13 |
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| 57 | 57 | | deprivation, or disqualification of licensure; withholding or disqualifying from financial aid and 14 |
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| 58 | 58 | | other assistance; impediments to creating any healthcare institution or payer or expanding or 15 |
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| 59 | 59 | | improving said healthcare institution or payer; impediments to acquiring, associating with, or 16 |
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| 60 | 60 | | merging with any other healthcare institution or payer; the threat thereof with regard to any of the 17 |
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| 61 | 61 | | preceding; or any other penalty, disciplinary, or retaliatory action, whether executed or threatened. 18 |
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| 62 | 62 | | Discrimination excludes the negotiation or purchase of insurance by a non-government entity. 19 |
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| 63 | 63 | | (4) "Healthcare institution" means any organization, corporation, partnership, association, 20 |
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| 64 | 64 | | agency, network, sole proprietorship, joint venture, or other entity that provides medical procedures 21 |
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| 65 | 65 | | or services. The term includes, but is not limited to, any public or private hospital, clinic, medical 22 |
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| 66 | 66 | | center, physician organization, professional association, ambulatory surgical center, private 23 |
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| 67 | 67 | | physician’s office, pharmacy, nursing home, medical school, nursing school, medical training 24 |
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| 68 | 68 | | facility, or any other entity or location in which medical procedures or services are performed. 25 |
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| 69 | 69 | | (5) "Healthcare payer" means any employer, health plan, health maintenance organization, 26 |
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| 70 | 70 | | insurance company, management services organization, or any other entity that pays for or arranges 27 |
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| 71 | 71 | | for the payment of any medical procedure or service provided to any patient, whether that payment 28 |
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| 72 | 72 | | is made in whole or in part. 29 |
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| 73 | 73 | | (6) "Medical practitioner" means any person or individual who may be or is asked to 30 |
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| 74 | 74 | | participate in any way in any medical procedure or service. This includes, but is not limited to, 31 |
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| 75 | 75 | | doctors, nurse practitioners, physician’s assistants, nurses, nurses’ aides, allied health professionals, 32 |
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| 76 | 76 | | medical assistants, hospital employees, clinic employees, nursing home employees, pharmacists, 33 |
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| 77 | 77 | | pharmacy technicians and employees, medical school faculty and students, nursing school faculty 34 |
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| 79 | 79 | | |
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| 80 | 80 | | LC000377 - Page 3 of 7 |
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| 81 | 81 | | and students, psychology and counseling faculty and students, medical researchers, laboratory 1 |
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| 82 | 82 | | technicians, psychologists, psychiatrists, counselors, mental health professionals, social workers, 2 |
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| 83 | 83 | | or any other person who facilitates or participates in the provision of a medical procedure or service. 3 |
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| 84 | 84 | | (7) "Medical procedure or service" means medical care provided to any patient at any time 4 |
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| 85 | 85 | | over the entire course of treatment, or medical research. This includes, but is not limited to, testing; 5 |
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| 86 | 86 | | diagnosis; referral; dispensing and/or administering any drug, medication, or device; psychological 6 |
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| 87 | 87 | | therapy or counseling; research; prognosis; therapy; record making procedures; notes related to 7 |
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| 88 | 88 | | treatment; set up or performance of a surgery or procedure; or any other care or services performed 8 |
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| 89 | 89 | | or provided by any medical practitioner including, but not limited to, physicians, nurses, allied 9 |
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| 90 | 90 | | health professionals, paraprofessionals, contractors, or employees of healthcare institutions. 10 |
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| 91 | 91 | | (8) "Participate" in a medical procedure or service means to provide, perform, assist with, 11 |
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| 92 | 92 | | facilitate, refer for, counsel for, advise with regard to, admit for the purposes of providing, or take 12 |
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| 93 | 93 | | part in any way in providing any medical procedure or service, or any form of such service. 13 |
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| 94 | 94 | | (9) "Pay" or "payment" means to pay for, contract for, arrange for the payment of, whether 14 |
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| 95 | 95 | | in whole or in part, reimburse or remunerate. 15 |
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| 96 | 96 | | 23-104-3. Rights of conscience of medical practitioners, healthcare institutions and 16 |
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| 97 | 97 | | healthcare payers. 17 |
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| 98 | 98 | | (a) Freedom of conscience. A medical practitioner, healthcare institution, or healthcare 18 |
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| 99 | 99 | | payer has the right not to participate in or pay for any medical procedure or service which violates 19 |
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| 100 | 100 | | their conscience. 20 |
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| 101 | 101 | | (b) Limitations. The exercise of the right of conscience is limited to conscience-based 21 |
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| 102 | 102 | | objections to a particular medical procedure or service. This section shall not be construed to waive 22 |
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| 103 | 103 | | or modify any duty a health care practitioner, health care institution, or health care payer may have 23 |
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| 104 | 104 | | to provide other medical procedures or services that do not violate the practitioner’s, institution’s 24 |
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| 105 | 105 | | or payer’s conscience. 25 |
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| 106 | 106 | | (c) Immunity from liability. No medical practitioner, healthcare institution, or healthcare 26 |
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| 107 | 107 | | payer shall be civilly, criminally, or administratively liable for exercising their right of conscience 27 |
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| 108 | 108 | | not to participate in or pay for a medical procedure or service. No healthcare institution shall be 28 |
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| 109 | 109 | | civilly, criminally, or administratively liable for the exercise of conscience rights not to participate 29 |
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| 110 | 110 | | in a medical procedure or service by a medical practitioner employed, contracted, or granted 30 |
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| 111 | 111 | | admitting privileges by the healthcare institution. 31 |
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| 112 | 112 | | (d) Discrimination. No medical practitioner, healthcare institution, or healthcare payer 32 |
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| 113 | 113 | | shall be discriminated against in any manner as a result of their decision to decline to participate in 33 |
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| 114 | 114 | | or pay for a medical procedure or service on the basis of conscience. 34 |
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| 115 | 115 | | |
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| 116 | 116 | | |
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| 117 | 117 | | LC000377 - Page 4 of 7 |
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| 118 | 118 | | (e) Exception. Notwithstanding any other provision of this chapter to the contrary, a 1 |
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| 119 | 119 | | religious medical practitioner, healthcare institution, or healthcare payer that holds itself out to the 2 |
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| 120 | 120 | | public as religious, states in its governing documents that it has a religious purpose or mission, and 3 |
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| 121 | 121 | | has internal operating policies or procedures that implement its religious beliefs, shall have the right 4 |
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| 122 | 122 | | to make employment, staffing, contracting, and admitting privilege decisions consistent with its 5 |
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| 123 | 123 | | religious beliefs. 6 |
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| 124 | 124 | | (f) Opt-in required. A health care practitioner may not be scheduled for, assigned, or 7 |
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| 125 | 125 | | requested to directly or indirectly perform, facilitate, refer for, or participate in an abortion unless 8 |
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| 126 | 126 | | the practitioner first affirmatively consents in writing to perform, facilitate, refer for, or participate 9 |
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| 127 | 127 | | in the abortion. 10 |
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| 128 | 128 | | (g) Emergency medical treatments. This chapter shall not be construed to override the 11 |
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| 129 | 129 | | requirement to provide emergency medical treatment to all patients as set forth in 42 U.S.C. § 12 |
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| 130 | 130 | | 1395dd. 13 |
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| 131 | 131 | | 23-104-4. Whistleblower protection. 14 |
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| 132 | 132 | | (a) No medical practitioner shall be discriminated against in any manner because the 15 |
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| 133 | 133 | | medical practitioner: 16 |
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| 134 | 134 | | (1) Provided, caused to be provided, or is about to provide or cause to be provided to their 17 |
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| 135 | 135 | | employer, the attorney general, department of health, any state agency charged with protecting 18 |
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| 136 | 136 | | health care rights of conscience, the U.S. Department of Health and Human Services, Office of 19 |
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| 137 | 137 | | Civil Rights, or any other federal agency charged with protecting health care rights of conscience 20 |
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| 138 | 138 | | information relating to any violation of, or any act or omission the medical practitioner reasonable 21 |
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| 139 | 139 | | believes to be a violation of, any provision of this chapter; 22 |
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| 140 | 140 | | (2) Testified or is about to testify in a proceeding concerning such violation; or 23 |
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| 141 | 141 | | (3) Assisted or participated, or is about to assist or participate, in such a proceeding. 24 |
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| 142 | 142 | | (b) Unless the disclosure is specifically prohibited by law, no medical practitioner shall be 25 |
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| 143 | 143 | | discriminated against in any manner because the medical practitioner disclosed any information 26 |
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| 144 | 144 | | that the medical practitioner reasonably believes evinces: 27 |
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| 145 | 145 | | (1) Any violation of any law, rule, or regulation; 28 |
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| 146 | 146 | | (2) Any violation of any ethical guidelines for the provisions of any medical procedure or 29 |
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| 147 | 147 | | service; or 30 |
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| 148 | 148 | | (3) Gross mismanagement, a gross waste of funds, an abuse of authority, practices or 31 |
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| 149 | 149 | | methods of treatment that may put patient health at risk, or a substantial and specific danger to 32 |
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| 150 | 150 | | public health or safety. 33 |
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| 151 | 151 | | (c) The board of medical licensure and discipline shall not reprimand, sanction, or revoke 34 |
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| 152 | 152 | | |
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| 153 | 153 | | |
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| 154 | 154 | | LC000377 - Page 5 of 7 |
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| 155 | 155 | | or threaten to revoke a license, certificate, or registration of a health care practitioner for engaging 1 |
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| 156 | 156 | | in speech or expressive activity protected under the first amendment of the U.S. Constitution, unless 2 |
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| 157 | 157 | | the board demonstrates beyond a reasonable doubt that the practitioner’s speech was the direct 3 |
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| 158 | 158 | | cause of physical harm to a person with whom the health care practitioner had a practitioner-patient 4 |
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| 159 | 159 | | relationship within the three (3) years immediately preceding the incident of physical harm. 5 |
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| 160 | 160 | | (1) The board of medical licensure and discipline shall provide a medical practitioner with 6 |
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| 161 | 161 | | any complaints it has received which may result in the revocation of the medical practitioner’s 7 |
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| 162 | 162 | | license, certification, or registration, within seven (7) days after receipt of the complaint. 8 |
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| 163 | 163 | | (2) The board of medical licensure and discipline shall pay the medical practitioner an 9 |
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| 164 | 164 | | administrative penalty of five hundred dollars ($500) for each day the complaint is not provided to 10 |
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| 165 | 165 | | the medical practitioner after the seven (7) day period set forth in subsection (c)(1) of this section. 11 |
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| 166 | 166 | | 23-104-5. Civil remedies. 12 |
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| 167 | 167 | | (a) Civil action for violation of right of conscience. A civil action for damages or injunctive 13 |
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| 168 | 168 | | relief, or both, may be brought by any medical practitioner, healthcare institution, or healthcare 14 |
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| 169 | 169 | | payer for any violation of this chapter. Any additional burden or expense on another medical 15 |
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| 170 | 170 | | practitioner, healthcare institution, or healthcare payer arising from the exercise of the right of 16 |
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| 171 | 171 | | conscience shall not be a defense to any violation of this chapter. However, no civil action may be 17 |
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| 172 | 172 | | brought against an individual who declines to use or purchase medical procedure or services from 18 |
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| 173 | 173 | | a specific medical practitioner, healthcare institution, or healthcare payer for exercising the rights 19 |
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| 174 | 174 | | set forth in § 23-104-3. 20 |
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| 175 | 175 | | (b) Other remedies. Any party aggrieved by any violation of this chapter may commence a 21 |
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| 176 | 176 | | civil action and upon a finding of a violation, shall be entitled to recover threefold their actual 22 |
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| 177 | 177 | | damages sustained, along with the costs of the action and reasonable attorneys' fees. Such damages 23 |
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| 178 | 178 | | shall be cumulative and in no way limited by any other remedies which may be available under any 24 |
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| 179 | 179 | | other federal, state, or municipal law. A court considering such civil action may also award 25 |
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| 180 | 180 | | injunction relief, which may include, but it not limited to, reinstatement of a medical practitioner 26 |
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| 181 | 181 | | to their previous position, reinstatement of board certification, and re-licensure of a healthcare 27 |
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| 182 | 182 | | institution or healthcare payer. 28 |
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| 183 | 183 | | 23-104-6. Severability. 29 |
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| 184 | 184 | | Any provision of this chapter held to be invalid or unenforceable by its terms, or as applied 30 |
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| 185 | 185 | | to any person or circumstance, shall be construed so as to give it the maximum effect permitted by 31 |
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| 186 | 186 | | law, unless such holding shall be one of utter invalidity or unenforceability, in which event such 32 |
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| 187 | 187 | | provision shall be deemed severable herefrom and shall not affect the remainder hereof or the 33 |
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| 188 | 188 | | application of such provision to other persons not similarly situated or to other, dissimilar 34 |
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| 189 | 189 | | |
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| 190 | 190 | | |
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| 191 | 191 | | LC000377 - Page 6 of 7 |
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| 192 | 192 | | circumstances. 1 |
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| 193 | 193 | | SECTION 2. This act shall take effect upon passage. 2 |
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| 194 | 194 | | ======== |
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| 195 | 195 | | LC000377 |
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| 196 | 196 | | ======== |
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| 197 | 197 | | |
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| 199 | 199 | | LC000377 - Page 7 of 7 |
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| 200 | 200 | | EXPLANATION |
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| 201 | 201 | | BY THE LEGISLATIVE COUNCIL |
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| 202 | 202 | | OF |
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| 203 | 203 | | A N A C T |
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| 204 | 204 | | RELATING TO HEALTH AND SAFETY -- MEDICAL ETHICS DEFENSE ACT |
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| 205 | 205 | | *** |
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| 206 | 206 | | This act would establish the right of a medical practitioner, healthcare institution, or 1 |
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| 207 | 207 | | healthcare payer not to participate in or pay for any medical procedure or service that violates their 2 |
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| 208 | 208 | | conscience. This act would further protect medical practitioners and institutions from lawsuits or 3 |
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| 209 | 209 | | criminal charges for exercising their right of conscience. This act would ensure that a doctor or 4 |
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| 210 | 210 | | nurse cannot be fired, demoted, or otherwise discriminated against by their employer for declining 5 |
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| 211 | 211 | | to participate in a procedure that violates his or her conscience. 6 |
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| 212 | 212 | | This act would take effect upon passage. 7 |
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| 213 | 213 | | ======== |
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| 214 | 214 | | LC000377 |
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