Texas 2021 87th Regular

Texas Senate Bill SB1173 Comm Sub / Bill

Filed 04/28/2021

                    By: Hancock, et al. S.B. No. 1173
 (Schaefer, Oliverson, Klick, et al.)


 A BILL TO BE ENTITLED
 AN ACT
 relating to the regulation of abortion, including information
 regarding perinatal palliative care and prohibiting discriminatory
 abortions; authorizing disciplinary action; providing a civil
 remedy; creating a criminal offense.
 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
 SECTION 1.  This Act may be cited as the Preborn
 Nondiscrimination Act.
 SECTION 2.  The legislature finds that:
 (1)  Texas has a compelling state interest in
 protecting all Texans from discrimination based on sex, race, and
 disability; and
 (2)  Texas enforces prohibitions against
 discrimination based on sex, race, and disability in various areas,
 including housing, employment, education, insurance, and health
 program and service provision.
 SECTION 3.  Chapter 161, Health and Safety Code, is amended
 by adding Subchapter X to read as follows:
 SUBCHAPTER X.  PERINATAL PALLIATIVE CARE
 Sec. 161.701.  PURPOSE OF SUBCHAPTER. The purpose of this
 subchapter is to ensure that a pregnant woman who receives a
 diagnosis of a life-threatening disability of the woman's preborn
 child is informed of the availability of perinatal palliative care.
 Sec. 161.702.  DEFINITION. In this subchapter, "perinatal
 palliative care" means the provision of comprehensive, supportive
 care to reduce the suffering of a pregnant woman, her preborn child,
 and her family, from diagnosis of the preborn child's
 life-threatening disability through the delivery and possible
 death of the child as a result of the life-threatening disability.
 The term includes medical, social, and mental health care,
 including counseling and health care provided by maternal-fetal
 medical specialists, obstetricians, neonatologists, anesthesia
 specialists, specialty nurses, clergy, social workers, and other
 individuals focused on alleviating fear and pain and ensuring the
 pregnant woman, her preborn child, and her family experience a
 supportive environment.
 Sec. 161.703.  PERINATAL PALLIATIVE CARE INFORMATIONAL
 MATERIALS. (a) The commission shall develop perinatal palliative
 care informational materials and post the materials on the
 commission's Internet website. The materials must include:
 (1)  a description of the health care and other
 services available through perinatal palliative care; and
 (2)  information about medical assistance benefits
 that may be available for prenatal care, childbirth, and perinatal
 palliative care.
 (b)  The commission shall develop, regularly update, and
 publish a geographically indexed list of all perinatal palliative
 care providers and programs in this state. The commission may
 include perinatal palliative care providers and programs in other
 states that provide care to residents of this state but may not
 include an abortion provider, as defined by Section 171.002, or an
 affiliate, as defined by Section 2272.001, Government Code, as
 added by Chapter 501 (S.B. 22), Acts of the 86th Legislature,
 Regular Session, 2019, of an abortion provider. The commission
 shall post the list of perinatal palliative care providers and
 programs, including contact information, on the commission's
 Internet website and note the providers and programs that provide
 services free of charge.
 Sec. 161.704.  PERINATAL PALLIATIVE CARE CERTIFICATION
 FORM. The commission shall develop a form on which a pregnant woman
 certifies that she has received the perinatal palliative care
 informational materials and list of the perinatal palliative care
 providers and programs described by Section 161.703.
 Sec. 161.705.  HEALTH CARE PROVIDER DUTIES ON DIAGNOSIS OF
 PREBORN CHILD'S LIFE-THREATENING DISABILITY. A health care
 provider who diagnoses a pregnant woman's preborn child as having a
 life-threatening disability shall, at the time of the diagnosis:
 (1)  provide the pregnant woman with a written copy of:
 (A)  the perinatal palliative care informational
 materials and list of the perinatal palliative care providers and
 programs described by Section 161.703; and
 (B)  the perinatal palliative care certification
 form described by Section 161.704; and
 (2)  obtain from the pregnant woman the signed
 perinatal palliative care certification form and place the form in
 the pregnant woman's medical records.
 Sec. 161.706.  EXCEPTION. A health care provider is not
 required to provide the perinatal palliative care informational
 materials or perinatal palliative care certification form under
 this subchapter if the health care provider verifies the pregnant
 woman's medical record contains a signed perinatal palliative care
 certification form for that pregnancy as required under Section
 161.705(2).
 SECTION 4.  Chapter 170, Health and Safety Code, is amended
 by designating Sections 170.001 and 170.002 as Subchapter A and
 adding a subchapter heading to read as follows:
 SUBCHAPTER A. GENERAL PROVISIONS; THIRD TRIMESTER
 ABORTION PROHIBITED
 SECTION 5.  Section 170.001, Health and Safety Code, is
 amended by adding Subdivision (2-a) to read as follows:
 (2-a)  "Preborn child" means an unborn child as defined
 by Section 171.061.
 SECTION 6.  Section 170.002, Health and Safety Code, is
 amended to read as follows:
 Sec. 170.002.  PROHIBITED ACTS; EXEMPTION. (a) Except as
 provided by Subsection (b), a person may not intentionally or
 knowingly perform an abortion on a woman who is pregnant with a
 preborn [viable unborn] child during the third trimester of the
 pregnancy.
 (b)  Subsection (a) does not prohibit a person from
 performing an abortion if at the time of the abortion the person is
 a physician and concludes in good faith according to the
 physician's best medical judgment that[:
 [(1)  the fetus is not a viable fetus and the pregnancy
 is not in the third trimester;
 [(2)]  the abortion is necessary due to a medical
 emergency, as defined by Section 171.002 [to prevent the death or a
 substantial risk of serious impairment to the physical or mental
 health of the woman; or
 [(3)  the fetus has a severe and irreversible
 abnormality, identified by reliable diagnostic procedures].
 (c)  A physician who performs an abortion that, according to
 the physician's best medical judgment at the time of the abortion,
 is to abort a preborn [viable unborn] child during the third
 trimester of the pregnancy shall certify in writing to the
 commission, on a form prescribed by the commission, the medical
 indications supporting the physician's judgment that the abortion
 was authorized by Subsection (b) [(b)(2) or (3). If the physician
 certifies the abortion was authorized by Subsection (b)(3), the
 physician shall certify in writing on the form the fetal
 abnormality identified by the physician]. The certification must
 be made not later than the 30th day after the date the abortion was
 performed.
 SECTION 7.  Chapter 170, Health and Safety Code, is amended
 by adding Subchapter B to read as follows:
 SUBCHAPTER B. DISCRIMINATORY ABORTION PROHIBITED
 Sec. 170.051.  DEFINITION. In this subchapter, "disability"
 means:
 (1)  a physical or mental impairment that would
 substantially limit one or more of an individual's major life
 activities;
 (2)  an assessment referencing an individual's
 impairment described by Subdivision (1); or
 (3)  a physical disfigurement, scoliosis, dwarfism,
 Down syndrome, albinism, amelia, or any other type of physical,
 mental, or intellectual abnormality or disease.
 Sec. 170.052.  DISCRIMINATORY ABORTION PROHIBITED. A person
 may not:
 (1)  knowingly perform or attempt to perform on a
 pregnant woman an abortion based on the race, ethnicity, sex, or
 disability of the woman's preborn child, including a probability of
 diagnosis that the child has a disability; or
 (2)  use force or the threat of force to intentionally
 injure or intimidate a person to coerce the performance or
 attempted performance of an abortion based on the race, ethnicity,
 sex, or disability of the woman's preborn child, including a
 probability of diagnosis that the child has a disability.
 Sec. 170.053.  CRIMINAL PENALTY. (a) A person who violates
 Section 170.052 commits an offense. An offense under this
 subsection is a Class A misdemeanor.
 (b)  A woman on whom an abortion is performed or attempted in
 violation of Section 170.052 may not be prosecuted for a violation
 of that section or for conspiracy to commit a violation of that
 section.
 Sec. 170.054.  LICENSE SUSPENSION OR REVOCATION. A
 physician who violates Section 170.052 engages in unprofessional
 conduct for which the physician's license may be suspended or
 revoked under Chapter 164, Occupations Code.
 Sec. 170.055.  CIVIL REMEDIES. (a) A civil action may be
 brought against a person who violates Section 170.052 by:
 (1)  the woman on whom an abortion was performed or
 attempted in violation of Section 170.052;
 (2)  the father of the preborn child for an abortion
 performed or attempted on a pregnant woman in violation of Section
 170.052, unless the woman's pregnancy resulted from the father's
 criminal conduct; or
 (3)  a maternal grandparent of the preborn child for an
 abortion performed or attempted in violation of Section 170.052 on
 a pregnant woman who was less than 18 years of age at the time of the
 violation, unless the woman's pregnancy resulted from the maternal
 grandparent's criminal conduct.
 (b)  A person who brings an action under this section may
 obtain:
 (1)  injunctive relief;
 (2)  damages incurred by the person, including:
 (A)  actual damages for all psychological,
 emotional, and physical injuries resulting from the violation of
 Section 170.052;
 (B)  court costs; and
 (C)  reasonable attorney's fees; or
 (3)  both injunctive relief and damages.
 (c)  An action for damages or injunctive relief under this
 section must be filed:
 (1)  in a district court in the county in which the
 woman on whom an abortion was performed or attempted in violation of
 Section 170.052 resides; and
 (2)  not later than the sixth anniversary of the date
 the abortion was performed or attempted in violation of Section
 170.052.
 (d)  The damages and injunctive relief authorized by this
 section are in addition to any other remedy available by law.
 (e)  A civil action under this section may not be brought
 against a woman on whom an abortion is performed or attempted in
 violation of Section 170.052.
 SECTION 8.  Section 171.002, Health and Safety Code, is
 amended by adding Subdivision (3-a) to read as follows:
 (3-a)  "Preborn child" means an unborn child as defined
 by Section 171.061.
 SECTION 9.  Section 171.012, Health and Safety Code, is
 amended by amending Subsection (a) and adding Subsections (g) and
 (h) to read as follows:
 (a)  Consent to an abortion is voluntary and informed only
 if:
 (1)  the physician who is to perform the abortion
 informs the pregnant woman on whom the abortion is to be performed
 of:
 (A)  the physician's name;
 (B)  the particular medical risks associated with
 the particular abortion procedure to be employed, including, when
 medically accurate:
 (i)  the risks of infection and hemorrhage;
 (ii)  the potential danger to a subsequent
 pregnancy and of infertility; and
 (iii)  the possibility of increased risk of
 breast cancer following an induced abortion and the natural
 protective effect of a completed pregnancy in avoiding breast
 cancer;
 (C)  the probable gestational age of the preborn
 [unborn] child at the time the abortion is to be performed; [and]
 (D)  the medical risks associated with carrying
 the preborn child to term; and
 (E)  the state law prohibiting abortion of a
 preborn child solely on the basis of the preborn child's race,
 ethnicity, sex, or disability as defined by Section 170.051,
 including a probability of diagnosis that the child has a
 disability;
 (2)  the physician who is to perform the abortion or the
 physician's agent informs the pregnant woman that:
 (A)  medical assistance benefits may be available
 for prenatal care, childbirth, and neonatal care;
 (B)  the father is liable for assistance in the
 support of the child without regard to whether the father has
 offered to pay for the abortion; and
 (C)  public and private agencies provide
 pregnancy prevention counseling and medical referrals for
 obtaining pregnancy prevention medications or devices, including
 emergency contraception for victims of rape or incest;
 (3)  the physician who is to perform the abortion or the
 physician's agent:
 (A)  provides the pregnant woman with the printed
 materials described by Section 171.014; and
 (B)  informs the pregnant woman that those
 materials:
 (i)  have been provided by the Health and
 Human Services Commission [Department of State Health Services];
 (ii)  are accessible on an Internet website
 sponsored by the commission [department];
 (iii)  describe the preborn [unborn] child
 and list agencies that offer alternatives to abortion; and
 (iv)  include a list of agencies that offer
 sonogram services at no cost to the pregnant woman;
 (4)  before any sedative or anesthesia is administered
 to the pregnant woman and at least 24 hours before the abortion or
 at least two hours before the abortion if the pregnant woman waives
 this requirement by certifying that she currently lives 100 miles
 or more from the nearest abortion provider that is a facility
 licensed under Chapter 245 or a facility that performs more than 50
 abortions in any 12-month period:
 (A)  the physician who is to perform the abortion
 or an agent of the physician who is also a sonographer certified by
 a national registry of medical sonographers performs a sonogram on
 the pregnant woman on whom the abortion is to be performed;
 (B)  the physician who is to perform the abortion
 displays the sonogram images in a quality consistent with current
 medical practice in a manner that the pregnant woman may view them;
 (C)  the physician who is to perform the abortion
 provides, in a manner understandable to a layperson, a verbal
 explanation of the results of the sonogram images, including a
 medical description of the dimensions of the embryo or fetus, the
 presence of cardiac activity, and the presence of external members
 and internal organs; and
 (D)  the physician who is to perform the abortion
 or an agent of the physician who is also a sonographer certified by
 a national registry of medical sonographers makes audible the heart
 auscultation for the pregnant woman to hear, if present, in a
 quality consistent with current medical practice and provides, in a
 manner understandable to a layperson, a simultaneous verbal
 explanation of the heart auscultation;
 (5)  before receiving a sonogram under Subdivision
 (4)(A) and before the abortion is performed and before any sedative
 or anesthesia is administered, the pregnant woman completes and
 certifies with her signature an election form that states as
 follows:
 "ABORTION AND SONOGRAM ELECTION
 (1)  THE INFORMATION AND PRINTED MATERIALS
 DESCRIBED BY SECTIONS 171.012(a)(1)-(3), TEXAS HEALTH
 AND SAFETY CODE, HAVE BEEN PROVIDED AND EXPLAINED TO
 ME.
 (2)  I UNDERSTAND THE NATURE AND CONSEQUENCES OF
 AN ABORTION.
 (3)  TEXAS LAW REQUIRES THAT I RECEIVE A SONOGRAM
 PRIOR TO RECEIVING AN ABORTION.
 (4)  I UNDERSTAND THAT I HAVE THE OPTION TO VIEW
 THE SONOGRAM IMAGES.
 (5)  I UNDERSTAND THAT I HAVE THE OPTION TO HEAR
 THE HEARTBEAT.
 (6)  I UNDERSTAND THAT I AM REQUIRED BY LAW TO
 HEAR AN EXPLANATION OF THE SONOGRAM IMAGES UNLESS I
 CERTIFY IN WRITING TO ONE OF THE FOLLOWING:
 ___  I AM PREGNANT AS A RESULT OF A SEXUAL
 ASSAULT, INCEST, OR OTHER VIOLATION OF THE TEXAS PENAL
 CODE THAT HAS BEEN REPORTED TO LAW ENFORCEMENT
 AUTHORITIES OR THAT HAS NOT BEEN REPORTED BECAUSE I
 REASONABLY BELIEVE THAT DOING SO WOULD PUT ME AT RISK
 OF RETALIATION RESULTING IN SERIOUS BODILY INJURY.
 ___  I AM A MINOR AND OBTAINING AN ABORTION IN
 ACCORDANCE WITH JUDICIAL BYPASS PROCEDURES UNDER
 CHAPTER 33, TEXAS FAMILY CODE.
 [___  MY FETUS HAS AN IRREVERSIBLE MEDICAL
 CONDITION OR ABNORMALITY, AS IDENTIFIED BY RELIABLE
 DIAGNOSTIC PROCEDURES AND DOCUMENTED IN MY MEDICAL
 FILE.]
 (7)  I AM MAKING THIS ELECTION OF MY OWN FREE WILL
 AND WITHOUT COERCION.
 (8)  FOR A WOMAN WHO LIVES 100 MILES OR MORE FROM
 THE NEAREST ABORTION PROVIDER THAT IS A FACILITY
 LICENSED UNDER CHAPTER 245, TEXAS HEALTH AND SAFETY
 CODE, OR A FACILITY THAT PERFORMS MORE THAN 50
 ABORTIONS IN ANY 12-MONTH PERIOD ONLY:
 I CERTIFY THAT, BECAUSE I CURRENTLY LIVE 100
 MILES OR MORE FROM THE NEAREST ABORTION PROVIDER THAT
 IS A FACILITY LICENSED UNDER CHAPTER 245, TEXAS HEALTH
 AND SAFETY CODE, OR A FACILITY THAT PERFORMS MORE THAN
 50 ABORTIONS IN ANY 12-MONTH PERIOD, I WAIVE THE
 REQUIREMENT TO WAIT 24 HOURS AFTER THE SONOGRAM IS
 PERFORMED BEFORE RECEIVING THE ABORTION PROCEDURE. MY
 PLACE OF RESIDENCE IS:__________.
 ________________________________________
 SIGNATURE                        DATE";
 (6)  before the abortion is performed, the physician
 who is to perform the abortion receives a copy of the signed,
 written certification required by Subdivision (5); and
 (7)  the pregnant woman is provided the name of each
 person who provides or explains the information required under this
 subsection.
 (g)  If the pregnant woman's preborn child has been diagnosed
 with a life-threatening disability, the physician who is to perform
 the abortion shall, at least 24 hours before the abortion or at
 least two hours before the abortion if the pregnant woman waives
 this requirement by certifying that she currently lives 100 miles
 or more from the nearest abortion provider that is a facility
 licensed under Chapter 245 or a facility in which more than 50
 abortions are performed in any 12-month period:
 (1)  orally and in person, inform the pregnant woman of
 the availability of perinatal palliative care, as that term is
 defined by Section 161.702; and
 (2)  provide the pregnant woman with a written copy of:
 (A)  the perinatal palliative care informational
 materials and list of the perinatal palliative care providers and
 programs described by Section 161.703; and
 (B)  the perinatal palliative care certification
 form described by Section 161.704.
 (h)  If a pregnant woman described by Subsection (g), after
 receiving from the physician who is to perform the abortion the
 perinatal palliative care informational materials and
 certification form described by that subsection in the manner
 required by that subsection, chooses to have an abortion instead of
 continuing the pregnancy in perinatal palliative care, the
 physician may perform the abortion only after:
 (1)  the pregnant woman signs the certification form;
 and
 (2)  the physician places the signed certification form
 in the pregnant woman's medical records.
 SECTION 10.  Section 171.0121, Health and Safety Code, is
 amended to read as follows:
 Sec. 171.0121.  MEDICAL RECORD. (a) Before the abortion
 begins, a copy of the signed, written certification received by the
 physician under Section 171.012(a)(6) and, if applicable, under
 Section 161.704 must be placed in the pregnant woman's medical
 records.
 (b)  A copy of the signed, written certification required
 under Sections 171.012(a)(5) and (6) and of any signed, written
 certification required under Section 161.704 shall be retained by
 the facility where the abortion is performed until:
 (1)  the seventh anniversary of the date the
 certification [it] is signed; or
 (2)  if the pregnant woman is a minor, the later of:
 (A)  the seventh anniversary of the date the
 certification [it] is signed; or
 (B)  the woman's 21st birthday.
 SECTION 11.  Section 171.0122(d), Health and Safety Code, is
 amended to read as follows:
 (d)  A pregnant woman may choose not to receive the verbal
 explanation of the results of the sonogram images under Section
 171.012(a)(4)(C) if:
 (1)  the woman's pregnancy is a result of a sexual
 assault, incest, or other violation of the Penal Code that has been
 reported to law enforcement authorities or that has not been
 reported because she has a reason that she declines to reveal
 because she reasonably believes that to do so would put her at risk
 of retaliation resulting in serious bodily injury; or
 (2)  the woman is a minor and obtaining an abortion in
 accordance with judicial bypass procedures under Chapter 33, Family
 Code[; or
 [(3)  the fetus has an irreversible medical condition
 or abnormality, as previously identified by reliable diagnostic
 procedures and documented in the woman's medical file].
 SECTION 12.  Section 171.014(a), Health and Safety Code, is
 amended to read as follows:
 (a)  The department shall publish informational materials
 that include:
 (1)  the information required to be provided under
 Sections 171.012(a)(1)(B), [and] (D), and (E) and (a)(2)(A), (B),
 and (C); and
 (2)  the materials required by Sections 161.703,
 171.015, and 171.016.
 SECTION 13.  Section 171.042, Health and Safety Code, is
 amended to read as follows:
 Sec. 171.042.  DEFINITION [DEFINITIONS].  In this
 subchapter,[:
 [(1)]  "post-fertilization [Post-fertilization] age"
 means the age of the preborn [unborn] child as calculated from the
 fusion of a human spermatozoon with a human ovum.
 [(2)  "Severe fetal abnormality" has the meaning
 assigned by Section 285.202.]
 SECTION 14.  Sections 171.043, 171.044, and 171.045, Health
 and Safety Code, are amended to read as follows:
 Sec. 171.043.  DETERMINATION OF POST-FERTILIZATION AGE
 REQUIRED.  Except as otherwise provided by Section 171.046, a
 physician may not perform or induce or attempt to perform or induce
 an abortion without, prior to the procedure:
 (1)  making a determination of the probable
 post-fertilization age of the preborn [unborn] child; or
 (2)  possessing and relying on a determination of the
 probable post-fertilization age of the preborn [unborn] child made
 by another physician.
 Sec. 171.044.  ABORTION OF PREBORN [UNBORN] CHILD OF 20 OR
 MORE WEEKS POST-FERTILIZATION AGE PROHIBITED. Except as otherwise
 provided by Section 171.046, a person may not perform or induce or
 attempt to perform or induce an abortion on a woman if it has been
 determined, by the physician performing, inducing, or attempting to
 perform or induce the abortion or by another physician on whose
 determination that physician relies, that the probable
 post-fertilization age of the preborn [unborn] child is 20 or more
 weeks.
 Sec. 171.045.  METHOD OF ABORTION. (a) This section applies
 only to an abortion authorized under Section 171.046(a)(1) or (2)
 in which:
 (1)  the probable post-fertilization age of the preborn
 [unborn] child is 20 or more weeks; or
 (2)  the probable post-fertilization age of the preborn
 [unborn] child has not been determined but could reasonably be 20 or
 more weeks.
 (b)  Except as otherwise provided by Section 171.046(a)(3),
 a physician performing an abortion under Subsection (a) shall
 terminate the pregnancy in the manner that, in the physician's
 reasonable medical judgment, provides the best opportunity for the
 preborn [unborn] child to survive.
 SECTION 15.  Section 171.046(a), Health and Safety Code, is
 amended to read as follows:
 (a)  The prohibitions and requirements under Sections
 171.043, 171.044, and 171.045(b) do not apply to an abortion
 performed if there exists a condition that, in the physician's
 reasonable medical judgment, so complicates the medical condition
 of the woman that, to avert the woman's death or a serious risk of
 substantial and irreversible physical impairment of a major bodily
 function, other than a psychological condition, it necessitates, as
 applicable:
 (1)  the immediate abortion of her pregnancy without
 the delay necessary to determine the probable post-fertilization
 age of the preborn [unborn] child;
 (2)  the abortion of her pregnancy even though the
 post-fertilization age of the preborn [unborn] child is 20 or more
 weeks; or
 (3)  the use of a method of abortion other than a method
 described by Section 171.045(b).
 SECTION 16.  Section 285.202(a), Health and Safety Code, is
 amended to read as follows:
 (a)  In this section, "medical emergency" means[:
 [(1)]  a condition exists that, in a physician's good
 faith clinical judgment, complicates the medical condition of the
 pregnant woman and necessitates the immediate abortion of her
 pregnancy to avert her death or to avoid a serious risk of
 substantial impairment of a major bodily function[; or
 [(2)  the fetus has a severe fetal abnormality].
 SECTION 17.  Section 164.052(a), Occupations Code, is
 amended to read as follows:
 (a)  A physician or an applicant for a license to practice
 medicine commits a prohibited practice if that person:
 (1)  submits to the board a false or misleading
 statement, document, or certificate in an application for a
 license;
 (2)  presents to the board a license, certificate, or
 diploma that was illegally or fraudulently obtained;
 (3)  commits fraud or deception in taking or passing an
 examination;
 (4)  uses alcohol or drugs in an intemperate manner
 that, in the board's opinion, could endanger a patient's life;
 (5)  commits unprofessional or dishonorable conduct
 that is likely to deceive or defraud the public, as provided by
 Section 164.053, or injure the public;
 (6)  uses an advertising statement that is false,
 misleading, or deceptive;
 (7)  advertises professional superiority or the
 performance of professional service in a superior manner if that
 advertising is not readily subject to verification;
 (8)  purchases, sells, barters, or uses, or offers to
 purchase, sell, barter, or use, a medical degree, license,
 certificate, or diploma, or a transcript of a license, certificate,
 or diploma in or incident to an application to the board for a
 license to practice medicine;
 (9)  alters, with fraudulent intent, a medical license,
 certificate, or diploma, or a transcript of a medical license,
 certificate, or diploma;
 (10)  uses a medical license, certificate, or diploma,
 or a transcript of a medical license, certificate, or diploma that
 has been:
 (A)  fraudulently purchased or issued;
 (B)  counterfeited; or
 (C)  materially altered;
 (11)  impersonates or acts as proxy for another person
 in an examination required by this subtitle for a medical license;
 (12)  engages in conduct that subverts or attempts to
 subvert an examination process required by this subtitle for a
 medical license;
 (13)  impersonates a physician or permits another to
 use the person's license or certificate to practice medicine in
 this state;
 (14)  directly or indirectly employs a person whose
 license to practice medicine has been suspended, canceled, or
 revoked;
 (15)  associates in the practice of medicine with a
 person:
 (A)  whose license to practice medicine has been
 suspended, canceled, or revoked; or
 (B)  who has been convicted of the unlawful
 practice of medicine in this state or elsewhere;
 (16)  performs or procures a criminal abortion, aids or
 abets in the procuring of a criminal abortion, attempts to perform
 or procure a criminal abortion, or attempts to aid or abet the
 performance or procurement of a criminal abortion;
 (17)  directly or indirectly aids or abets the practice
 of medicine by a person, partnership, association, or corporation
 that is not licensed to practice medicine by the board;
 (18)  performs an abortion on a woman who is pregnant
 with a preborn [viable unborn] child during the third trimester of
 the pregnancy unless[:
 [(A)]  the abortion is necessary due to a medical
 emergency, as defined by Section 171.002, Health and Safety Code
 [to prevent the death of the woman;
 [(B)  the viable unborn child has a severe,
 irreversible brain impairment; or
 [(C)  the woman is diagnosed with a significant
 likelihood of suffering imminent severe, irreversible brain damage
 or imminent severe, irreversible paralysis];
 (19)  performs an abortion on an unemancipated minor
 without the written consent of the child's parent, managing
 conservator, or legal guardian or without a court order, as
 provided by Section 33.003 or 33.004, Family Code, unless the
 abortion is necessary due to a medical emergency, as defined by
 Section 171.002, Health and Safety Code;
 (20)  otherwise performs an abortion on an
 unemancipated minor in violation of Chapter 33, Family Code;
 (21)  performs or induces or attempts to perform or
 induce an abortion in violation of Subchapter C, F, or G, Chapter
 171, Health and Safety Code; [or]
 (22)  in complying with the procedures outlined in
 Sections 166.045 and 166.046, Health and Safety Code, wilfully
 fails to make a reasonable effort to transfer a patient to a
 physician who is willing to comply with a directive; or
 (23)  performs or attempts to perform an abortion or
 engages in other conduct in violation of Section 170.052, Health
 and Safety Code.
 SECTION 18.  Section 164.055(b), Occupations Code, is
 amended to read as follows:
 (b)  The sanctions provided by Subsection (a) are in addition
 to any other grounds for refusal to admit persons to examination
 under this subtitle or to issue a license or renew a license to
 practice medicine under this subtitle. The criminal penalties
 provided by Section 165.152 do not apply to a violation of Section
 170.002 or 170.052, Health and Safety Code, or Subchapter C, F, or
 G, Chapter 171, Health and Safety Code.
 SECTION 19.  The following provisions of the Health and
 Safety Code are repealed:
 (1)  Section 171.046(c); and
 (2)  Sections 285.202(a-1) and (a-2).
 SECTION 20.  Not later than December 1, 2021:
 (1)  the Health and Human Services Commission shall:
 (A)  develop the perinatal palliative care
 informational materials, list of perinatal palliative care
 providers and programs, and perinatal palliative care
 certification form required by Subchapter X, Chapter 161, Health
 and Safety Code, as added by this Act; and
 (B)  update any forms and informational materials
 under Subchapter B, Chapter 171, Health and Safety Code, as amended
 by this Act; and
 (2)  the executive commissioner of the Health and Human
 Services Commission shall adopt any rules necessary to implement
 Subchapter X, Chapter 161, Health and Safety Code, as added by this
 Act, and Subchapter B, Chapter 171, Health and Safety Code, as
 amended by this Act.
 SECTION 21.  (a)  Subchapter X, Chapter 161, Health and
 Safety Code, as added by this Act, applies only to a diagnosis of a
 life-threatening disability of a pregnant woman's preborn child
 made on or after January 1, 2022.
 (b)  Chapter 170, Health and Safety Code, as amended by this
 Act, Subchapters B and C, Chapter 171, Health and Safety Code, as
 amended by this Act, and Chapter 164, Occupations Code, as amended
 by this Act, apply only to an abortion performed, induced, or
 attempted or other conduct that occurred on or after January 1,
 2022. An abortion performed, induced, or attempted or other
 conduct that occurred before that date is governed by the law in
 effect immediately before the effective date of this Act, and that
 law is continued in effect for that purpose.
 SECTION 22.  It is the intent of the legislature that every
 provision, section, subsection, sentence, clause, phrase, or word
 of this Act and every application of the provisions of this Act to
 each person or entity are severable from each other. If a court for
 any reason finds any application of any provision of this Act to any
 person, group of persons, or circumstances to be invalid, the
 remaining applications of that provision to all other persons and
 circumstances shall be severed and may not be affected.
 SECTION 23.  This Act takes effect September 1, 2021.