House Amendment to Senate File 471 S-3289 Amend Senate File 471, as amended, passed, and reprinted by 1 the Senate, as follows: 2 1. By striking everything after the enacting clause and 3 inserting: 4 < DIVISION I 5 PREREQUISITES FOR ABORTION 6 Section 1. Section 146A.1, Code 2017, is amended by striking 7 the section and inserting in lieu thereof the following: 8 146A.1 Prerequisites for abortion —— ultrasound —— licensee 9 discipline —— interpretation. 10 1. A physician performing an abortion shall obtain written 11 certification from the pregnant woman of all of the following 12 at least seventy-two hours prior to performing an abortion: 13 a. That the woman has undergone an ultrasound imaging of the 14 unborn child that displays the approximate age of the unborn 15 child. 16 b. That the woman was given the opportunity to see the 17 unborn child by viewing the ultrasound image of the unborn 18 child. 19 c. That the woman was given the option of hearing a 20 description of the unborn child based on the ultrasound image 21 and hearing the heartbeat of the unborn child. 22 d. (1) That the woman has been provided information 23 regarding all of the following, based upon the materials 24 developed by the department of public health pursuant to 25 subparagraph (2): 26 (a) The options relative to a pregnancy, including 27 continuing the pregnancy to term and retaining parental rights 28 following the child’s birth, continuing the pregnancy to 29 term and placing the child for adoption, and terminating the 30 pregnancy. 31 (b) The indicators, contra-indicators, and risk factors 32 including any physical, psychological, or situational factors 33 related to the abortion in light of the woman’s medical history 34 and medical condition. 35 -1- SF471.2073.H (2) 87 md 1/ 9 #1.

(2) The department of public health shall make available to 1 physicians, upon request, all of the following information: 2 (a) Geographically indexed materials designed to inform the 3 woman about public and private agencies and services available 4 to assist a woman through pregnancy, at the time of childbirth, 5 and while the child is dependent. The materials shall include 6 a comprehensive list of the agencies available, categorized by 7 the type of services offered, and a description of the manner 8 by which the agency may be contacted. 9 (b) Materials that encourage consideration of placement for 10 adoption. The materials shall inform the woman of the benefits 11 of adoption, including the requirements of confidentiality in 12 the adoption process, the importance of adoption to individuals 13 and society, and the state’s interest in promoting adoption by 14 preferring adoption over abortion. 15 (c) Materials that contain objective information describing 16 the methods of abortion procedures commonly used, the medical 17 risks commonly associated with each such procedure, and the 18 possible detrimental physical and psychological effects of 19 abortion. 20 2. Compliance with the prerequisites of this section shall 21 not apply to any of the following: 22 a. An abortion performed to save the life of a pregnant 23 woman. 24 b. An abortion performed in a medical emergency. 25 c. The performance of a medical procedure by a physician 26 that in the physician’s reasonable medical judgment is designed 27 to or intended to prevent the death or to preserve the life of 28 the pregnant woman. 29 3. A physician who violates this section is subject to 30 licensee discipline pursuant to section 148.6. 31 4. This section shall not be construed to impose civil 32 or criminal liability on a woman upon whom an abortion is 33 performed, or to prohibit the sale, use, prescription, or 34 administration of a measure, drug, or chemical designed for the 35 -2- SF471.2073.H (2) 87 md 2/ 9

purposes of contraception. 1 5. The board of medicine shall adopt rules pursuant to 2 chapter 17A to administer this section. 3 6. As used in this section, “unborn child” means an 4 individual organism of the species homo sapiens from 5 fertilization to live birth. 6 DIVISION II 7 PROHIBITIONS ON ABORTION —— TWENTY WEEKS POSTFERTILIZATION 8 Sec. 2. NEW SECTION . 146B.1 Definitions. 9 As used in this chapter, unless the context otherwise 10 requires: 11 1. “Abortion” means the termination of a human pregnancy 12 with the intent other than to produce a live birth or to remove 13 a dead fetus. 14 2. “Attempt to perform an abortion” means an act, or 15 an omission of a statutorily required act, that, under the 16 circumstances as the actor believes them to be, constitutes a 17 substantial step in a course of conduct planned to culminate in 18 the performing of an abortion. 19 3. “Department” means the department of public health. 20 4. “Fertilization” means the fusion of a human spermatozoon 21 with a human ovum. 22 5. “Major bodily function” includes but is not limited 23 to functions of the immune system, normal cell growth, and 24 digestive, bowel, bladder, neurological, brain, respiratory, 25 circulatory, endocrine, and reproductive functions. 26 6. “Medical emergency” means a situation in which an 27 abortion is performed to preserve the life of the pregnant 28 woman whose life is endangered by a physical disorder, physical 29 illness, or physical injury, including a life-endangering 30 physical condition caused by or arising from the pregnancy, or 31 when continuation of the pregnancy will create a serious risk 32 of substantial and irreversible impairment of a major bodily 33 function of the pregnant woman. 34 7. “Medical facility” means any public or private hospital, 35 -3- SF471.2073.H (2) 87 md 3/ 9

clinic, center, medical school, medical training institution, 1 health care facility, physician’s office, infirmary, 2 dispensary, ambulatory surgical center, or other institution or 3 location where medical care is provided to any person. 4 8. “Perform” , “performed” , or “performing” , relative to an 5 abortion, means the use of any means, including medical or 6 surgical, to terminate the pregnancy of a woman known to be 7 pregnant with the intent other than to produce a live birth or 8 to remove a dead fetus. 9 9. “Physician” means a person licensed under chapter 148. 10 10. “Postfertilization age” means the age of the unborn 11 child as calculated from fertilization. 12 11. “Probable postfertilization age” means what, in 13 reasonable medical judgment, will with reasonable probability 14 be the postfertilization age of the unborn child at the time 15 the abortion is to be performed. 16 12. “Reasonable medical judgment” means a medical judgment 17 made by a reasonably prudent physician who is knowledgeable 18 about the case and the treatment possibilities with respect to 19 the medical conditions involved. 20 13. “Unborn child” means an individual organism of the 21 species homo sapiens from fertilization until live birth. 22 Sec. 3. NEW SECTION . 146B.2 Determination of 23 postfertilization age —— abortion prohibited at twenty or 24 more weeks postfertilization age —— exceptions —— reporting 25 requirements —— penalties. 26 1. Except in the case of a medical emergency, in addition 27 to compliance with the prerequisites of chapter 146A, an 28 abortion shall not be performed or be attempted to be performed 29 unless the physician performing the abortion has first made 30 a determination of the probable postfertilization age of the 31 unborn child or relied upon such a determination made by 32 another physician. In making such a determination, a physician 33 shall make such inquiries of the pregnant woman and perform or 34 cause to be performed such medical examinations and tests the 35 -4- SF471.2073.H (2) 87 md 4/ 9

physician considers necessary in making a reasonable medical 1 judgment to accurately determine the postfertilization age of 2 the unborn child. 3 2. a. A physician shall not perform or attempt to perform 4 an abortion upon a pregnant woman when it has been determined, 5 by the physician performing the abortion or by another 6 physician upon whose determination that physician relies, 7 that the probable postfertilization age of the unborn child 8 is twenty or more weeks unless, in the physician’s reasonable 9 medical judgment, any of the following applies: 10 (1) The pregnant woman has a condition which the physician 11 deems a medical emergency. 12 (2) The abortion is necessary to preserve the life of an 13 unborn child. 14 b. If an abortion is performed under this subsection, the 15 physician shall terminate the human pregnancy in the manner 16 which, in the physician’s reasonable medical judgment, provides 17 the best opportunity for an unborn child to survive, unless, in 18 the physician’s reasonable medical judgment, termination of the 19 human pregnancy in that manner would pose a greater risk than 20 any other available method of the death of the pregnant woman 21 or of the substantial and irreversible physical impairment of a 22 major bodily function. A greater risk shall not be deemed to 23 exist if it is based on a claim or diagnosis that the pregnant 24 woman will engage in conduct which would result in the pregnant 25 woman’s death or in substantial and irreversible physical 26 impairment of a major bodily function. 27 3. A physician who performs or attempts to perform an 28 abortion shall report to the department, on a schedule and in 29 accordance with forms and rules adopted by the department, all 30 of the following: 31 a. If a determination of probable postfertilization age of 32 the unborn child was made, the probable postfertilization age 33 determined and the method and basis of the determination. 34 b. If a determination of probable postfertilization age of 35 -5- SF471.2073.H (2) 87 md 5/ 9

the unborn child was not made, the basis of the determination 1 that a medical emergency existed. 2 c. If the probable postfertilization age of the unborn 3 child was determined to be twenty or more weeks, the basis of 4 the determination of a medical emergency, or the basis of the 5 determination that the abortion was necessary to preserve the 6 life of an unborn child. 7 d. The method used for the abortion and, in the case of 8 an abortion performed when the probable postfertilization age 9 was determined to be twenty or more weeks, whether the method 10 of abortion used was one that, in the physician’s reasonable 11 medical judgment, provided the best opportunity for an unborn 12 child to survive or, if such a method was not used, the basis 13 of the determination that termination of the human pregnancy 14 in that manner would pose a greater risk than would any other 15 available method of the death of the pregnant woman or of the 16 substantial and irreversible physical impairment of a major 17 bodily function. 18 4. a. By June 30, annually, the department shall issue a 19 public report providing statistics for the previous calendar 20 year, compiled from the reports for that year submitted in 21 accordance with subsection 3. The department shall ensure that 22 none of the information included in the public reports could 23 reasonably lead to the identification of any woman upon whom an 24 abortion was performed. 25 b. (1) A physician who fails to submit a report by the end 26 of thirty days following the due date shall be subject to a 27 late fee of five hundred dollars for each additional thirty-day 28 period or portion of a thirty-day period the report is overdue. 29 (2) A physician required to report in accordance with 30 subsection 3 who has not submitted a report or who has 31 submitted only an incomplete report more than one year 32 following the due date, may, in an action brought in the 33 manner in which actions are brought to enforce chapter 148, 34 be directed by a court of competent jurisdiction to submit a 35 -6- SF471.2073.H (2) 87 md 6/ 9

complete report within a time period stated by court order or 1 be subject to contempt of court. 2 (3) A physician who intentionally or recklessly falsifies 3 a report required under this section is subject to a civil 4 penalty of one hundred dollars. 5 5. Any medical facility in which a physician is authorized 6 to perform an abortion shall implement written medical 7 policies and procedures consistent with the requirements and 8 prohibitions of this chapter. 9 6. The department shall adopt rules to implement this 10 section. 11 Sec. 4. NEW SECTION . 146B.3 Civil actions and penalties. 12 1. Failure of a physician to comply with any provision of 13 section 146B.2, with the exception of the late filing of a 14 report or failure to submit a complete report in compliance 15 with a court order, is grounds for licensee discipline under 16 chapter 148. 17 2. A woman upon whom an abortion has been performed in 18 violation of this chapter may maintain an action against the 19 physician who performed the abortion in intentional or reckless 20 violation of this chapter for actual damages. 21 3. A woman upon whom an abortion has been attempted in 22 violation of this chapter may maintain an action against the 23 physician who attempted the abortion in intentional or reckless 24 violation of this chapter for actual damages. 25 4. A cause of action for injunctive relief to prevent a 26 physician from performing abortions may be maintained against a 27 physician who has intentionally violated this chapter by the 28 woman upon whom the abortion was performed or attempted, by 29 a parent or guardian of the woman if the woman is less than 30 eighteen years of age at the time the abortion was performed 31 or attempted, by a current or former licensed health care 32 provider of the woman, by a county attorney with appropriate 33 jurisdiction, or by the attorney general. 34 5. If the plaintiff prevails in an action brought under 35 -7- SF471.2073.H (2) 87 md 7/ 9

this section, the plaintiff shall be entitled to an award for 1 reasonable attorney fees. 2 6. If the defendant prevails in an action brought under 3 this section and the court finds that the plaintiff’s suit was 4 frivolous and brought in bad faith, the defendant shall be 5 entitled to an award for reasonable attorney fees. 6 7. Damages and attorney fees shall not be assessed against 7 the woman upon whom an abortion was performed or attempted 8 except as provided in subsection 6. 9 8. In a civil proceeding or action brought under this 10 chapter, the court shall rule whether the anonymity of any 11 woman upon whom an abortion has been performed or attempted 12 shall be preserved from public disclosure if the woman does not 13 provide consent to such disclosure. The court, upon motion 14 or on its own motion, shall make such a ruling and, upon 15 determining that the woman’s anonymity should be preserved, 16 shall issue orders to the parties, witnesses, and counsel 17 and shall direct the sealing of the record and exclusion of 18 individuals from courtrooms or hearing rooms to the extent 19 necessary to safeguard the woman’s identity from public 20 disclosure. Each such order shall be accompanied by specific 21 written findings explaining why the anonymity of the woman 22 should be preserved from public disclosure, why the order is 23 essential to that end, how the order is narrowly tailored to 24 serve that interest, and why no reasonable less restrictive 25 alternative exists. In the absence of written consent of the 26 woman upon whom an abortion has been performed or attempted, 27 anyone, other than a public official, who brings an action 28 under this section shall do so under a pseudonym. This 29 subsection shall not be construed to conceal the identity 30 of the plaintiff or of witnesses from the defendant or from 31 attorneys for the defendant. 32 9. This chapter shall not be construed to impose civil 33 or criminal liability on a woman upon whom an abortion is 34 performed or attempted. 35 -8- SF471.2073.H (2) 87 md 8/ 9

DIVISION III 1 LEGISLATIVE INTENT 2 Sec. 5. LEGISLATIVE INTENT. It is the intent of the 3 general assembly to enact policies that protect all unborn 4 life. However, this Act shall not be interpreted to create or 5 recognize a right to an abortion or to prohibit abortion prior 6 to an unborn child reaching a postfertilization age of twenty 7 weeks. 8 DIVISION IV 9 SEVERABILITY —— EFFECTIVE DATE 10 Sec. 6. SEVERABILITY CLAUSE. If any provision of this Act 11 or its application to a person or circumstance is held invalid, 12 the invalidity does not affect other provisions of applications 13 of this Act which can be given effect without the invalid 14 provision or application, and to this end the provisions of 15 this Act are severable. 16 Sec. 7. EFFECTIVE UPON ENACTMENT. This Act, being deemed of 17 immediate importance, takes effect upon enactment. > 18 2. Title page, by striking lines 1 and 2 and inserting 19 < An Act relating to limitations on and prerequisites for an 20 abortion, providing for licensee discipline, providing civil 21 penalties, and including effective date provisions. > 22 -9- SF471.2073.H (2) 87 md 9/ 9