Senate Amendment to House File 571 H-8174 Amend House File 571, as amended, passed, and reprinted by 1 the House, as follows: 2 1. By striking everything after the enacting clause and 3 inserting: 4 < Section 1. SHORT TITLE. This Act shall be known and may be 5 cited as the “Medical Ethics Defense Act”. 6 Sec. 2. NEW SECTION . 135S.1 Definitions. 7 As used in this chapter, unless the context otherwise 8 requires: 9 1. a. “Conscience” means the ethical, moral, or religious 10 beliefs or principles held by a medical practitioner or health 11 care institution. 12 b. With respect to persons who are institutions, 13 corporations, or other legal entities, “conscience” is 14 determined by reference to that entity’s governing documents 15 including but not limited to published ethical, moral, or 16 religious guidelines or directives, mission statements, 17 constitutions, articles of incorporation, bylaws, policies, or 18 regulations. 19 2. “Discrimination” means an adverse action, including but 20 not limited to any penalty, disciplinary, or retaliatory action 21 taken against, or a threat of adverse action communicated 22 to, a medical practitioner or health care institution as a 23 result of the refusal of the medical practitioner or health 24 care institution to participate in a health care service on 25 the basis of conscience. “ Discrimination” not does include 26 the negotiation or purchase of insurance or a health care 27 service by a nongovernmental entity or individual, the refusal 28 to use or purchase insurance or a health care service by 29 a nongovernmental entity or individual, or a health care 30 institution’s good-faith effort to accommodate a medical 31 practitioner’s or health care institution’s exercise of 32 conscience. 33 3. “Health care institution” means an organization, 34 corporation, partnership, association, agency, network, sole 35 -1- HF 571.3288.S (1) 91 mb 1/ 7 #1.
proprietorship, joint venture, or other entity that provides 1 a health care service. 2 4. “Health care service” means medical research and medical 3 care provided to a patient or client at any time during the 4 patient’s or client’s course of treatment, including but 5 not limited to testing; diagnosis; record making; referral; 6 prescribing, dispensing, or administering any drug, medication, 7 or device; therapy or counseling; and preparation or 8 arrangement for a surgical procedure. 9 5. “Medical practitioner” means a person who facilitates 10 or participates, or who is asked to facilitate or participate 11 in a health care service, including but not limited to a 12 health-related professional licensed by a board designated in 13 section 147.13, and any other person licensed, certified, or 14 otherwise authorized or permitted by the laws of this state 15 to administer a health care service in the ordinary course 16 of business or in the practice of a profession. “Medical 17 practitioner” includes any student enrolled in an educational 18 institution who is a prospective medical practitioner. 19 6. “Participate in a health care service” means to provide, 20 perform, assist with, facilitate, refer for, provide counseling 21 for, advise with regard to, admit for the purposes of 22 providing, or take part in a health care service in any way. 23 Sec. 3. NEW SECTION . 135S.2 Exercise of conscience for 24 health care institutions and medical practitioners —— exception. 25 1. a. A medical practitioner or health care institution 26 has the right not to participate in or pay for a health care 27 service that violates the medical practitioner’s or health 28 care institution’s conscience. A medical practitioner shall 29 inform the medical practitioner’s employer of the nature of the 30 medical’s practitioner’s objection based on the practitioner’s 31 conscience. This paragraph shall not be construed to waive or 32 modify a duty a medical practitioner or health care institution 33 may have to participate in a health care service that does not 34 violate the medical practitioner’s conscience. 35 -2- HF 571.3288.S (1) 91 mb 2/ 7
b. A medical practitioner or health care institution who 1 refuses to participate in a health care service under this 2 section shall not be discriminated against for the medical 3 practitioner’s or health care institution’s exercise of 4 conscience. 5 2. This section shall not be construed to relieve a health 6 care institution of the requirement to provide emergency 7 medical services to individuals as required under 42 U.S.C. 8 §1395dd. 9 3. Notwithstanding any other provision of this chapter to 10 the contrary, a medical practitioner or health care institution 11 that holds itself out to the public as religion-based, states 12 in the entity’s governing documents that the entity has a 13 religious purpose or mission, and that has internal operating 14 policies or procedures that implement the entity’s religious 15 beliefs, shall have the right to make employment, staffing, 16 contracting, and admitting privilege decisions consistent with 17 the entity’s religious beliefs. 18 Sec. 4. NEW SECTION . 135S.3 Exercise of conscience —— 19 immunity. 20 1. A medical practitioner or health care institution shall 21 not be civilly, criminally, or administratively liable for the 22 medical practitioner’s or health care institution’s good-faith 23 exercise of conscience. 24 2. A health care institution shall not be civilly, 25 criminally, or administratively liable for the good-faith 26 exercise of conscience by a medical practitioner employed, 27 contracted, or granted admitting privileges by the health care 28 institution. 29 Sec. 5. NEW SECTION . 135S.4 Whistleblower protections. 30 1. A medical practitioner or health care institution shall 31 not be discriminated against because the medical practitioner 32 or health care institution does any of the following: 33 a. Provides, causes to be provided, or intends to provide 34 or cause to be provided information relating to a suspected 35 -3- HF 571.3288.S (1) 91 mb 3/ 7
violation of this chapter to the medical practitioner’s or 1 health care institution’s employer, the attorney general, any 2 state agency charged with protecting health care rights of 3 conscience, the United States department of health and human 4 services, the United States commission on civil rights, or any 5 other federal agency charged with protecting health care rights 6 of conscience. 7 b. Testifies or intends to testify in a proceeding 8 concerning a violation of this chapter. 9 c. Assists or participates, or intends to assist or 10 participate, in a proceeding under this chapter. 11 2. It shall be unlawful to discriminate against a medical 12 practitioner or health care institution because the medical 13 practitioner or health care institution discloses information 14 that the medical practitioner or health care institution 15 reasonably believes evidences any of the following: 16 a. A violation of any law or rule. 17 b. A violation of any standard of care or ethical guidelines 18 for the provision of any health care service. 19 c. Gross mismanagement, a gross waste of funds, an abuse 20 of authority, practices or methods of treatment that may put a 21 patient or client health at risk, or a substantial and specific 22 danger to public health or safety. 23 3. This section shall not be construed to exempt a 24 person from the requirements of the federal Health Insurance 25 Portability and Accountability Act of 1996, Pub. L. No. 26 104-191, including amendments thereto and regulations 27 promulgated thereunder, or any other applicable confidentiality 28 and patient or client privacy requirements. 29 Sec. 6. NEW SECTION . 135S.5 Free speech protections —— 30 notification of complaints —— penalty. 31 1. The department of health and human services, a licensing 32 board designated under chapter 147, or any other state 33 licensing or certifying entity of a medical practitioner 34 shall not reprimand, sanction, or revoke or threaten to 35 -4- HF 571.3288.S (1) 91 mb 4/ 7
revoke a license or certification of a medical practitioner 1 or health care institution who is licensed or certified 2 by the department, licensing board, or other licensing or 3 certifying entity, for engaging in speech, expressive activity, 4 or association protected under the first amendment to the 5 Constitution of the United States, unless the department, 6 licensing board, or other licensing or certifying entity 7 demonstrates by clear and convincing evidence that the medical 8 practitioner’s or health care institution’s speech, expressive 9 activity, or association was the direct cause of physical harm 10 to a person with whom the medical practitioner or health care 11 institution had a medical practitioner-patient or medical 12 practitioner-client relationship within the three years 13 immediately preceding the incident of physical harm. 14 2. a. Within twenty-one days of receipt of a complaint 15 that alleges a violation of speech, expressive activity, or 16 association protected under subsection 1 that may result 17 in revocation of a medical practitioner’s or health care 18 institution’s license, certification, or registration, the 19 department, licensing board, or other licensing or certifying 20 entity shall provide the medical practitioner or health care 21 institution with a copy of the complaint. 22 b. If the department, licensing board, or other licensing 23 or certifying entity fails to provide a copy of the complaint 24 to the medical practitioner or health care institution within 25 twenty-one days of receipt, the department, licensing board, 26 or other certifying entity shall pay the medical practitioner 27 or health care institution an administrative penalty of five 28 hundred dollars for each day of noncompliance. 29 3. The state shall not contract with, recognize, approve, 30 or require a medical practitioner or health care institution 31 to obtain a certification or credential issued or approved 32 by the department of health and human services, a licensing 33 board designated under chapter 147, or any other licensing or 34 certifying entity of a medical practitioner or health care 35 -5- HF 571.3288.S (1) 91 mb 5/ 7
institution that revokes or refuses to issue a certification 1 or credential to the medical practitioner or health care 2 institution if the medical practitioner or health care 3 institution is in compliance with this chapter and did not 4 provide medical advice or treatment to a patient or client. 5 Sec. 7. NEW SECTION . 135S.6 Unlawful interference —— 6 relief. 7 1. It is unlawful for a person to interfere or attempt to 8 interfere with the exercise of conscience not to participate in 9 a health care service, or in the whistleblower or free speech 10 rights and protections under this chapter, whether by duress, 11 coercion, or any other means. 12 2. A health care institution or medical practitioner that 13 alleges injury by unlawful interference by a person under 14 this chapter may bring a civil action in a court of competent 15 jurisdiction. If a court of competent jurisdiction finds a 16 person liable under this section, the court may order any of 17 the following: 18 a. Injunctive relief, when appropriate, including but not 19 limited to reinstatement of a medical practitioner to the 20 medical practitioner’s previous position, or reinstatement 21 or reactivation of licensure or certification of a medical 22 practitioner, or reactivation or reinstatement of licensure of 23 a health care institution. 24 b. Monetary damages for injuries suffered. 25 c. Reasonable costs and attorney fees. 26 3. The rights, remedies, and prohibitions contained in this 27 chapter shall be in addition to and cumulative of any other 28 right, remedy, or prohibition accorded by common law or state 29 or federal law. This chapter shall not be construed to deny, 30 abrogate, or impair any such common law or statutory right, 31 remedy, or prohibition. 32 4. Any additional burden or expense to another medical 33 practitioner or health care institution arising from the 34 exercise of conscience pursuant to this chapter shall not be a 35 -6- HF 571.3288.S (1) 91 mb 6/ 7
defense to a violation of this chapter. 1 5. A person shall not bring a civil action against a person 2 who declines to use or purchase a health care service from a 3 medical practitioner or health care institution because of the 4 medical practitioner’s or health care institution’s exercise of 5 conscience under this chapter. 6 Sec. 8. NEW SECTION . 135S.7 Severability. 7 If any provision of this chapter or its application to any 8 person or circumstance is held invalid, the invalidity shall 9 not affect other provisions or applications of this chapter 10 which can be given effect without the invalid provision or 11 application, and to this end the provisions of this chapter are 12 severable. > 13 2. Title page, lines 1 and 2, by striking < practitioners, 14 health care institutions, and health care payors > and inserting 15 < practitioners and health care institutions, > 16 -7- HF 571.3288.S (1) 91 mb 7/ 7