H.F. 2239 DIVISION I 1 WOMAN’S RIGHT TO KNOW ACT 2 Section 1. NEW SECTION . 146A.1 Title. 3 This chapter shall be known and may be cited as the “Woman’s 4 Right to Know Act” . 5 Sec. 2. NEW SECTION . 146A.2 Definitions. 6 As used in this chapter, unless the context otherwise 7 requires: 8 1. “Abortion” means abortion as defined in section 146.1. 9 2. “Attempt to perform an unlawful abortion” means an act, 10 or an omission of an act required by law, that constitutes a 11 substantial step in a course of conduct intended to culminate 12 in the performance of an abortion in violation of this chapter. 13 3. “Department” means the department of public health. 14 4. “Fetus” means a human pregnancy in the postembryonic 15 state. 16 5. “Medical emergency” means any condition which, on 17 the basis of a physician’s good faith clinical judgment, 18 so complicates the medical condition of a pregnant woman 19 as to necessitate the immediate performance of an abortion 20 to avert the pregnant woman’s death, or to necessitate the 21 immediate performance of an abortion to avert a serious risk 22 of substantial and irreversible impairment of a major bodily 23 function if the performance of the abortion is delayed. 24 6. “Physician” means a person licensed to practice medicine 25 and surgery or osteopathic medicine and surgery pursuant to 26 chapter 148. 27 Sec. 3. NEW SECTION . 146A.3 Voluntary and informed consent. 28 1. An abortion shall not be performed in this state without 29 the voluntary and informed consent of the woman upon whom the 30 abortion is to be performed. Except in the case of a medical 31 emergency, consent to an abortion is voluntary and informed 32 only if the requirements of this section are met. 33 2. The referring physician, the physician who will perform 34 the abortion, or an agent of either physician shall provide 35 -1- LSB 5192YH (6) 84 pf/rj 1/ 17

H.F. 2239 all of the following information to the woman by telephone, 1 by audiotape, or in person, at the time the woman initially 2 contacts the physician’s private office or a facility 3 that provides abortions to inquire about or to schedule an 4 appointment for an abortion: 5 a. Information that medical assistance benefits may be 6 available to the woman for prenatal care, childbirth, and 7 neonatal care. 8 b. Information that the putative father is liable to assist 9 in the support of the child and that efforts to collect support 10 may result in, but are not guaranteed to result in, financial 11 support of the child, even if the putative father has offered 12 to pay for the abortion. 13 c. Information that the woman has the right to review the 14 printed materials described in subsection 3. 15 d. Information that the woman has the right to be given 16 the opportunity to undergo an ultrasound imaging of the fetus 17 prior to the performance of an abortion, to view the ultrasound 18 image, and to hear a description of the ultrasound image and 19 hear the heartbeat of the fetus at least twenty-four hours 20 before the abortion is performed. 21 3. a. After being informed of the woman’s right to review 22 printed materials pursuant to subsection 2, if the woman wishes 23 to review the materials, all of the following shall apply: 24 (1) If the department establishes an internet site, the 25 woman shall be informed that the materials are available 26 through a state-sponsored internet site and shall be informed 27 of the internet site address. 28 (2) If the woman initially contacts the physician’s private 29 office or a facility that provides abortions in person, the 30 materials shall be provided to the woman at that time. 31 (3) If the woman initially contacts the physician’s private 32 office or a facility that provides abortions by telephone and 33 wishes to review the materials, the materials shall be mailed 34 to the woman by regular mail or by restricted certified mail, 35 -2- LSB 5192YH (6) 84 pf/rj 2/ 17

H.F. 2239 as defined in section 618.15, as requested by the woman. 1 (4) The woman shall be informed that the materials have been 2 provided by the state and that they describe the fetus and list 3 agencies that offer alternatives to abortion. 4 b. The printed materials shall include all of the following: 5 (1) Geographically indexed materials designed to inform 6 the woman of public and private agencies and services 7 available to assist a woman through pregnancy, at the time 8 of childbirth, and while the child is dependent, including 9 adoption agencies. The materials shall include a comprehensive 10 list of the agencies available, categorized by the type of 11 services offered, and a description of the manner, including 12 telephone numbers, by which the agencies may be contacted. The 13 department may also provide a toll-free, twenty-four-hour-a-day 14 telephone number which may be called to obtain, orally, a list 15 and description of agencies in the locality of the caller and 16 of the services offered. 17 (2) Materials that encourage consideration of placement for 18 adoption. The materials shall inform the woman of the benefits 19 of adoption, including the requirements of confidentiality in 20 the adoption process, the importance of adoption to individuals 21 and society, and the state’s interest in promoting adoption by 22 preferring childbirth over abortion. 23 (3) Materials designed to inform the woman of the probable 24 anatomical and physiological characteristics of the fetus 25 at two-week gestational increments from the time that it is 26 medically possible to make a determination of pregnancy to full 27 term. The materials shall include any relevant information 28 regarding the possibility of the survival of the fetus and 29 pictures or drawings representing the development of the fetus 30 at two-week gestational increments, provided that any pictures 31 or drawings shall contain the dimensions of the fetus and 32 shall be realistic and appropriate for the state of pregnancy 33 depicted. The materials shall be objective, nonjudgmental, and 34 designed to convey only accurate scientific information about 35 -3- LSB 5192YH (6) 84 pf/rj 3/ 17

H.F. 2239 the fetus at various gestational stages. The materials shall 1 also contain objective information describing the methods of 2 abortion procedures commonly used, the medical risks commonly 3 associated with each such procedure, the possible detrimental 4 psychological effects of abortion, and the medical risks 5 commonly associated with carrying a fetus to term. 6 4. A physician shall not perform an abortion on a woman 7 unless both of the following conditions are met: 8 a. The physician obtains written certification that the 9 information required pursuant to subsection 2 was provided 10 to the woman. The physician shall retain a copy of the 11 certification and shall provide a copy of the certification to 12 the woman. 13 b. The physician certifies that the woman has been offered 14 the opportunity to undergo an ultrasound of the fetus, to view 15 the ultrasound, to hear a description of the image, and to 16 hear the heartbeat of the fetus at least twenty-four hours 17 before an abortion is performed. In order to comply with 18 this requirement, the ultrasound image must be of a quality 19 consistent with standard medical practice in the community, 20 must contain the dimensions of the fetus, and must accurately 21 portray the presence of external members and internal organs, 22 including the heartbeat, if present or viewable, of the fetus. 23 The auscultation of the fetal heart tone also must be of a 24 quality consistent with standard medical practice in the 25 community. The physician shall document that the woman has 26 been offered the opportunity to undergo the ultrasound and the 27 woman’s response to the offers, including the date and time of 28 the offers and the woman’s signature attesting to the woman’s 29 informed decision. 30 5. a. By October 1, 2012, the department shall cause 31 the information described in subsection 3 to be published in 32 printed format. The information shall be provided in an easily 33 comprehensible manner. The information shall be published in 34 a typeface large enough to be clearly legible. The printed 35 -4- LSB 5192YH (6) 84 pf/rj 4/ 17

H.F. 2239 information shall be available from the department at no cost, 1 upon request, and in an appropriate number, to any person. 2 b. The department may establish and maintain an internet 3 site to provide the information described in subsection 3. The 4 internet site shall provide for confidentiality of individuals 5 who access the site and no information identifying the 6 individual shall be collected or maintained. The department 7 shall monitor the internet site to ensure that the site is 8 secure and to prevent and correct any tampering with the site. 9 Sec. 4. NEW SECTION . 146A.4 Procedure in case of medical 10 emergency. 11 If a medical emergency necessitates the performance of 12 an abortion, the physician shall inform the woman, prior to 13 the performance of the abortion, if possible, of the medical 14 indications supporting the physician’s judgment that the 15 immediate performance of an abortion is necessary to avert the 16 woman’s death or that a delay in the performance of an abortion 17 will create a serious risk of substantial and irreversible 18 impairment of a major bodily function. 19 Sec. 5. NEW SECTION . 146A.5 Criminal penalties. 20 1. A person who knowingly or recklessly performs or attempts 21 to perform an abortion in violation of this chapter is guilty 22 of a class “C” felony. 23 2. A criminal penalty shall not be imposed under this 24 chapter on a woman upon whom an abortion is performed or 25 attempted to be performed. A criminal penalty shall not be 26 imposed for failure of a woman to comply with the requirement 27 of written certification pursuant to section 146A.3, if the 28 department has not made the information available at the time 29 the physician or the physician’s agent is required to inform 30 the woman of the woman’s right to review the information. 31 Sec. 6. NEW SECTION . 146A.6 Protection of privacy in court 32 proceedings —— penalty. 33 1. In every criminal proceeding brought pursuant to this 34 chapter, the court proceedings shall be conducted in a manner 35 -5- LSB 5192YH (6) 84 pf/rj 5/ 17

H.F. 2239 which protects the confidentiality of the woman, and all 1 court documents pertaining to the proceedings shall remain 2 confidential and shall be sealed. The court shall direct the 3 exclusion of individuals from courtrooms or hearing rooms to 4 the extent necessary to safeguard the woman’s identity from 5 public disclosure. 6 2. This section shall not be construed to conceal the 7 identity of witnesses from the defendant. 8 3. A person who knowingly violates the confidentiality 9 requirements of this section relating to court proceedings and 10 documents is guilty of a simple misdemeanor. 11 Sec. 7. EFFECTIVE DATES. 12 1. The provisions of this division of this Act requiring the 13 department of public health to publish information described 14 in section 146A.3, subsection 3, as enacted in this Act, by 15 October 1, 2012, being deemed of immediate importance, take 16 effect upon enactment. 17 2. The remainder of this division of this Act takes effect 18 October 1, 2012. 19 DIVISION II 20 APPLICATION OF AMBULATORY SURGICAL CENTER REGULATIONS TO 21 FACILITIES THAT PROVIDE ABORTIONS 22 Sec. 8. Section 135.61, subsection 21, Code 2011, is amended 23 to read as follows: 24 21. “Outpatient surgical facility” means a any of the 25 following: 26 a. A facility which as its primary function provides, 27 through an organized medical staff and on an outpatient basis 28 to patients who are generally ambulatory, surgical procedures 29 not ordinarily performed in a private physician’s office, but 30 not requiring twenty-four hour hospitalization, and which is 31 neither not a part of a hospital nor and is not owned wholly or 32 in part by a hospital. “Outpatient surgical facility” also does 33 not include the private office of a health care provider who 34 there engages in the lawful practice of surgery. “Outpatient 35 -6- LSB 5192YH (6) 84 pf/rj 6/ 17

H.F. 2239 surgical facility” includes a 1 b. A facility certified or seeking certification as an 2 ambulatory surgical center, under the federal Medicare program 3 or under the medical assistance program established pursuant to 4 chapter 249A . 5 c. A facility that provides for the performing or inducing 6 of any abortions. 7 Sec. 9. NEW SECTION . 135P.1 Definitions. 8 As used in this chapter, unless the context otherwise 9 requires: 10 1. “Ambulatory surgical center” means an outpatient surgical 11 facility as defined in section 135.61 or an ambulatory surgical 12 facility as defined in section 514.5. 13 2. “Department” means the department of inspections and 14 appeals. 15 Sec. 10. NEW SECTION . 135P.2 Licenses —— fees —— criteria. 16 1. A person shall not operate an ambulatory surgical center 17 in this state without first obtaining a license from the 18 department after meeting the requirements of this chapter. The 19 application shall be on a form prescribed by the department and 20 shall require information the department deems necessary. Each 21 application for license shall be accompanied by a nonrefundable 22 biennial license fee determined by the department. 23 2. The ambulatory surgical center shall meet the 24 requirements of 42 C.F.R. pt. 416 before a license is issued. 25 The department shall provide the necessary personnel to inspect 26 the ambulatory surgical center to determine if the ambulatory 27 surgical center complies with necessary requirements before 28 a license is issued. An ambulatory surgical center that is 29 certified under the federal Medicare program and thereby meets 30 the requirements of 42 C.F.R. pt. 416 shall be licensed without 31 inspection by the department. 32 Sec. 11. NEW SECTION . 135P.3 Denial, suspension, or 33 revocation of license. 34 The department may deny, suspend, or revoke a license if 35 -7- LSB 5192YH (6) 84 pf/rj 7/ 17

H.F. 2239 the department determines an ambulatory surgical center fails 1 to comply with this chapter or the rules adopted pursuant 2 to this chapter. A denial, suspension, or revocation may 3 be appealed under chapter 17A. The department may reissue 4 a license following a suspension or revocation after the 5 ambulatory surgical center corrects the conditions upon which 6 the suspension or revocation was based. 7 Sec. 12. NEW SECTION . 135P.4 Limitation, expiration, and 8 renewal of license. 9 A license for an ambulatory surgical center shall be issued 10 only for the premises, person, or facility named in the 11 application and is not transferable or assignable. A license, 12 unless sooner suspended or revoked, shall expire two years 13 after the date of issuance and shall be renewed biennially 14 upon an application by the licensee. Application for renewal 15 shall be made in writing to the department at least thirty days 16 prior to the expiration of the license. The fee for a license 17 renewal shall be determined by the department. 18 Sec. 13. NEW SECTION . 135P.5 Rules. 19 Except as otherwise provided in this chapter, the department 20 shall adopt rules pursuant to chapter 17A necessary to 21 administer this chapter, subject to approval of the state board 22 of health. Formulation of the rules shall include consultation 23 with persons affected by this chapter. 24 Sec. 14. Section 514.5, Code 2011, is amended to read as 25 follows: 26 514.5 Contracts for service. 27 1. A hospital service corporation organized under 28 chapter 504, Code 1989, or current chapter 504 may enter 29 into contracts for the rendering of hospital service to any 30 of its subscribers with hospitals maintained and operated by 31 the state or any of its political subdivisions, or by any 32 corporation, association, or individual. Such hospital service 33 corporation may also contract with an ambulatory surgical 34 facility to provide surgical services to the corporation’s 35 -8- LSB 5192YH (6) 84 pf/rj 8/ 17

H.F. 2239 subscribers. Hospital service is meant to include bed and 1 board, general nursing care, use of the operating room, use of 2 the delivery room, ordinary medications and dressings and other 3 customary routine care. “Ambulatory surgical facility” means 4 a facility constructed and operated for the specific purpose 5 of providing surgery to patients admitted to and discharged 6 from the facility within the same day or an “outpatient surgical 7 facility” as defined in section 135.61 . 8 2. A medical service corporation organized under this 9 chapter may enter into contracts with subscribers to furnish 10 health care service through physicians and surgeons, dentists, 11 podiatric physicians, osteopathic physicians, osteopathic 12 physicians and surgeons, or chiropractors. 13 3. Any pharmaceutical or optometric service corporation 14 organized under the provisions of said this chapter may 15 enter into contracts for the rendering of pharmaceutical or 16 optometric service to any of its subscribers. Membership in 17 any pharmaceutical service corporation shall be open to all 18 pharmacies licensed under chapter 155A . 19 4. A hospital service corporation or medical service 20 corporation organized under this chapter may enter into 21 contracts with subscribers and providers to furnish health care 22 services not otherwise allocated by this section . 23 DIVISION III 24 MEDICAL ABORTIONS 25 Sec. 15. NEW SECTION . 146B.1 Medical abortions —— 26 restrictions —— in-person administration —— penalties. 27 1. For the purpose of this section: 28 a. “Medical abortion” means the use of a medication 29 including but not limited to mifepristone or ulipristal acetate 30 to terminate a pregnancy. 31 b. “Physician” means a person licensed to practice medicine 32 and surgery or osteopathic medicine and surgery pursuant to 33 chapter 148. 34 2. a. Only a physician shall prescribe, dispense, or 35 -9- LSB 5192YH (6) 84 pf/rj 9/ 17

H.F. 2239 administer any medication for the purpose of inducing a medical 1 abortion. 2 b. Any physician prescribing, dispensing, or administering 3 a medication for the purpose of inducing a medical abortion 4 shall also comply with all federal regulations relating to the 5 prescribing, dispensing, and administering of such medication. 6 c. A physician shall only administer a medication for 7 the purpose of inducing a medical abortion in person and in 8 a clinic or hospital with the capacity to provide surgical 9 intervention in cases resulting in an incomplete abortion or 10 severe bleeding. 11 3. A physician who knowingly performs a medical abortion in 12 violation of this section is guilty of a serious misdemeanor 13 and is subject to revocation of licensure pursuant to chapter 14 148. 15 DIVISION IV 16 PREVENTION OF COERCED ABORTIONS 17 Sec. 16. NEW SECTION . 146C.1 Prevention of coerced abortion 18 —— signage. 19 1. a. Any facility in which abortions are performed shall 20 conspicuously post a sign in each patient admission area, 21 waiting room, and patient consultation room used by patients on 22 whom abortions are performed which state: 23 It is against the law for anyone, regardless of the 24 individual’s relationship to you, to force you to have an 25 abortion. You have the right to contact any local or state law 26 enforcement or social services agency to receive protection 27 from any actual or threatened physical, emotional, or 28 psychological abuse. It is against the law to perform, induce, 29 prescribe for, or provide you with the means for an abortion 30 without your voluntary consent. 31 b. In addition to the posting of the signs required under 32 this subsection, a pregnant woman shall be informed orally in 33 a private room in the facility of the prohibition against a 34 coerced abortion by a physician or an agent of the physician 35 -10- LSB 5192YH (6) 84 pf/rj 10/ 17

H.F. 2239 who performs abortions at the facility. 1 2. The department of public health shall make the signs 2 required under this section available for download in a 3 printable format on its internet site. 4 Sec. 17. NEW SECTION . 707.8B Coerced abortion —— prohibited 5 —— penalty. 6 1. For the purposes of this section, “coerces” means any act 7 or attempted act including a threat of physical harm intended 8 to compel a pregnant woman to have an abortion performed in 9 otherwise lawful circumstances but performed against the 10 pregnant woman’s will. 11 2. A person who coerces a pregnant woman to have an abortion 12 is guilty of a class “C” felony. 13 DIVISION V 14 ABORTION PROVISIONS RELATING TO MINORS 15 Sec. 18. NEW SECTION . 135L.6A Causing, aiding, or assisting 16 a minor in obtaining abortion —— noncompliance with requirements 17 —— civil liability. 18 1. A person shall not intentionally cause a minor to obtain 19 or aid or assist a minor in obtaining an abortion without 20 complying with this chapter. 21 2. A person who violates subsection 1 shall be civilly 22 liable to the minor and to the person to whom notification is 23 required to be given under this chapter. Appropriate relief 24 under this subsection may include compensatory damages for all 25 injuries, psychological and physical, resulting from violation 26 of subsection 1. 27 3. It shall not be a defense to a claim brought under this 28 section that the abortion was performed pursuant to consent to 29 the abortion provided in a manner that is otherwise lawful in 30 the state or jurisdiction where the abortion was performed if 31 not otherwise in compliance with this chapter. 32 Sec. 19. NEW SECTION . 146D.1 Definition. 33 For the purpose of this chapter, unless the context 34 otherwise requires, “minor” means a person under eighteen years 35 -11- LSB 5192YH (6) 84 pf/rj 11/ 17

H.F. 2239 of age who has not been and is not married. 1 Sec. 20. NEW SECTION . 146D.2 Persons providing abortions 2 for minors —— required reporting of sexual abuse —— penalty. 3 1. An individual who is a physician or an agent of a 4 physician and who performs abortions on minors shall report 5 any suspected sexual abuse, as defined in section 709.1, of 6 a minor no later than forty-eight hours after the suspected 7 sexual abuse has been brought to the individual’s attention. 8 The individual shall not delegate the responsibility to report 9 suspected sexual abuse to any other person but shall make the 10 report personally. The individual shall make the report to the 11 local law enforcement agency, the department of public safety, 12 or the department of human services. 13 2. The individual making the report shall identify the name 14 and address of the minor as well as the name and address of the 15 parent or legal guardian of the minor. The individual making 16 the report shall provide any information the individual may 17 possess relating to the suspected sexual abuse as specified by 18 the agency or department receiving the report. 19 3. A physician or an agent of a physician who performs 20 abortions on minors who has reason to believe that a minor’s 21 physical or mental health or welfare has been adversely 22 affected due to suspected sexual abuse and who knowingly does 23 not report such suspected sexual abuse as required under this 24 section, is guilty of a serious misdemeanor. 25 Sec. 21. NEW SECTION . 146D.3 Maintenance of forensic 26 samples from abortions performed on certain minors —— penalties. 27 1. A physician who performs an abortion on a minor shall 28 preserve fetal tissue extracted during the abortion in 29 accordance with rules adopted by the department of public 30 health in cooperation with the department of public safety 31 pursuant to this section. The physician shall submit the 32 tissue to the department of public safety. 33 2. The department of public health in cooperation with 34 the department of public safety shall adopt rules pursuant to 35 -12- LSB 5192YH (6) 84 pf/rj 12/ 17

H.F. 2239 chapter 17A prescribing all of the following: 1 a. The amount and type of fetal tissue to be preserved and 2 submitted by a physician pursuant to this section. 3 b. The procedures for the proper preservation of such 4 tissue for the purpose of deoxyribonucleic acid testing and 5 examination. 6 c. The procedures for documenting the chain of custody of 7 such tissue for use as evidence. 8 d. The procedures for proper disposal of fetal tissue 9 preserved pursuant to this section. 10 e. A uniform reporting instrument to be utilized by 11 physicians when submitting fetal tissue under this section 12 which shall include the name of the physician submitting the 13 fetal tissue and the complete residential address and name 14 of the parent or legal guardian of the minor upon whom the 15 abortion was performed. 16 f. The procedures for communication with law enforcement 17 agencies regarding evidence and information obtained pursuant 18 to this section. 19 3. Failure of a physician to comply with any provision 20 of this section or any rule adopted pursuant to this section 21 constitutes a serious misdemeanor and a basis for license 22 discipline under section 148.6. 23 EXPLANATION 24 Division I of this bill establishes new Code chapter 146A, 25 relating to informed consent prior to an abortion. The Code 26 chapter is known and cited as the “Woman’s Right to Know Act”. 27 Division I specifies the required informed consent 28 provisions, including provision of certain information to 29 a woman by the physician or an agent of the physician, and 30 required certification by the woman of provision to the woman 31 of the required information, receipt of the certification by 32 the physician prior to the performance of an abortion, and 33 receipt of documentation by the physician regarding the woman’s 34 response to offers of undergoing of an ultrasound prior to the 35 -13- LSB 5192YH (6) 84 pf/rj 13/ 17

H.F. 2239 performance of an abortion. Division I requires the department 1 of public health to publish information by October 1, 2012, 2 relating to options for managing a pregnancy. Division I 3 authorizes the department to establish and maintain an internet 4 site to provide the information. 5 Division I also provides for alternatives to providing 6 informed consent in the case of a medical emergency. 7 Division I establishes a criminal penalty of a class “C” 8 felony for a person who knowingly or recklessly performs or 9 attempts to perform an abortion in violation of the new Code 10 chapter. A class “C” felony is punishable by confinement 11 for no more than 10 years and a fine of at least $1,000 but 12 not more than $10,000. Division I prohibits the imposition 13 of a criminal penalty against a woman upon whom an abortion 14 is performed or attempted to be performed, and prohibits the 15 imposition of a criminal penalty against a woman for failure to 16 comply with certification requirements if the department has 17 not made the printed materials available as required. Division 18 I also provides for protection of confidentiality of a woman 19 with regard to criminal court proceedings relating to an action 20 under the new Code chapter. 21 The provisions of division I relating to the department of 22 public health publishing information as prescribed in the bill 23 take effect upon enactment. The remainder of division I takes 24 effect October 1, 2012. 25 Division II of the bill defines an outpatient surgical 26 facility or ambulatory surgical center to include any 27 facility that provides for performing or inducing abortions, 28 thereby making these establishments subject to certificate of 29 need requirements and other regulatory provisions to which 30 outpatient surgical facilities or ambulatory surgical centers 31 are subject. Division II also amends the definition of an 32 outpatient surgical facility to exclude facilities that are 33 owned wholly or in part by a hospital. 34 Division II also requires that ambulatory surgical centers 35 -14- LSB 5192YH (6) 84 pf/rj 14/ 17

H.F. 2239 be licensed and meet the requirements of the centers for 1 Medicare and Medicaid services of the United States department 2 of health and human services for ambulatory surgical services. 3 Division III of the bill relates to restrictions for medical 4 abortions. The bill defines “medical abortion” as the use 5 of a medication including but not limited to mifepristone or 6 ulipristal acetate to terminate a pregnancy. Division III 7 provides that only a physician shall prescribe, dispense, 8 or administer any medication for the purpose of inducing a 9 medical abortion. Additionally, division III requires that 10 any physician prescribing, dispensing, or administering a 11 medication for the purpose of inducing a medical abortion 12 shall comply with all federal regulations relating to such 13 medication; and a physician shall only administer a medication 14 for the purpose of inducing a medical abortion in person and 15 in a clinic or hospital with the capacity to provide surgical 16 intervention in cases resulting in an incomplete abortion or 17 severe bleeding. 18 A physician who knowingly performs a medical abortion in 19 violation of division III of the bill is guilty of a serious 20 misdemeanor and is subject to revocation of licensure pursuant 21 to Code chapter 148. A serious misdemeanor is punishable by 22 confinement for no more than one year or a fine of at least $315 23 but not more than $1,875, or by both. 24 Division IV of the bill relates to prevention of coerced 25 abortions. The division requires any facility in which 26 abortions are performed to conspicuously post a sign in each 27 patient admission area, waiting room, and patient consultation 28 room used by patients on whom abortions are performed which 29 state specific language regarding the prohibition against 30 forcing a pregnant woman to have an abortion. In addition to 31 the posting of the signs, division IV requires that a pregnant 32 woman be informed orally in a private room in the facility of 33 the prohibition against a coerced abortion by a physician or an 34 agent of the physician who performs abortions at the facility. 35 -15- LSB 5192YH (6) 84 pf/rj 15/ 17

H.F. 2239 The division directs the department of public health to make 1 the signs required available for download in a printable format 2 on its internet site. 3 Division IV of the bill also provides that a person who 4 coerces a pregnant woman to have an abortion is guilty of a 5 class “C” felony. Division IV defines “coerces” as any act 6 or attempted act including a threat of physical harm intended 7 to compel a pregnant woman to have an abortion performed in 8 otherwise lawful circumstances but performed against the 9 pregnant woman’s will. 10 Division V of the bill includes abortion provisions relating 11 to minors. Division V provides a new provision under Code 12 chapter 135L, (notification requirements regarding pregnant 13 minors) to prohibit a person from intentionally causing a 14 minor to obtain or aiding or assisting a minor in obtaining an 15 abortion without complying with the Code chapter. A person 16 who violates the prohibition is civilly liable to the minor 17 and to the person to whom notification is required to be given 18 under the Code chapter. The division provides that appropriate 19 relief may include compensatory damages for all injuries, 20 psychological and physical, resulting from the violation. 21 Additionally, the division provides that it is not a defense to 22 a claim that the abortion was performed pursuant to consent to 23 the abortion provided in a manner that is otherwise lawful in 24 the state or jurisdiction where the abortion was performed if 25 not otherwise in compliance with the Code chapter. 26 Division V also includes provisions requiring that a 27 physician or an agent of a physician who performs abortions on 28 minors shall report any suspected sexual abuse of a minor no 29 later than 48 hours after the abuse has been brought to the 30 individual’s attention. The division prohibits the individual 31 from delegating the responsibility to report sexual abuse to 32 any other person and requires the individual to make the report 33 personally. The individual is required to make the report to 34 the local law enforcement agency, the department of public 35 -16- LSB 5192YH (6) 84 pf/rj 16/ 17

H.F. 2239 safety, or the department of human services. The division 1 prescribes the information to be included in the report. The 2 division provides that a physician or an agent of a physician 3 who performs abortions on minors who has reason to believe 4 that a minor’s physical or mental health or welfare has been 5 adversely affected due to sexual abuse and who knowingly does 6 not report such sexual abuse as required, is guilty of a 7 serious misdemeanor. A serious misdemeanor is punishable by 8 confinement for no more than one year and a fine of at least 9 $315 but not more than $1,875. 10 Division V also requires that a physician, who performs an 11 abortion on minors, preserve fetal tissue extracted during the 12 abortion in accordance with rules adopted by the department 13 of public health in cooperation with the department of public 14 safety pursuant to this Code section. The division requires 15 the physician to submit the tissue to the department of 16 public safety. The bill specifies the rules to be adopted 17 and provides that failure of a physician to comply with the 18 requirements relating to preserving of fetal tissue constitutes 19 a basis for license discipline and is a serious misdemeanor. A 20 serious misdemeanor is punishable by confinement for no more 21 than one year and a fine of at least $315 but not more than 22 $1,875. 23 -17- LSB 5192YH (6) 84 pf/rj 17/ 17