H.F. 298 Section 1. NEW SECTION . 146B.1 Definitions. 1 As used in this chapter, unless the context otherwise 2 requires: 3 1. “Abortion” means abortion as defined in section 146.1. 4 2. “Attempt to perform or induce an abortion” means an act, 5 or an omission of a statutorily required act, that, under the 6 circumstances as the actor believes them to be, constitutes a 7 substantial step in a course of conduct planned to culminate in 8 the performance or inducing of an abortion. 9 3. “Department” means the department of public health. 10 4. “Fertilization” means the fusion of a human spermatozoon 11 with a human ovum. 12 5. “Human pregnancy” means an individual organism of the 13 species homo sapiens from fertilization until live birth. 14 6. “Medical emergency” means a condition which, in 15 reasonable medical judgment, so complicates the medical 16 condition of a pregnant woman as to necessitate the immediate 17 abortion of the human pregnancy to avert the woman’s death or 18 for which a delay will create a serious risk of substantial and 19 irreversible physical impairment of a major bodily function. 20 “Medical emergency” does not include a condition which is based 21 on a claim or diagnosis that the pregnant woman will engage in 22 conduct which would result in the pregnant woman’s death or in 23 substantial and irreversible physical impairment of a major 24 bodily function. 25 7. “Medical facility” means any public or private hospital, 26 clinic, center, medical school, medical training institution, 27 health care facility, physician’s office, infirmary, 28 dispensary, ambulatory surgical center, or other institution or 29 location where medical care is provided to any person. 30 8. “Physician” means a person licensed under chapter 148. 31 9. “Postfertilization age” means the age of the human 32 pregnancy as calculated from the fertilization of the human 33 ovum. 34 10. “Probable postfertilization age” means what, in 35 -1- LSB 2233YH (1) 87 pf/nh 1/ 9

H.F. 298 reasonable medical judgment, will with reasonable probability 1 be the postfertilization age of the human pregnancy at the time 2 the abortion is to be performed. 3 11. “Reasonable medical judgment” means a medical judgment 4 made by a reasonably prudent physician who is knowledgeable 5 about the case and the treatment possibilities with respect to 6 the medical conditions involved. 7 12. “Unborn child” means a human pregnancy in the 8 postembryonic stage. 9 Sec. 2. NEW SECTION . 146B.2 Determination of 10 postfertilization age —— abortion prohibited twenty or more weeks 11 postfertilization —— exceptions —— reporting requirements —— 12 penalties. 13 1. Except in the case of a medical emergency, an abortion 14 shall not be performed or induced or be attempted to be 15 performed or induced unless the physician performing or 16 inducing the abortion has first made a determination of the 17 probable postfertilization age of the human pregnancy or relied 18 upon such a determination made by another physician. In making 19 such a determination, a physician shall make such inquiries 20 of the pregnant woman and perform or cause to be performed 21 such medical examinations and tests the physician considers 22 necessary in making a reasonable medical judgment to accurately 23 determine the postfertilization age of the human pregnancy. 24 2. a. A physician shall not perform or induce or attempt 25 to perform or induce an abortion upon a pregnant woman when it 26 has been determined, by the physician performing or inducing 27 the abortion or by another physician upon whose determination 28 that physician relies, that the probable postfertilization age 29 of the human pregnancy is twenty or more weeks unless, in the 30 physician’s reasonable medical judgment, any of the following 31 applies: 32 (1) The pregnant woman has a condition which the physician 33 deems a medical emergency. 34 (2) It is necessary to preserve the life of the unborn 35 -2- LSB 2233YH (1) 87 pf/nh 2/ 9

H.F. 298 child. 1 b. If an abortion is performed or induced under this 2 subsection, the physician shall terminate the human pregnancy 3 in the manner which, in the physician’s reasonable medical 4 judgment, provides the best opportunity for the unborn child 5 to survive, unless, in the physician’s reasonable medical 6 judgment, termination of the human pregnancy in that manner 7 would pose a greater risk than any other available method of 8 the death of the pregnant woman or of the substantial and 9 irreversible physical impairment of a major bodily function. 10 A greater risk shall not be deemed to exist if it is based on 11 a claim or diagnosis that the pregnant woman will engage in 12 conduct which would result in the pregnant woman’s death or in 13 substantial and irreversible physical impairment of a major 14 bodily function. 15 3. A physician who performs or induces or attempts to 16 perform or induce an abortion shall report to the department, 17 on a schedule and in accordance with forms and rules adopted by 18 the department, all of the following: 19 a. If a determination of probable postfertilization age of 20 the human pregnancy was made, the probable postfertilization 21 age determined and the method and basis of the determination. 22 b. If a determination of probable postfertilization 23 age of the human pregnancy was not made, the basis of the 24 determination that a medical emergency existed. 25 c. If the probable postfertilization age of the human 26 pregnancy was determined to be twenty or more weeks, the basis 27 of the determination of a medical emergency. 28 d. The method used for the abortion and, in the case of 29 an abortion performed when the probable postfertilization age 30 was determined to be twenty or more weeks, whether the method 31 of abortion used was one that, in the physician’s reasonable 32 medical judgment, provided the best opportunity for the unborn 33 child to survive or, if such a method was not used, the basis 34 of the determination that termination of the human pregnancy 35 -3- LSB 2233YH (1) 87 pf/nh 3/ 9

H.F. 298 in that manner would pose a greater risk than would any other 1 available method of the death of the pregnant woman or of the 2 substantial and irreversible physical impairment of a major 3 bodily function. 4 4. a. By June 30, annually, the department shall issue a 5 public report providing statistics for the previous calendar 6 year, compiled from the reports for that year submitted in 7 accordance with subsection 3. Each report shall also provide 8 the statistics for all previous calendar years, adjusted to 9 reflect any additional information from late or corrected 10 reports. The department shall ensure that none of the 11 information included in the public reports could reasonably 12 lead to the identification of any woman upon whom an abortion 13 was performed. 14 b. (1) A physician who fails to submit a report by the end 15 of thirty days following the due date shall be subject to a 16 late fee of five hundred dollars for each additional thirty-day 17 period or portion of a thirty-day period the report is overdue. 18 (2) A physician required to report in accordance with 19 subsection 3 who has not submitted a report or who has 20 submitted only an incomplete report more than one year 21 following the due date, may, in an action brought in the 22 manner in which actions are brought to enforce chapter 148, 23 be directed by a court of competent jurisdiction to submit a 24 complete report within a time period stated by court order or 25 be subject to contempt of court. 26 (3) A physician who intentionally or recklessly falsifies 27 a report required under this section is subject to a civil 28 penalty of one hundred dollars. 29 5. The department shall adopt rules to implement this 30 section. 31 Sec. 3. NEW SECTION . 146B.3 Civil and criminal actions 32 —— penalties. 33 1. Failure of a physician to comply with any provision of 34 section 146B.2, with the exception of the late filing of a 35 -4- LSB 2233YH (1) 87 pf/nh 4/ 9

H.F. 298 report or failure to submit a complete report in compliance 1 with a court order, is grounds for license discipline under 2 chapter 148. 3 2. A physician who intentionally or recklessly performs or 4 attempts to perform an abortion in violation of this chapter is 5 guilty of a class “C” felony. 6 3. A medical facility licensed in this state in which 7 abortions are performed or induced in violation of this chapter 8 is subject to immediate revocation of licensure. 9 4. A medical facility licensed in this state in which 10 abortions are performed or induced in violation of this chapter 11 is ineligible to receive state funding and is subject to 12 repayment of any state funds received from the state during the 13 time after which an abortion in violation of this chapter was 14 performed or induced. 15 5. A woman upon whom an abortion has been performed in 16 violation of this chapter or the biological father may maintain 17 an action against the physician who performed the abortion in 18 intentional or reckless violation of this chapter for actual 19 damages. 20 6. A woman upon whom an abortion has been attempted in 21 violation of this chapter may maintain an action against the 22 physician who attempted to perform the abortion in intentional 23 or reckless violation of this chapter for actual damages. 24 7. A cause of action for injunctive relief to prevent a 25 physician from performing abortions may be maintained against a 26 physician who has intentionally violated this chapter by the 27 woman upon whom the abortion was performed or attempted to be 28 performed, by the spouse of the woman, by a parent or guardian 29 of the woman if the woman is less than eighteen years of age or 30 unmarried at the time the abortion was performed or attempted 31 to be performed, 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 8. A woman upon whom an abortion was performed or was 35 -5- LSB 2233YH (1) 87 pf/nh 5/ 9

H.F. 298 attempted to be performed shall not be subject to prosecution 1 for a violation of this chapter. 2 9. If the plaintiff prevails in an action brought under 3 this section, the plaintiff shall be entitled to an award for 4 reasonable attorney fees. 5 10. If the defendant prevails in an action brought under 6 this section and the court finds that the plaintiff’s suit was 7 frivolous and brought in bad faith, the defendant shall be 8 entitled to an award for reasonable attorney fees. 9 11. Damages and attorney fees shall not be assessed against 10 the woman upon whom an abortion was performed or attempted to 11 be performed except as provided in subsection 10. 12 12. In a civil or criminal proceeding or action brought 13 under this chapter, the court shall rule whether the anonymity 14 of any woman upon whom an abortion has been performed or 15 attempted shall be preserved from public disclosure if the 16 woman does not provide consent to such disclosure. The court, 17 upon motion or on its own motion, shall make such a ruling 18 and, upon determining that the woman’s anonymity should be 19 preserved, shall issue orders to the parties, witnesses, 20 and counsel and shall direct the sealing of the record and 21 exclusion of individuals from courtrooms or hearing rooms to 22 the extent necessary to safeguard the woman’s identity from 23 public disclosure. Each such order shall be accompanied by 24 specific written findings explaining why the anonymity of the 25 woman should be preserved from public disclosure, why the 26 order is essential to that end, how the order is narrowly 27 tailored to serve that interest, and why no reasonable less 28 restrictive alternative exists. In the absence of written 29 consent of the woman upon whom an abortion has been performed 30 or attempted, anyone, other than a public official, who brings 31 an action under this section shall do so under a pseudonym. 32 This subsection shall not be construed to conceal the identity 33 of the plaintiff or of witnesses from the defendant or from 34 attorneys for the defendant. 35 -6- LSB 2233YH (1) 87 pf/nh 6/ 9

H.F. 298 Sec. 4. NEW SECTION . 146B.4 Construction. 1 1. Nothing in this chapter shall be construed as creating or 2 recognizing a right to an abortion. 3 2. Nothing in this chapter shall be construed as determining 4 life to begin at twenty weeks’ gestation. Instead, it is 5 recognized that life begins at conception. 6 Sec. 5. NEW SECTION . 146B.5 Severability clause. 7 If any provision of this chapter or its application to any 8 person or circumstance is held invalid, the invalidity does 9 not affect other provisions or application 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 Sec. 6. EFFECTIVE UPON ENACTMENT. This Act, being deemed of 14 immediate importance, takes effect upon enactment. 15 EXPLANATION 16 The inclusion of this explanation does not constitute agreement with 17 the explanation’s substance by the members of the general assembly. 18 This bill relates to abortions. The bill provides that, 19 except in the case of a medical emergency, an abortion shall 20 not be performed or induced or be attempted to be performed 21 or induced unless the physician performing or inducing the 22 abortion has first made a determination of the probable 23 postfertilization age of the human pregnancy. Additionally, 24 the bill prohibits a physician from performing or inducing 25 or attempting to perform or induce an abortion upon a 26 pregnant woman when it has been determined, that the probable 27 postfertilization age is 20 or more weeks unless, in the 28 physician’s reasonable medical judgment, either the pregnant 29 woman has a condition which the physician deems a medical 30 emergency or it is necessary to preserve the life of the 31 unborn child. If an abortion is performed or induced when 32 the probable postfertilization age is 20 or more weeks, the 33 physician is required to terminate the pregnancy in a manner 34 which, in the physician’s reasonable medical judgment, provides 35 -7- LSB 2233YH (1) 87 pf/nh 7/ 9

H.F. 298 the best opportunity for the unborn child to survive unless 1 such termination would pose a greater risk either of the death 2 of the pregnant woman or of the substantial and irreversible 3 physical impairment of a major bodily function of the woman 4 than would another available method. 5 The bill also requires certain reports to be filed by a 6 physician who performs or induces or attempts to perform or 7 induce an abortion with the department of public health, on 8 a schedule and in accordance with forms and rules adopted by 9 the department. The department is required to compile the 10 information collected annually and issue a public report, 11 ensuring that none of the information included in the public 12 reports could reasonably lead to the identification of any 13 pregnant woman upon whom an abortion was performed. The bill 14 provides monetary penalties for a physician who fails to submit 15 a report in a timely manner, submits an incomplete report, or 16 intentionally or recklessly falsifies a required report. 17 The bill provides for civil and criminal actions and 18 penalties relating to violations of the bill. Failure of a 19 physician to comply with any provision, with the exception of 20 the late filing of a report or failure to submit a complete 21 report in compliance with a court order, is grounds for license 22 discipline. A physician who intentionally or recklessly 23 performs or attempts to perform an abortion in violation of the 24 bill is guilty of a class “C” felony, which is punishable by 25 confinement for no more than 10 years and a fine of at least 26 $1,000 but not more than $10,000. The bill also provides that 27 a medical facility licensed in the state in which abortions 28 are performed or induced in violation of the bill is subject 29 to immediate revocation of licensure. Additionally, a 30 medical facility licensed in this state in which abortions are 31 performed or induced in violation of the bill is ineligible to 32 receive state funding and is subject to repayment of any state 33 funds received from the state during the time after which an 34 abortion in violation of the bill was performed or induced. 35 -8- LSB 2233YH (1) 87 pf/nh 8/ 9

H.F. 298 However, the woman upon whom the abortion was performed or was 1 attempted to be performed is not subject to prosecution for a 2 violation of the bill. The bill provides for the maintaining 3 of actions by certain people based on alleged violations of 4 the bill. A woman upon whom an abortion has been performed in 5 violation of the bill or the biological father may maintain 6 an action against the physician who performed the abortion 7 in intentional or reckless violation of the bill for actual 8 damages. A woman upon whom an abortion has been attempted 9 in violation of the bill may maintain an action against the 10 physician who attempted to perform the abortion in intentional 11 or reckless violation of the bill for actual damages. 12 Additionally, a cause of action for injunctive relief to 13 prevent a physician from performing abortions may be maintained 14 against a physician who has intentionally violated the bill by 15 the woman upon whom the abortion was performed or attempted 16 to be performed, by the spouse of the woman, by a parent or 17 guardian of the woman if the woman is less than 18 years of 18 age or unmarried at the time the abortion was performed or 19 attempted to be performed, by a current or former licensed 20 health care provider of the woman, by a county attorney with 21 appropriate jurisdiction, or by the attorney general. 22 The bill provides a process for preserving the anonymity of 23 the woman upon whom an abortion has been performed or attempted 24 from public disclosure if the woman does not provide consent to 25 such disclosure during any proceeding or action under the bill. 26 The bill also provides that the bill is not to be construed 27 as creating or recognizing a right to an abortion, and the 28 bill is not to be construed as determining life to begin at 20 29 weeks’ gestation; instead, it is recognized that life begins 30 at conception. 31 The bill includes a severability clause as is applicable to 32 every Act or statute pursuant to Code section 4.12. 33 The bill takes effect upon enactment. 34 -9- LSB 2233YH (1) 87 pf/nh 9/ 9