HF 193 (LSB 1127HH (3) 89)

HOUSE FILE 193

BY  SALMON

A BILL FOR

An Act relating to actions relative to treatment or intervention regarding the discordance between a minor’s sex and gender identity, and providing civil penalties. 
BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:

    Section 1.  FINDINGS.  The general assembly finds all of the following:
   1.  “Sex” is the biological state of being female or male, based on sex organs, chromosomes, and endogenous hormone profiles. An individual’s sex is genetically encoded into an individual at the moment of conception, and it cannot be changed.
   2.  Some individuals, including minors, may experience discordance between their sex and their internal sense of gender identity. Individuals who experience severe psychological distress as a result of this discordance may be diagnosed with gender dysphoria.
   3.  The cause of the individual’s impression of discordance between sex and gender identity is unknown. Diagnosis is based exclusively on the individual’s self-report of feelings and beliefs.
   4.  This internal sense of discordance is not permanent or fixed. To the contrary, numerous studies have shown that a substantial majority of children who experience discordance between their sex and gender identity will outgrow the discordance once they go through puberty and will eventually have a gender identity that aligns with their sex.
   5.  As a result, taking a wait-and-see approach to children who reveal signs of gender nonconformity results in a large majority of such children resolving to a gender identity congruent with their sex by late adolescence. 
   6.  Some in the medical community are aggressively pushing for interventions on children that medically alter a child’s hormonal balance and remove healthy external and internal sex organs when the child expresses a desire to appear as a sex different from the child’s own.
   7.  This course of treatment for children commonly begins with encouraging and assisting a child to socially transition to dressing and presenting as the opposite sex. In the case of prepubertal children, as puberty begins, doctors then administer long-acting gonadotropin-releasing hormone (GnRH) agonists or puberty blockers that suppress the pubertal development of the child. This use of puberty blockers for gender nonconforming children is experimental and not approved by the United States food and drug administration.
   8.  After puberty is blocked, the child is administered cross-sex hormonal treatments that induce the development of secondary sex characteristics of the other sex, such as causing the development of breasts and wider hips in male children taking estrogen and greater muscle mass, bone density, body hair, and a deeper voice in female children taking testosterone. Some children are administered these hormones independent of any prior pubertal blockade.
   9.  The final phase of treatment is for the child to undergo cosmetic and other surgical procedures, often to create an appearance similar to that of the opposite sex. These surgical procedures may include a mastectomy to remove a female child’s breasts and bottom surgery that removes a child’s healthy reproductive organs and creates an artificial form aiming to approximate the appearance of the genitals of the opposite sex.
   10.  For children who are placed on puberty blockers that inhibit their bodies from experiencing the natural process of sexual development, the overwhelming majority will continue down a path toward cross-sex hormones and cosmetic surgery. 
   11.  This unproven, poorly studied series of interventions results in numerous harmful effects for children, as well as risks of effects simply unknown due to the new and experimental nature of these interventions. 
   12.  Among the known harms from puberty blockers are diminished bone density. The full effect of puberty blockers on brain development and cognition are yet unknown, though reason for concern is now present. There is no research on the long-term risks to children of persistent exposure to puberty blockers. With the administration of cross-sex hormones comes increased risks of cardiovascular disease, thromboembolic stroke, asthma, chronic obstructive pulmonary disease, and cancer. 
   13.  Puberty blockers prevent gonadal maturation and thus render children taking these drugs infertile. Introducing cross-sex hormones to children with immature gonads as a direct result of pubertal blockade is expected to cause irreversible sterility. Sterilization is also permanent for those who undergo surgery to remove reproductive organs, and such children are likely to suffer through a lifetime of complications from the surgery, infections, and other difficulties requiring yet more medical intervention. 
   14.  Several studies demonstrate that hormonal and surgical interventions often do not resolve the underlying psychological issues affecting the individual. For example, individuals who undergo cross-sex cosmetic surgical procedures have been found to suffer from elevated mortality rates from medical and psychological conditions. Their suicide rate is nineteen times higher than the general population. They experience significantly higher rates of substance abuse, depression, and psychiatric hospitalizations. 
   15.  Children, and often their parents, are unable to comprehend and fully appreciate the risk and life implications, including permanent sterility, that result from the use of puberty blockers, cross-sex hormones, and surgical procedures.
   16.  For these reasons, the decision to pursue a course of hormonal and surgical interventions to address a discordance between an individual’s sex and sense of gender identity should not be presented to or determined for children who are incapable of comprehending the negative implications and life-course difficulties resulting from these interventions. 
    Sec. 2.  NEW SECTION.  147.163  Definitions.
   As used in this chapter, unless the context otherwise requires: 
   1.  “Gender dysphoria” means discomfort or distress over a marked incongruence between an individual’s sex and the gender with which the individual identifies. 
   2.  “Gender nonconformity” means behavior or gender expression by an individual that does not match gender norms for the individual’s sex. 
   3.  “Government agency” means a state agency or an agent, employee, volunteer, or contractor of a state agency.
   4.  “Medical professional” means a physician or surgeon or osteopathic physician and surgeon licensed pursuant to chapter 148, a physician assistant licensed pursuant to chapter 148C, a nurse or advanced registered nurse practitioner licensed pursuant to chapter 152, a nurse or advanced practice registered nurse licensed pursuant to chapter 152E, or a psychiatrist licensed pursuant to chapter 148. 
   5.  “Mental health professional” means the same as defined in section 228.1. 
   6.  “Minor” or “minor child” means an unemancipated individual under eighteen years of age.
   7.  “Parent” means a parent, custodian, or guardian as defined in section 232.2.
   8.  “Political subdivision” means a city, county, township, school district, municipal corporation, special purpose district, board, department, commission, or any other division of local government, or an agent, employee, volunteer, or contractor of such entity. 
   9.  “Sex” means the biological state of being female or male, based on sex organs, chromosomes, and endogenous hormone profiles.
   10.  “State agency” means the same as defined in section 8.11.
    Sec. 3.  NEW SECTION.  147.164  Prohibited practices.
   1.  Notwithstanding any other provision of law to the contrary, it shall be unlawful for a medical professional to engage in any of the following practices upon a minor, or to cause such practice to be performed to facilitate a minor’s desire to present or appear in a manner that is inconsistent with the minor’s sex:
   a.  Performing a surgery that sterilizes, including castration, vasectomy, hysterectomy, oophorectomy, metoidioplasty, orchiectomy, penectomy, phalloplasty, and vaginoplasty.
   b.  Performing a mastectomy.
   c.  Administering or supplying the following medications that induce transient or permanent infertility: 
   (1)  Puberty-blocking medication to stop or delay normal puberty.
   (2)  Supraphysiologic doses of testosterone or other androgens to members of the female sex.
   (3)  Supraphysiologic doses of estrogen or synthetic compounds with estrogenic activity to members of the male sex.
   d.  Removing any otherwise healthy or nondiseased body part or tissue.
   2.  A medical professional who engages in any of the practices prohibited under this section or who causes such practices to be performed shall be subject to revocation of licensure and other appropriate discipline by the medical professional’s licensing board. A medical professional who violates this section shall also be subject to a civil penalty of up to one thousand dollars per occurrence of a violation. 
   3.  This section shall not apply to the good faith medical decision of a parent of a minor born with a medically verifiable genetic disorder of sexual development, including any of the following:
   a.  A minor with external biological sex characteristics that are irresolvably ambiguous, such as a minor born with forty-six XX chromosomes with virilization, forty-six XY chromosomes with undervirilization, or with both ovarian and testicular tissue.
   b.  When a medical professional has otherwise diagnosed a disorder of sexual development in which the medical professional has determined through genetic testing that the minor does not have the normal sex chromosome structure for a male or female.
    Sec. 4.  NEW SECTION.  147.165  Counseling.
   A government agency, political subdivision, or any organization with authority to license or discipline the members of a profession shall not prohibit, impose any penalty, or take any adverse action against any member of such profession who gives or receives counsel, advice, guidance, or any other communication however described, and whether or not in exchange for a fee, in accordance with this chapter and consistent with the professional’s conscience or religious belief.
    Sec. 5.  NEW SECTION.  147.166  Protection of parental rights.
   1.  A parent, in exercising the fundamental right to care for the parent’s minor child, may withhold consent for any treatment, activity, or mental health service that is designed and intended to form the minor child’s conception of sex and gender or to treat gender dysphoria or gender nonconformity. A government agency or political subdivision shall not infringe upon or impede the exercise of this right.
   2.  Notwithstanding any provision to the contrary, a government agency or political subdivision shall not encourage or coerce a minor to withhold information from the minor’s parent, and shall not withhold information from a minor’s parent that is relevant to the physical or mental health of the minor exhibiting symptoms of gender dysphoria, gender nonconformity, or otherwise demonstrating a desire to be treated in a manner incongruent with the minor’s sex. 
   3.  Notwithstanding any provision to the contrary, if a government agency or political subdivision has knowledge that a minor under the care or supervision of a government agency or political subdivision has exhibited symptoms of gender dysphoria, gender nonconformity, or has otherwise demonstrated a desire to be treated in a manner incongruent with the minor’s sex, the government agency or political subdivision shall immediately notify, in writing, any parent of the minor. The notice shall describe all of the relevant circumstances with reasonable specificity.
    Sec. 6.  NEW SECTION.  147.167  Whistleblower protection.
   1.  An individual shall not be discriminated against in any manner because the individual does any of the following:
   a.  Provides or causes to be provided to the individual’s employer, the office of the attorney general, the civil rights commission, or any applicable federal agency, information relating to any violation of this chapter.
   b.  Testifies in a proceeding concerning a violation of this chapter. 
   c.  Assists or participates in a proceeding concerning violation of this chapter.
   2.  Unless the disclosure is otherwise specifically prohibited by law, an individual shall not be discriminated against in any manner because the individual disclosed information under this chapter that the individual believes evinces any of the following:
   a.  A violation of any law, rule, or regulation. 
   b.  A violation of any standard of care or other ethical guidelines for the provision of any health care service.
   c.  Gross mismanagement, a gross waste of funds, an abuse of authority, or a substantial and specific danger to public health or safety.
    Sec. 7.  NEW SECTION.  147.168  Judicial relief.
   1.  A person harmed by a violation of section 147.164 may bring an action for injunctive relief, compensatory and special damages, and any other relief available under law against any person responsible for the violation. 
   2.  A person harmed by a violation of section 147.165, 147.166, or 147.167 may bring an action for injunctive relief, compensatory and special damages, and any other relief available under law against a government agency, political subdivision, or any other person who is responsible for the violation.
   3.  a.  Unless paragraph “b” applies, an action under this chapter is barred unless the action is commenced within two years after the cause of action accrues. 
   b.  Notwithstanding any provision to the contrary, including sections 614.8 and 614.8A, a minor injured by practices prohibited under section 147.164 may bring an action during the minor’s minority through a parent or next friend, and may bring an action in the minor’s own name upon reaching majority and for twenty years after reaching majority.
   4.  A person shall have standing to assert a claim or defense under this section if the person is adversely affected by an alleged violation or the alleged failure to perform a duty or act under this chapter. 
   5.  A person who prevails on a claim brought pursuant to this section shall be entitled to monetary damages, including for all psychological, emotional, and physical harm suffered, reasonable attorney fees and costs, and any other appropriate relief.
    Sec. 8.  NEW SECTION.  147.169  Preemption —— immunity.
   1.  A political subdivision is preempted from enacting, adopting, maintaining, or enforcing any order, ordinance, rule, regulation, policy, or other similar measure that prohibits, restricts, limits, controls, directs, or otherwise interferes with the professional conduct and judgment of a mental health professional, including speech, undertaken under this chapter within the course of treatment and communication with clients, patients, other persons, or the public, including but not limited to therapies, counseling, referrals, and education.
   2.  The attorney general or a mental health professional adversely affected may bring an action for injunctive relief to prevent or restrain a violation of this section. A mental health professional may recover reasonable costs and attorney’s fees incurred in obtaining injunctive relief under this section.
   3.  Sovereign and governmental immunity from a civil action or from liability do not apply to violations of this chapter.
    Sec. 9.  CODE EDITOR DIRECTIVE.  The Code editor may create a new subchapter in chapter 147, codifying sections 147.163 through 147.169, as enacted in this Act, entitled “Gender and Sexual Discordance —— Minors”.
EXPLANATION
The inclusion of this explanation does not constitute agreement with
the explanation’s substance by the members of the general assembly.
   This bill includes provisions relating to practices undertaken to cause a minor to physically appear more like a person of the opposite sex and less like the minor’s own sex, or to conform to a gender identity incongruent with the minor’s sex. The bill contains findings regarding the harms and ineffectiveness of such practices and contains definitions used in the bill. 
   The bill makes it unlawful for a medical professional to perform interventions or surgical procedures specified in the bill on a minor, and subjects a medical professional to disciplinary action and civil penalties for providing the prohibited treatments to or performing surgical procedures on a minor, unless the treatment occurs based on the good faith medical decision of a parent of a minor born with a medically verifiable genetic disorder of sexual development. 
   The bill protects the freedom of members of a profession to provide counseling, in accordance with the bill and consistent with the individual’s conscience or religious belief. 
   The bill includes protections for parents to decline treatment, activity, or mental health care services intended to form their minor child’s conception of sex and gender or to treat gender dysphoria or gender nonconformity. The bill also requires government agencies and political subdivisions to inform parents of any information relevant to the physical or mental health of a minor exhibiting symptoms of gender dysphoria, gender nonconformity, or otherwise demonstrating a desire to be treated in a manner incongruent with the minor’s sex. 
   The bill includes protections for individuals who provide information relating to violations of the bill. 
   The bill provides a private right of action against any person who violates the bill, and creates a statute of limitations for minors to bring certain claims within 20 years of reaching majority. 
   The bill preempts political subdivisions from having measures in place that interfere with the professional conduct and judgment of a mental health professional undertaken under the bill within a course of treatment or communication; provides for injunctive relief for a violation of this provision; and provides that sovereign and governmental immunity from a civil action or from liability do not apply to violations of the bill.