H.F. 327 Section 1. NEW SECTION . 147.163 Gender dysphoria —— consent 1 by parents or legal guardians to medical procedures —— licensee 2 discipline. 3 1. As used in this section: 4 a. “Gender dysphoria” means gender dysphoria as designated 5 in the diagnostic and statistical manual of mental disorders, 6 fifth edition. 7 b. “Minor” means a person during the period of minority as 8 specified in section 599.1. 9 c. “Physician” means a person licensed as a physician 10 and surgeon or osteopathic physician and surgeon pursuant to 11 chapter 148. 12 d. “Practitioner” means a physician and surgeon or 13 osteopathic physician and surgeon licensed under chapter 148 14 who specializes in the practice of psychiatry; a psychologist 15 licensed under chapter 154B; a licensed marital and family 16 therapist or mental health counselor or a temporary licensed 17 marital and family therapist or mental health counselor as 18 defined in section 154D.1; a social worker licensed pursuant to 19 chapter 154C; a licensed school counselor, school psychologist, 20 or school social worker; an advanced registered nurse 21 practitioner licensed pursuant to chapter 152 or an advanced 22 practice registered nurse under chapter 152E; a practitioner 23 as defined in section 272.1; a victim counselor as defined in 24 section 915.20A; a psychiatric nurse; any other person who 25 provides counseling or mental health or behavioral health 26 services as a part of the person’s professional training or 27 practice under Iowa law or rule; or any student, intern, 28 volunteer, or other person assisting or acting under the 29 direction or guidance of any of these professionals. 30 2. a. A physician shall not perform any treatment or 31 intervention on the sex characteristics of a minor diagnosed 32 with gender dysphoria unless all of the following conditions 33 are met: 34 (1) The physician provides written and oral disclosure 35 -1- LSB 1550YH (3) 89 pf/rh 1/ 4

H.F. 327 to all parents or legal guardians of the minor that informed 1 consent must be obtained from all parents or legal guardians 2 of the minor. 3 (2) The physician provides written and oral disclosure to 4 all parents or legal guardians of the minor in nontechnical 5 terms that include all of the following: 6 (a) A description of the treatment or intervention to be 7 performed, including any necessary health care management or 8 long-term follow-up care to be expected following the treatment 9 or intervention. 10 (b) A description of any attendant discomfort and risks to 11 the minor in the short term and long term, including but not 12 limited to any irreparable or irreversible harm or limitations 13 regarding future fertility or development or construction of 14 female-typical or male-typical characteristics, which may 15 reasonably be expected following the treatment or intervention. 16 (c) An explanation of any benefits that the minor may 17 reasonably expect following the treatment or intervention. 18 (d) An explanation of any appropriate alternative 19 procedures, drugs, or devices, including any delay of the 20 procedure, that might be advantageous to the minor, and the 21 relative risks and benefits of these alternatives. 22 (e) An offer to answer any inquiries concerning the 23 treatment or intervention involved. 24 (3) The physician obtains the written consent of all 25 parents or legal guardians of the minor prior to performing the 26 treatment or intervention. 27 b. The physician shall retain the original written consent 28 in the medical record of the minor and shall provide a copy of 29 the written consent to all parents or legal guardians of the 30 minor. 31 c. A physician who violates this subsection shall be subject 32 to licensee discipline pursuant to section 148.6. 33 3. a. A practitioner who engages in discussions or 34 counseling regarding gender dysphoria treatment or intervention 35 -2- LSB 1550YH (3) 89 pf/rh 2/ 4

H.F. 327 options with a minor shall fully and accurately disclose all 1 known and documented adverse events relating to such treatment 2 options. 3 b. A practitioner who violates this subsection is subject 4 to suspension of the practitioner’s license or other practice 5 authorization for a minimum of three years and a civil penalty 6 of twenty-five thousand dollars. 7 4. The board of medicine and any appropriate licensing 8 entity or disciplinary authority with professional jurisdiction 9 over a practitioner under this section shall adopt rules 10 pursuant to chapter 17A to administer this section. 11 Sec. 2. CODE EDITOR DIRECTIVE. The Code editor shall create 12 a new subchapter in chapter 147, codifying section 147.163, 13 as enacted in this Act, as “Minors —— gender dysphoria —— 14 treatment and intervention”. 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 treatment or intervention involving a 19 minor diagnosed with gender dysphoria. 20 The bill includes definitions used in the bill including 21 “gender dysphoria”, “minor”, “physician”, and “practitioner”. 22 The bill prohibits a physician from performing any treatment 23 or intervention on the sex characteristics of a minor diagnosed 24 with gender dysphoria unless the physician provides written 25 and oral disclosure to all parents or legal guardians of the 26 minor that informed consent must be obtained from all parents 27 or legal guardians of the minor; provides written and oral 28 disclosure to all parents or legal guardians of the minor in 29 nontechnical terms that include a description of the treatment 30 or intervention to be performed, a description of any attendant 31 discomfort and risks to the minor in the short term and 32 long term, an explanation of any benefits that the minor may 33 reasonably expect following the treatment or intervention, an 34 explanation of any appropriate alternative procedures, drugs, 35 -3- LSB 1550YH (3) 89 pf/rh 3/ 4

H.F. 327 or devices, and an offer to answer any inquiries concerning 1 the treatment or intervention involved; and obtains written 2 consent from all parents or legal guardians of the minor. The 3 physician shall retain the original written consent in the 4 medical record of the minor and shall provide a copy of the 5 written consent to all parents or legal guardians of the minor. 6 A physician who violates this provision of the bill is subject 7 to licensee discipline which may include a civil penalty not to 8 exceed $10,000 pursuant to Code section 148.6. 9 The bill also provides that a practitioner who engages in 10 discussions or counseling regarding gender dysphoria treatment 11 or intervention options with a minor shall fully and accurately 12 disclose all known and documented adverse events relating to 13 such treatment or intervention options. A practitioner who 14 violates this provision of the bill is subject to suspension of 15 the practitioner’s license or other practice authorization for 16 a minimum of three years and a civil penalty of $25,000. 17 The board of medicine and any appropriate licensing entity 18 or disciplinary authority with professional jurisdiction over a 19 practitioner under the bill shall adopt administrative rules 20 to administer the bill. 21 -4- LSB 1550YH (3) 89 pf/rh 4/ 4