Senate File 129 - Introduced SENATE FILE 129 BY SALMON A BILL FOR An Act relating to actions relative to treatment or 1 intervention regarding the discordance between a minor’s sex 2 and gender identity, and providing civil penalties. 3 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA: 4 TLSB 1922XS (2) 90 pf/rh
S.F. 129 Section 1. FINDINGS. The general assembly finds all of the 1 following: 2 1. “Sex” is the biological state of being female or male, 3 based on sex organs, chromosomes, and endogenous hormone 4 profiles. An individual’s sex is genetically encoded into 5 an individual at the moment of conception, and it cannot be 6 changed. 7 2. Some individuals, including minors, may experience 8 discordance between their sex and their internal sense 9 of gender identity. Individuals who experience severe 10 psychological distress as a result of this discordance may be 11 diagnosed with gender dysphoria. 12 3. The cause of the individual’s impression of discordance 13 between sex and gender identity is unknown. Diagnosis is based 14 exclusively on the individual’s self-report of feelings and 15 beliefs. 16 4. This internal sense of discordance is not permanent or 17 fixed. To the contrary, numerous studies have shown that a 18 substantial majority of children who experience discordance 19 between their sex and gender identity will outgrow the 20 discordance once they go through puberty and will eventually 21 have a gender identity that aligns with their sex. 22 5. As a result, taking a wait-and-see approach to children 23 who reveal signs of gender nonconformity results in a large 24 majority of such children resolving to a gender identity 25 congruent with their sex by late adolescence. 26 6. Some in the medical community are aggressively pushing 27 for interventions on children that medically alter a child’s 28 hormonal balance and remove healthy external and internal sex 29 organs when the child expresses a desire to appear as a sex 30 different from the child’s own. 31 7. This course of treatment for children commonly begins 32 with encouraging and assisting a child to socially transition 33 to dressing and presenting as the opposite sex. In the case 34 of prepubertal children, as puberty begins, doctors then 35 -1- LSB 1922XS (2) 90 pf/rh 1/ 10
S.F. 129 administer long-acting gonadotropin-releasing hormone (GnRH) 1 agonists or puberty blockers that suppress the pubertal 2 development of the child. This use of puberty blockers for 3 gender nonconforming children is experimental and not approved 4 by the United States food and drug administration. 5 8. After puberty is blocked, the child is administered 6 cross-sex hormonal treatments that induce the development 7 of secondary sex characteristics of the other sex, such as 8 causing the development of breasts and wider hips in male 9 children taking estrogen and greater muscle mass, bone density, 10 body hair, and a deeper voice in female children taking 11 testosterone. Some children are administered these hormones 12 independent of any prior pubertal blockade. 13 9. The final phase of treatment is for the child to undergo 14 cosmetic and other surgical procedures, often to create an 15 appearance similar to that of the opposite sex. These surgical 16 procedures may include a mastectomy to remove a female child’s 17 breasts and bottom surgery that removes a child’s healthy 18 reproductive organs and creates an artificial form aiming to 19 approximate the appearance of the genitals of the opposite sex. 20 10. For children who are placed on puberty blockers that 21 inhibit their bodies from experiencing the natural process of 22 sexual development, the overwhelming majority will continue 23 down a path toward cross-sex hormones and cosmetic surgery. 24 11. This unproven, poorly studied series of interventions 25 results in numerous harmful effects for children, as well as 26 risks of effects simply unknown due to the new and experimental 27 nature of these interventions. 28 12. Among the known harms from puberty blockers are 29 diminished bone density. The full effect of puberty blockers 30 on brain development and cognition are yet unknown, though 31 reason for concern is now present. There is no research on the 32 long-term risks to children of persistent exposure to puberty 33 blockers. With the administration of cross-sex hormones comes 34 increased risks of cardiovascular disease, thromboembolic 35 -2- LSB 1922XS (2) 90 pf/rh 2/ 10
S.F. 129 stroke, asthma, chronic obstructive pulmonary disease, and 1 cancer. 2 13. Puberty blockers prevent gonadal maturation and thus 3 render children taking these drugs infertile. Introducing 4 cross-sex hormones to children with immature gonads as a 5 direct result of pubertal blockade is expected to cause 6 irreversible sterility. Sterilization is also permanent for 7 those who undergo surgery to remove reproductive organs, 8 and such children are likely to suffer through a lifetime 9 of complications from the surgery, infections, and other 10 difficulties requiring yet more medical intervention. 11 14. Several studies demonstrate that hormonal and surgical 12 interventions often do not resolve the underlying psychological 13 issues affecting the individual. For example, individuals 14 who undergo cross-sex cosmetic surgical procedures have been 15 found to suffer from elevated mortality rates from medical 16 and psychological conditions. Their suicide rate is nineteen 17 times higher than the general population. They experience 18 significantly higher rates of substance abuse, depression, and 19 psychiatric hospitalizations. 20 15. Children, and often their parents, are unable to 21 comprehend and fully appreciate the risk and life implications, 22 including permanent sterility, that result from the use of 23 puberty blockers, cross-sex hormones, and surgical procedures. 24 16. For these reasons, the decision to pursue a course of 25 hormonal and surgical interventions to address a discordance 26 between an individual’s sex and sense of gender identity 27 should not be presented to or determined for children who 28 are incapable of comprehending the negative implications and 29 life-course difficulties resulting from these interventions. 30 Sec. 2. NEW SECTION . 147.164 Definitions. 31 As used in this chapter, unless the context otherwise 32 requires: 33 1. “Gender dysphoria” means discomfort or distress over a 34 marked incongruence between an individual’s sex and the gender 35 -3- LSB 1922XS (2) 90 pf/rh 3/ 10
S.F. 129 with which the individual identifies. 1 2. “Gender nonconformity” means behavior or gender 2 expression by an individual that does not match gender norms 3 for the individual’s sex. 4 3. “Government agency” means a state agency or an agent, 5 employee, volunteer, or contractor of a state agency. 6 4. “Medical professional” means a physician or surgeon 7 or osteopathic physician and surgeon licensed pursuant to 8 chapter 148, a physician assistant licensed pursuant to 9 chapter 148C, a nurse or advanced registered nurse practitioner 10 licensed pursuant to chapter 152, a nurse or advanced practice 11 registered nurse licensed pursuant to chapter 152E, or a 12 psychiatrist licensed pursuant to chapter 148. 13 5. “Mental health professional” means the same as defined 14 in section 228.1. 15 6. “Minor” or “minor child” means an unemancipated 16 individual under eighteen years of age. 17 7. “Parent” means a parent, custodian, or guardian as 18 defined in section 232.2. 19 8. “Political subdivision” means a city, county, township, 20 school district, municipal corporation, special purpose 21 district, board, department, commission, or any other division 22 of local government, or an agent, employee, volunteer, or 23 contractor of such entity. 24 9. “Sex” means the biological state of being female or 25 male, based on sex organs, chromosomes, and endogenous hormone 26 profiles. 27 10. “State agency” means the same as defined in section 28 8.11. 29 Sec. 3. NEW SECTION . 147.165 Prohibited practices. 30 1. Notwithstanding any other provision of law to the 31 contrary, it shall be unlawful for a medical professional to 32 engage in any of the following practices upon a minor, or to 33 cause such practice to be performed to facilitate a minor’s 34 desire to present or appear in a manner that is inconsistent 35 -4- LSB 1922XS (2) 90 pf/rh 4/ 10
S.F. 129 with the minor’s sex: 1 a. Performing a surgery that sterilizes, including 2 castration, vasectomy, hysterectomy, oophorectomy, 3 metoidioplasty, orchiectomy, penectomy, phalloplasty, and 4 vaginoplasty. 5 b. Performing a mastectomy. 6 c. Administering or supplying the following medications that 7 induce transient or permanent infertility: 8 (1) Puberty-blocking medication to stop or delay normal 9 puberty. 10 (2) Supraphysiologic doses of testosterone or other 11 androgens to members of the female sex. 12 (3) Supraphysiologic doses of estrogen or synthetic 13 compounds with estrogenic activity to members of the male sex. 14 d. Removing any otherwise healthy or nondiseased body part 15 or tissue. 16 2. A medical professional who engages in any of the 17 practices prohibited under this section or who causes such 18 practices to be performed shall be subject to revocation of 19 licensure and other appropriate discipline by the medical 20 professional’s licensing board. A medical professional who 21 violates this section shall also be subject to a civil penalty 22 of up to one thousand dollars per occurrence of a violation. 23 3. This section shall not apply to the good faith medical 24 decision of a parent of a minor born with a medically 25 verifiable genetic disorder of sexual development, including 26 any of the following: 27 a. A minor with external biological sex characteristics that 28 are irresolvably ambiguous, such as a minor born with forty-six 29 XX chromosomes with virilization, forty-six XY chromosomes with 30 undervirilization, or with both ovarian and testicular tissue. 31 b. When a medical professional has otherwise diagnosed 32 a disorder of sexual development in which the medical 33 professional has determined through genetic testing that the 34 minor does not have the normal sex chromosome structure for a 35 -5- LSB 1922XS (2) 90 pf/rh 5/ 10
S.F. 129 male or female. 1 Sec. 4. NEW SECTION . 147.166 Counseling. 2 A government agency, political subdivision, or any 3 organization with authority to license or discipline the 4 members of a profession shall not prohibit, impose any 5 penalty, or take any adverse action against any member of such 6 profession who gives or receives counsel, advice, guidance, 7 or any other communication however described, and whether or 8 not in exchange for a fee, in accordance with this chapter and 9 consistent with the professional’s conscience or religious 10 belief. 11 Sec. 5. NEW SECTION . 147.167 Protection of parental rights. 12 1. A parent, in exercising the fundamental right to care 13 for the parent’s minor child, may withhold consent for any 14 treatment, activity, or mental health service that is designed 15 and intended to form the minor child’s conception of sex and 16 gender or to treat gender dysphoria or gender nonconformity. A 17 government agency or political subdivision shall not infringe 18 upon or impede the exercise of this right. 19 2. Notwithstanding any provision to the contrary, a 20 government agency or political subdivision shall not encourage 21 or coerce a minor to withhold information from the minor’s 22 parent, and shall not withhold information from a minor’s 23 parent that is relevant to the physical or mental health of 24 the minor exhibiting symptoms of gender dysphoria, gender 25 nonconformity, or otherwise demonstrating a desire to be 26 treated in a manner incongruent with the minor’s sex. 27 3. Notwithstanding any provision to the contrary, if a 28 government agency or political subdivision has knowledge that 29 a minor under the care or supervision of a government agency 30 or political subdivision has exhibited symptoms of gender 31 dysphoria, gender nonconformity, or has otherwise demonstrated 32 a desire to be treated in a manner incongruent with the minor’s 33 sex, the government agency or political subdivision shall 34 immediately notify, in writing, any parent of the minor. The 35 -6- LSB 1922XS (2) 90 pf/rh 6/ 10
S.F. 129 notice shall describe all of the relevant circumstances with 1 reasonable specificity. 2 Sec. 6. NEW SECTION . 147.168 Whistleblower protection. 3 1. An individual shall not be discriminated against in any 4 manner because the individual does any of the following: 5 a. Provides or causes to be provided to the individual’s 6 employer, the office of the attorney general, the civil rights 7 commission, or any applicable federal agency, information 8 relating to any violation of this chapter. 9 b. Testifies in a proceeding concerning a violation of this 10 chapter. 11 c. Assists or participates in a proceeding concerning 12 violation of this chapter. 13 2. Unless the disclosure is otherwise specifically 14 prohibited by law, an individual shall not be discriminated 15 against in any manner because the individual disclosed 16 information under this chapter that the individual believes 17 evinces any of the following: 18 a. A violation of any law, rule, or regulation. 19 b. A violation of any standard of care or other ethical 20 guidelines for the provision of any health care service. 21 c. Gross mismanagement, a gross waste of funds, an abuse 22 of authority, or a substantial and specific danger to public 23 health or safety. 24 Sec. 7. NEW SECTION . 147.169 Judicial relief. 25 1. A person harmed by a violation of section 147.165 may 26 bring an action for injunctive relief, compensatory and special 27 damages, and any other relief available under law against any 28 person responsible for the violation. 29 2. A person harmed by a violation of section 147.166, 30 147.167, or 147.168 may bring an action for injunctive relief, 31 compensatory and special damages, and any other relief 32 available under law against a government agency, political 33 subdivision, or any other person who is responsible for the 34 violation. 35 -7- LSB 1922XS (2) 90 pf/rh 7/ 10
S.F. 129 3. a. Unless paragraph “b” applies, an action under this 1 chapter is barred unless the action is commenced within two 2 years after the cause of action accrues. 3 b. Notwithstanding any provision to the contrary, including 4 sections 614.8 and 614.8A, a minor injured by practices 5 prohibited under section 147.165 may bring an action during the 6 minor’s minority through a parent or guardian, and may bring an 7 action in the minor’s own name upon reaching majority and for 8 twenty years after reaching majority. 9 4. A person shall have standing to assert a claim or defense 10 under this section if the person is adversely affected by an 11 alleged violation or the alleged failure to perform a duty or 12 act under this chapter. 13 5. A person who prevails on a claim brought pursuant to 14 this section shall be entitled to monetary damages, including 15 for all psychological, emotional, and physical harm suffered, 16 reasonable attorney fees and costs, and any other appropriate 17 relief. 18 Sec. 8. NEW SECTION . 147.170 Preemption —— immunity. 19 1. A political subdivision is preempted from enacting, 20 adopting, maintaining, or enforcing any order, ordinance, rule, 21 regulation, policy, or other similar measure that prohibits, 22 restricts, limits, controls, directs, or otherwise interferes 23 with the professional conduct and judgment of a mental health 24 professional, including speech, undertaken under this chapter 25 within the course of treatment and communication with clients, 26 patients, other persons, or the public, including but not 27 limited to therapies, counseling, referrals, and education. 28 2. The attorney general or a mental health professional 29 adversely affected may bring an action for injunctive relief 30 to prevent or restrain a violation of this section. A mental 31 health professional may recover reasonable costs and attorney’s 32 fees incurred in obtaining injunctive relief under this 33 section. 34 3. Sovereign and governmental immunity from a civil action 35 -8- LSB 1922XS (2) 90 pf/rh 8/ 10
S.F. 129 or from liability do not apply to violations of this chapter. 1 Sec. 9. CODE EDITOR DIRECTIVE. The Code editor may create 2 a new subchapter in chapter 147, codifying sections 147.164 3 through 147.170, as enacted in this Act, entitled “Gender and 4 Sexual Discordance —— Minors”. 5 EXPLANATION 6 The inclusion of this explanation does not constitute agreement with 7 the explanation’s substance by the members of the general assembly. 8 This bill includes provisions relating to practices 9 undertaken to cause a minor to physically appear more like 10 a person of the opposite sex and less like the minor’s own 11 sex, or to conform to a gender identity incongruent with the 12 minor’s sex. The bill contains findings regarding the harms 13 and ineffectiveness of such practices and contains definitions 14 used in the bill. 15 The bill makes it unlawful for a medical professional to 16 perform interventions or surgical procedures specified in 17 the bill on a minor, and subjects a medical professional to 18 disciplinary action and civil penalties for providing the 19 prohibited treatments to or performing surgical procedures on 20 a minor, unless the treatment occurs based on the good faith 21 medical decision of a parent of a minor born with a medically 22 verifiable genetic disorder of sexual development. 23 The bill protects the freedom of members of a profession to 24 provide counseling, in accordance with the bill and consistent 25 with the individual’s conscience or religious belief. 26 The bill includes protections for parents to decline 27 treatment, activity, or mental health care services intended 28 to form their minor child’s conception of sex and gender or 29 to treat gender dysphoria or gender nonconformity. The bill 30 also requires government agencies and political subdivisions 31 to inform parents of any information relevant to the physical 32 or mental health of a minor exhibiting symptoms of gender 33 dysphoria, gender nonconformity, or otherwise demonstrating a 34 desire to be treated in a manner incongruent with the minor’s 35 -9- LSB 1922XS (2) 90 pf/rh 9/ 10
S.F. 129 sex. 1 The bill includes protections for individuals who provide 2 information relating to violations of the bill. 3 The bill provides a private right of action against any 4 person who violates the bill, and creates a statute of 5 limitations for minors to bring certain claims within 20 years 6 of reaching majority. 7 The bill preempts political subdivisions from having 8 measures in place that interfere with the professional conduct 9 and judgment of a mental health professional undertaken 10 under the bill within a course of treatment or communication; 11 provides for injunctive relief for a violation of this 12 provision; and provides that sovereign and governmental 13 immunity from a civil action or from liability do not apply to 14 violations of the bill. 15 -10- LSB 1922XS (2) 90 pf/rh 10/ 10