H.F. 2563 DIVISION I 1 ABORTION —— DEFINED 2 Section 1. Section 146B.1, subsection 1, Code 2026, is 3 amended to read as follows: 4 1. “Abortion” means the termination of a human pregnancy 5 with the intent other than to produce a live birth or to 6 remove a dead fetus. “Abortion” does not include a spontaneous 7 termination of pregnancy, commonly known as a miscarriage, if 8 not all the products of conception are expelled. 9 DIVISION II 10 INFORMED CONSENT 11 Sec. 2. Section 146A.1, Code 2026, is amended by adding the 12 following new subsection: 13 NEW SUBSECTION . 1A. Prior to performing an abortion, 14 a physician shall perform an in-person examination of the 15 pregnant woman including screening for indicia of coercion or 16 abuse. A physician shall, if necessary, refer the woman to an 17 appropriate health care provider for treatment consistent with 18 the examination results. 19 Sec. 3. Section 146A.1, subsection 6, Code 2026, is amended 20 by adding the following new paragraphs: 21 NEW PARAGRAPH . 0a. “Abortion” means the same as defined in 22 section 146B.1. 23 NEW PARAGRAPH . 00a. “Health care provider” means a 24 person who is licensed, certified, or otherwise authorized or 25 permitted by the laws of this state to administer health care 26 in the ordinary course of business or in the practice of a 27 profession. 28 NEW PARAGRAPH . 0b. “Physician” means the same as defined 29 in section 146B.1. 30 Sec. 4. NEW SECTION . 146A.2 Dispensing abortion-inducing 31 drugs —— licensee discipline. 32 1. As used in this section, unless the context otherwise 33 requires: 34 a. “Abortion-inducing drug” means the same as defined in 35 -1- LSB 5778HV (2) 91 ak/ko 1/ 11

H.F. 2563 section 146F.1. 1 b. “Chemical abortion” means the same as defined in section 2 146F.1. 3 c. “Dispense” means the same as defined in section 146F.1. 4 d. “Medical emergency” means the same as defined in section 5 146A.1. 6 e. “Pregnant” or “pregnancy” means the human female 7 reproductive condition of having a living unborn child within 8 the pregnant woman’s body throughout every stage of the unborn 9 child’s life and development, from fertilization to full 10 gestation and childbirth. 11 2. A physician who is performing or attempting to perform 12 a chemical abortion shall do all of the following prior to 13 prescribing or dispensing an abortion-inducing drug to a 14 pregnant woman: 15 a. Obtain the signature of the woman on the United States 16 food and drug administration patient agreement form required 17 for each abortion-inducing drug authorized to be manufactured 18 or sold in the United States. 19 b. Obtain written confirmation from the woman that the woman 20 has been informed of all of the following information: 21 (1) The gestational age-specific risks of abortion-inducing 22 drugs. 23 (2) The risks related to the specific abortion-inducing 24 drug or drugs to be used, including hemorrhage, failure to 25 remove all tissue of the unborn child, sepsis, sterility, and 26 possible continuation of the pregnancy. 27 (3) That the United States federal food and drug 28 administration recommends that the pregnant woman follow up 29 with the woman’s health care provider approximately seven 30 to fourteen calendar days after the administration of an 31 abortion-inducing drug to confirm complete termination of 32 pregnancy has occurred and to evaluate the degree of bleeding. 33 (4) That women using abortion-inducing drugs have suffered 34 trauma from seeing the remains of the unborn child in the 35 -2- LSB 5778HV (2) 91 ak/ko 2/ 11

H.F. 2563 process of a chemical abortion. 1 (5) That it may be possible to reverse the intended effects 2 of a chemical abortion, but time is of the essence. 3 (6) That information on reversing the effects of a chemical 4 abortion is available on the department’s internet site. 5 c. Advise the pregnant woman how to access emergency 6 surgical intervention in case of an incomplete abortion, severe 7 bleeding, or other medical complications. 8 3. Subsection 2 shall not apply to a chemical abortion 9 performed in a medical emergency. 10 4. This section shall not be construed to impose civil or 11 criminal liability on a woman upon whom a chemical abortion has 12 been performed. 13 5. A physician who fails to comply with this section is 14 subject to licensee discipline under chapter 148. 15 6. The board of medicine shall adopt rules pursuant to 16 chapter 17A to administer this section. 17 Sec. 5. NEW SECTION . 146A.3 Informational materials. 18 1. As used in this section, “chemical abortion” means the 19 same as defined in section 146F.1. 20 2. The department shall publish on the department’s 21 internet site, in an easily accessible location and format, all 22 of the following: 23 a. Notice that it may be possible to reverse the effects of 24 a chemical abortion. 25 b. Information and resources on reversing the effects of a 26 chemical abortion. 27 DIVISION III 28 DISPENSING AND REPORTING —— ABORTION-INDUCING DRUGS 29 Sec. 6. NEW SECTION . 146F.1 Definitions. 30 As used in this chapter, unless the context otherwise 31 requires: 32 1. “Abortion-inducing drug” means any of the following: 33 a. Mifepristone. 34 b. Misoprostol. 35 -3- LSB 5778HV (2) 91 ak/ko 3/ 11

H.F. 2563 c. Any other drug, measure, or chemical approved by the 1 United States food and drug administration when prescribed or 2 administered with the intent to terminate the pregnancy of a 3 woman known to be pregnant. “Abortion-inducing drug” includes 4 off-label use of a drug known to have abortion-inducing 5 properties, which is prescribed with the intent of causing an 6 abortion. “Abortion-inducing drug” does not include drugs that 7 may be known to cause an abortion but that are prescribed for 8 other medical conditions. 9 2. “Abortion-inducing drug complication” means any physical 10 or psychological condition which, in the reasonable medical 11 judgment of a health care provider, may occur as a primary or 12 secondary result of the patient’s use of abortion-inducing 13 drugs including but not limited to: 14 a. Uterine rupture, bleeding, or hemorrhage. 15 b. Failure to actually terminate the pregnancy. 16 c. Incomplete abortion or retained tissue. 17 d. Missed ectopic pregnancy. 18 e. Infection. 19 f. Sepsis. 20 3. “Chemical abortion” means an abortion performed by the 21 administration or use of an abortion-inducing drug. 22 4. “Department” means the department of health and human 23 services. 24 5. “Dispense” means to distribute, administer, or send an 25 abortion-inducing drug to the ultimate user. 26 6. “Health care provider” means the same as defined in 27 section 146A.1. 28 7. “Health care setting” means a pharmacy, clinic, medical 29 office, or hospital. 30 8. “Hospital” means the same as defined in section 135B.1. 31 9. “Interested party” means any of the following persons: 32 a. A woman upon whom a chemical abortion was performed or 33 attempted. 34 b. The personal representative of a woman upon whom a 35 -4- LSB 5778HV (2) 91 ak/ko 4/ 11

H.F. 2563 chemical abortion was performed or attempted. 1 10. “Medical emergency” means the same as defined in section 2 146A.1. 3 11. “Personal representative” means an administrator or 4 an executor, or if there is no such personal representative 5 appointed, then a person legally authorized to perform 6 substantially the same functions. 7 12. “Physician” means the same as defined in section 146B.1. 8 13. “Postfertilization age” means the same as defined in 9 section 146B.1. 10 14. “Pregnancy” or “pregnant” means the same as defined in 11 section 146A.2. 12 15. “Rural emergency hospital” means the same as defined in 13 section 135B.1. 14 Sec. 7. NEW SECTION . 146F.2 Dispensing of abortion-inducing 15 drugs —— restrictions. 16 1. A person shall not dispense an abortion-inducing drug in 17 this state unless all of the following criteria are met: 18 a. The drug is dispensed in a health care setting directly 19 to the woman prescribed the drug. 20 b. The person dispensing the drug is authorized to do so 21 pursuant to section 147.107. 22 2. Subsection 1 does not apply to the dispensing of an 23 abortion-inducing drug in response to a medical emergency. 24 Sec. 8. NEW SECTION . 146F.3 Abortion-inducing drug 25 complication —— reporting. 26 1. a. Within thirty calendar days of the date of discharge 27 or death of a woman who presented with or was treated for 28 an abortion-inducing drug complication, a hospital, rural 29 emergency hospital, or an attending physician shall file a 30 report with the department. The report shall be in a form 31 prescribed by the department and include a list of the most 32 common abortion complications and the most recent international 33 classification of diseases code as maintained by the world 34 health organization for each. The report must be completed and 35 -5- LSB 5778HV (2) 91 ak/ko 5/ 11

H.F. 2563 signed by the woman’s attending physician and contain all of 1 the following information: 2 (1) The age of the woman who presented with or was treated 3 for an abortion-inducing drug complication. 4 (2) The state and county of residence of the woman who 5 presented with or was treated for an abortion-inducing drug 6 complication. 7 (3) The date the abortion-inducing drug was used by the 8 woman. 9 (4) The probable postfertilization age of the unborn child 10 on the date of the abortion-inducing drug complication. 11 (5) The identity of the physician who performed the 12 chemical abortion, the facility where the chemical abortion was 13 performed, and the referring physician, agency, or service, if 14 any. 15 (6) The specific complication or complications that led to 16 the treatment and the most recent international classification 17 of diseases code for each complication as maintained by the 18 world health organization, if applicable. 19 b. A report shall not contain the name of the woman or 20 other information or identifiers that would make it possible to 21 identify the woman who suffered the reported abortion-inducing 22 drug complication. 23 2. A report filed pursuant to subsection 1 shall be 24 confidential and not subject to disclosure under chapter 22. 25 3. a. On or before December 31, 2026, and every calendar 26 year thereafter, the department shall prepare a comprehensive 27 statistical report based upon the aggregated data gathered from 28 reports filed pursuant to subsection 1 for the immediately 29 preceding calendar year. The aggregated data shall be 30 anonymized to prevent public disclosure of either of the 31 following: 32 (1) The hospital, rural emergency hospital, or attending 33 physician that filed a report. 34 (2) The woman about whom a report was filed. 35 -6- LSB 5778HV (2) 91 ak/ko 6/ 11

H.F. 2563 b. The anonymized aggregated data shall be made available to 1 the public by the department in a downloadable format on the 2 department’s internet site. 3 Sec. 9. NEW SECTION . 146F.4 Private cause of action —— 4 civil liability. 5 1. A person who dispenses an abortion-inducing drug 6 in violation of section 146F.2 shall be civilly liable 7 to any interested party for all damages caused by the 8 abortion-inducing drug. A person who is subject to licensee 9 discipline under chapter 148 or 155A shall be immune from civil 10 liability under this section. 11 2. In addition to compensatory or punitive damages, a 12 prevailing plaintiff who brings an action under this section is 13 entitled to court costs and reasonable attorney fees. 14 3. In an action brought under this section, the name and 15 other identifying characteristics of a woman who sought or 16 obtained an abortion-inducing drug shall be redacted without 17 a court order from all pleadings and documents filed in the 18 action. The court may make further orders as necessary to 19 protect the identity and privacy of the woman who sought or 20 obtained an abortion-inducing drug. 21 4. This section shall not be construed to impose civil or 22 criminal liability on a woman upon whom a chemical abortion is 23 performed. 24 Sec. 10. NEW SECTION . 146F.5 Licensee discipline. 25 A licensee who fails to comply with this chapter is subject 26 to licensee discipline under chapter 148 or 155A. 27 DIVISION IV 28 ABORTION-RELATED PROVISIONS 29 Sec. 11. Section 144.29A, subsection 1, paragraph k, Code 30 2026, is amended to read as follows: 31 k. The method used for an induced termination, including 32 whether mifepristone or misoprostol was used. 33 Sec. 12. Section 144.29A, subsection 1, Code 2026, is 34 amended by adding the following new paragraph: 35 -7- LSB 5778HV (2) 91 ak/ko 7/ 11

H.F. 2563 NEW PARAGRAPH . l. If a spontaneous termination of 1 pregnancy, whether the patient ingested mifepristone or 2 misoprostol within fourteen calendar days prior to the date of 3 the spontaneous termination of pregnancy. 4 Sec. 13. Section 144.29A, subsection 7, paragraph c, Code 5 2026, is amended to read as follows: 6 c. “Spontaneous termination of pregnancy” , commonly known 7 as a miscarriage, means the occurrence of an unintended 8 termination of pregnancy at any time during the period from 9 conception to twenty weeks gestation and which is not a 10 spontaneous termination of pregnancy at any time during the 11 period from twenty weeks or greater which is reported to the 12 department as a fetal death under this chapter . 13 EXPLANATION 14 The inclusion of this explanation does not constitute agreement with 15 the explanation’s substance by the members of the general assembly. 16 This bill relates to abortions, including informed 17 consent, dispensing of abortion-inducing drugs, and reporting 18 abortion-inducing drug complications. 19 DIVISION I —— ABORTION DEFINED. The bill excludes 20 a spontaneous termination of pregnancy, if not all the 21 products of conception are expelled, from the definition of 22 abortion for the purpose of the reporting requirements and 23 penalties on abortions under Code chapter 146B (abortion —— 24 postfertilization age). 25 DIVISION II —— INFORMED CONSENT. Under the bill, a 26 physician, prior to performing or attempting to perform an 27 abortion, is required to perform an in-person examination of 28 the woman seeking an abortion, including screening for indicia 29 of coercion or abuse; if necessary, the physician shall make a 30 referral to an appropriate health care provider consistent with 31 the examination results. 32 The bill requires a physician who is performing or 33 attempting to perform a chemical abortion, prior to prescribing 34 or dispensing an abortion-inducing drug, to do all of the 35 -8- LSB 5778HV (2) 91 ak/ko 8/ 11

H.F. 2563 following: have the woman being prescribed or dispensed the 1 drug sign a patient agreement form, obtain written confirmation 2 that the physician has informed the woman of specific health 3 and safety information related to abortion-inducing drugs 4 as detailed in the bill, and advise the pregnant woman how 5 to access emergency surgical intervention in cases of an 6 incomplete abortion, severe bleeding, or other medical 7 complications. The bill specifies that these requirements 8 shall not apply to a chemical abortion performed in response to 9 a medical emergency. The bill provides that the prohibition on 10 dispensing of abortion-inducing drugs shall not be construed 11 to impose civil or criminal liability on a woman upon whom 12 a chemical abortion has been performed. Under the bill, 13 a physician who fails to comply with the informed consent 14 requirements is subject to licensee discipline. The bill 15 requires the board of medicine to adopt rules to administer 16 this division of the bill. The bill defines “abortion-inducing 17 drug”, “chemical abortion”, “dispense”, “medical emergency”, 18 and “pregnant” or “pregnancy”. 19 The bill requires the department of health and human 20 services (HHS) to publish on HHS’s internet site notice that it 21 may be possible to reverse the effects of a chemical abortion, 22 and information and resources on reversing the effects of a 23 chemical abortion. 24 DIVISION III —— DISPENSING AND REPORTING —— 25 ABORTION-INDUCING DRUGS. The bill defines “abortion-inducing 26 drug”, “abortion-inducing drug complication”, “chemical 27 abortion”, “dispense”, “health care setting”, “interested 28 party”, “medical emergency”, “physician”, “postfertilization 29 age”, and “rural emergency hospital”. 30 The bill prohibits a person from dispensing an 31 abortion-inducing drug in this state unless the drug is 32 dispensed in a health care setting directly to the woman 33 prescribed the drug, and the person dispensing the drug is 34 authorized to do so pursuant to Code section 147.107 (drug 35 -9- LSB 5778HV (2) 91 ak/ko 9/ 11

H.F. 2563 dispensing, supplying, and prescribing —— limitations). These 1 requirements do not apply to a medical emergency. 2 The bill requires a hospital, rural emergency hospital, 3 or the attending physician to file a report with HHS using a 4 prescribed form within 30 days of discharge or death of a woman 5 who presented with or was treated for an abortion-inducing 6 drug complication. The form must be signed and completed 7 by the attending physician and contain the age of the woman 8 experiencing the abortion-inducing drug complication, 9 the woman’s state and county of residence, the date the 10 abortion-inducing drug was used by the woman, and the probable 11 postfertilization age of the unborn child at the time of 12 the abortion-inducing drug complication. The report must 13 identify the physician who performed the chemical abortion, 14 the facility where the chemical abortion was performed, 15 the referring physician, agency, or service, if any, and 16 the specific complication or complications that led to the 17 treatment performed along with the most recent international 18 classification of diseases code for each, if applicable. The 19 report shall be confidential and not subject to disclosure 20 under Code chapter 22 (open records). 21 The bill also requires HHS to prepare annually on or 22 before December 31 a comprehensive statistical report based 23 upon the aggregated data gathered from the reports filed on 24 abortion-inducing drug complications. Under the bill, the data 25 gathered by HHS must be anonymized to prevent public disclosure 26 of either the physician or hospital that filed a report, or the 27 woman about whom a report is filed. HHS is required to make the 28 anonymized data publicly available in a downloadable format on 29 its internet site. 30 This division of the bill imposes civil liabilities on any 31 person who dispenses an abortion-inducing drug in violation 32 of this division of the bill for all damages caused by the 33 abortion-inducing drug suffered by a woman upon whom a chemical 34 abortion was performed or was attempted or the personal 35 -10- LSB 5778HV (2) 91 ak/ko 10/ 11

H.F. 2563 representative of the woman upon whom a chemical abortion was 1 performed or was attempted. A licensed pharmacist or physician 2 is immune from civil liability. The bill defines “personal 3 representative” as an administrator or an executor, or if there 4 is no such personal representative appointed, then a person 5 legally authorized to perform substantially the same functions. 6 A prevailing plaintiff in an action brought under this division 7 of the bill, in addition to compensatory and punitive damages, 8 is entitled to court costs and reasonable attorney fees. In 9 an action brought under this division of the bill, the name 10 and other identifying characteristics of a woman who sought or 11 obtained an abortion-inducing drug shall be redacted from all 12 pleadings and documents filed in the action without a court 13 order, and the court may make further orders as necessary to 14 protect the identity and privacy of the woman who sought or 15 obtained an abortion-inducing drug. This division of the bill 16 is not to be construed to impose civil or criminal liability 17 upon a woman upon whom a chemical abortion is performed. 18 Under the bill, a licensed pharmacist or physician that 19 fails to comply with this division of the bill is subject to 20 licensee discipline. 21 DIVISION IV —— ABORTION-RELATED PROVISIONS. The bill amends 22 Code section 144.29A (termination of pregnancy reporting —— 23 legislative intent) to require a health care provider that 24 diagnoses or induces a spontaneous termination of pregnancy 25 to include in the required report to HHS if mifepristone or 26 misoprostol was used to induce a spontaneous termination of 27 pregnancy. Current law requires the health care provider to 28 only disclose if mifepristone was used to induce a spontaneous 29 termination of pregnancy. The bill also requires the health 30 care provider to disclose whether mifepristone or misoprostol 31 were ingested by the patient within 14 days prior to the 32 spontaneous termination of pregnancy. 33 -11- LSB 5778HV (2) 91 ak/ko 11/ 11