H.F. 2788 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 5778HZ (2) 91 ak/ko 1/ 11

H.F. 2788 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 5778HZ (2) 91 ak/ko 2/ 11

H.F. 2788 process of a chemical abortion. 1 c. Advise the pregnant woman how to access emergency 2 surgical intervention in case of an incomplete abortion, severe 3 bleeding, or other medical complications. 4 3. Subsection 2 shall not apply to a chemical abortion 5 performed in a medical emergency. 6 4. This section shall not be construed to impose civil or 7 criminal liability on a woman upon whom a chemical abortion has 8 been performed. 9 5. A physician who fails to comply with this section is 10 subject to licensee discipline under chapter 148. 11 6. The board of medicine shall adopt rules pursuant to 12 chapter 17A to administer this section. 13 DIVISION III 14 DISPENSING AND REPORTING —— ABORTION-INDUCING DRUGS 15 Sec. 5. NEW SECTION . 146F.1 Definitions. 16 As used in this chapter, unless the context otherwise 17 requires: 18 1. “Abortion-inducing drug” means any of the following: 19 a. Mifepristone. 20 b. Misoprostol. 21 c. Any other drug, measure, or chemical approved by the 22 United States food and drug administration when prescribed or 23 administered with the intent to terminate the pregnancy of a 24 woman known to be pregnant. “Abortion-inducing drug” includes 25 off-label use of a drug known to have abortion-inducing 26 properties, which is prescribed with the intent of causing an 27 abortion. “Abortion-inducing drug” does not include drugs that 28 may be known to cause an abortion but that are prescribed for 29 other medical conditions. 30 2. “Abortion-inducing drug complication” means any physical 31 or psychological condition which, in the reasonable medical 32 judgment of a health care provider, may occur as a primary or 33 secondary result of the patient’s use of abortion-inducing 34 drugs including but not limited to: 35 -3- LSB 5778HZ (2) 91 ak/ko 3/ 11

H.F. 2788 a. Uterine rupture, bleeding, or hemorrhage. 1 b. Failure to actually terminate the pregnancy. 2 c. Incomplete abortion or retained tissue. 3 d. Missed ectopic pregnancy. 4 e. Infection. 5 f. Sepsis. 6 3. “Chemical abortion” means an abortion performed by the 7 administration or use of an abortion-inducing drug. 8 4. “Department” means the department of health and human 9 services. 10 5. “Dispense” means to distribute, administer, or send an 11 abortion-inducing drug to the ultimate user. 12 6. “Health care provider” means the same as defined in 13 section 146A.1. 14 7. “Health care setting” means a pharmacy, clinic, medical 15 office, or hospital. 16 8. “Hospital” means the same as defined in section 135B.1. 17 9. “Interested party” means any of the following persons: 18 a. A woman upon whom a chemical abortion was performed or 19 attempted. 20 b. The personal representative of a woman upon whom a 21 chemical abortion was performed or attempted. 22 10. “Medical emergency” means the same as defined in section 23 146A.1. 24 11. “Personal representative” means an administrator or 25 an executor, or if there is no such personal representative 26 appointed, then a person legally authorized to perform 27 substantially the same functions. 28 12. “Physician” means the same as defined in section 146B.1. 29 13. “Postfertilization age” means the same as defined in 30 section 146B.1. 31 14. “Pregnancy” or “pregnant” means the same as defined in 32 section 146A.2. 33 15. “Rural emergency hospital” means the same as defined in 34 section 135B.1. 35 -4- LSB 5778HZ (2) 91 ak/ko 4/ 11

H.F. 2788 Sec. 6. NEW SECTION . 146F.2 Dispensing of abortion-inducing 1 drugs —— restrictions. 2 1. A person shall not dispense an abortion-inducing drug in 3 this state unless all of the following criteria are met: 4 a. The drug is dispensed in a health care setting directly 5 to the woman prescribed the drug. 6 b. The person dispensing the drug is authorized to do so 7 pursuant to section 147.107. 8 2. Subsection 1 does not apply to the dispensing of an 9 abortion-inducing drug in response to a medical emergency. 10 Sec. 7. NEW SECTION . 146F.3 Abortion-inducing drug 11 complication —— reporting. 12 1. a. Within thirty calendar days of the date of discharge 13 or death of a woman who presented with or was treated for 14 an abortion-inducing drug complication, a hospital, rural 15 emergency hospital, or an attending physician shall file a 16 report with the department. The report shall be in a form 17 prescribed by the department and include a list of the most 18 common abortion complications and the most recent international 19 classification of diseases code as maintained by the world 20 health organization for each. The report must be completed and 21 signed by the woman’s attending physician and contain all of 22 the following information: 23 (1) The age of the woman who presented with or was treated 24 for an abortion-inducing drug complication. 25 (2) The state and county of residence of the woman who 26 presented with or was treated for an abortion-inducing drug 27 complication. 28 (3) The date the abortion-inducing drug was used by the 29 woman. 30 (4) The probable postfertilization age of the unborn child 31 on the date of the abortion-inducing drug complication. 32 (5) The identity of the physician who performed the 33 chemical abortion, the facility where the chemical abortion was 34 performed, and the referring physician, agency, or service, if 35 -5- LSB 5778HZ (2) 91 ak/ko 5/ 11

H.F. 2788 any. 1 (6) The specific complication or complications that led to 2 the treatment and the most recent international classification 3 of diseases code for each complication as maintained by the 4 world health organization, if applicable. 5 b. A report shall not contain the name of the woman or 6 other information or identifiers that would make it possible to 7 identify the woman who suffered the reported abortion-inducing 8 drug complication. 9 2. A report filed pursuant to subsection 1 shall be 10 confidential and not subject to disclosure under chapter 22. 11 3. a. On or before December 31, 2026, and every calendar 12 year thereafter, the department shall prepare a comprehensive 13 statistical report based upon the aggregated data gathered from 14 reports filed pursuant to subsection 1 for the immediately 15 preceding calendar year. The aggregated data shall be 16 anonymized to prevent public disclosure of either of the 17 following: 18 (1) The hospital, rural emergency hospital, or attending 19 physician that filed a report. 20 (2) The woman about whom a report was filed. 21 b. The anonymized aggregated data shall be made available to 22 the public by the department in a downloadable format on the 23 department’s internet site. 24 Sec. 8. NEW SECTION . 146F.4 Private cause of action —— 25 civil liability. 26 1. A person who dispenses an abortion-inducing drug 27 in violation of section 146F.2 shall be civilly liable 28 to any interested party for all damages caused by the 29 abortion-inducing drug. A person who is subject to licensee 30 discipline under chapter 148 or 155A shall be immune from civil 31 liability under this section. 32 2. In addition to compensatory or punitive damages, a 33 prevailing plaintiff who brings an action under this section is 34 entitled to court costs and reasonable attorney fees. 35 -6- LSB 5778HZ (2) 91 ak/ko 6/ 11

H.F. 2788 3. In an action brought under this section, the name and 1 other identifying characteristics of a woman who sought or 2 obtained an abortion-inducing drug shall be redacted without 3 a court order from all pleadings and documents filed in the 4 action. The court may make further orders as necessary to 5 protect the identity and privacy of the woman who sought or 6 obtained an abortion-inducing drug. 7 4. This section shall not be construed to impose civil or 8 criminal liability on a woman upon whom a chemical abortion is 9 performed. 10 Sec. 9. NEW SECTION . 146F.5 Licensee discipline. 11 A licensee who fails to comply with this chapter is subject 12 to licensee discipline under chapter 148 or 155A. 13 DIVISION IV 14 ABORTION-RELATED PROVISIONS 15 Sec. 10. Section 144.29A, subsection 1, paragraph k, Code 16 2026, is amended to read as follows: 17 k. The method used for an induced termination, including 18 whether mifepristone or misoprostol was used. 19 Sec. 11. Section 144.29A, subsection 1, Code 2026, is 20 amended by adding the following new paragraph: 21 NEW PARAGRAPH . l. If a spontaneous termination of 22 pregnancy, whether the patient ingested mifepristone or 23 misoprostol within fourteen calendar days prior to the date of 24 the spontaneous termination of pregnancy. 25 Sec. 12. Section 144.29A, subsection 7, paragraph c, Code 26 2026, is amended to read as follows: 27 c. “Spontaneous termination of pregnancy” , commonly known 28 as a miscarriage, means the occurrence of an unintended 29 termination of pregnancy at any time during the period from 30 conception to twenty weeks gestation and which is not a 31 spontaneous termination of pregnancy at any time during the 32 period from twenty weeks or greater which is reported to the 33 department as a fetal death under this chapter . 34 EXPLANATION 35 -7- LSB 5778HZ (2) 91 ak/ko 7/ 11

H.F. 2788 The inclusion of this explanation does not constitute agreement with 1 the explanation’s substance by the members of the general assembly. 2 This bill relates to abortions, including informed 3 consent, dispensing of abortion-inducing drugs, and reporting 4 abortion-inducing drug complications. 5 DIVISION I —— ABORTION DEFINED. The bill excludes 6 a spontaneous termination of pregnancy, if not all the 7 products of conception are expelled, from the definition of 8 abortion for the purpose of the reporting requirements and 9 penalties on abortions under Code chapter 146B (abortion —— 10 postfertilization age). 11 DIVISION II —— INFORMED CONSENT. Under the bill, a 12 physician, prior to performing or attempting to perform an 13 abortion, is required to perform an in-person examination of 14 the woman seeking an abortion, including screening for indicia 15 of coercion or abuse; if necessary, the physician shall make a 16 referral to an appropriate health care provider consistent with 17 the examination results. 18 The bill requires a physician who is performing or 19 attempting to perform a chemical abortion, prior to prescribing 20 or dispensing an abortion-inducing drug, to do all of the 21 following: have the woman being prescribed or dispensed the 22 drug sign a patient agreement form, obtain written confirmation 23 that the physician has informed the woman of specific health 24 and safety information related to abortion-inducing drugs 25 as detailed in the bill, and advise the pregnant woman how 26 to access emergency surgical intervention in cases of an 27 incomplete abortion, severe bleeding, or other medical 28 complications. The bill specifies that these requirements 29 shall not apply to a chemical abortion performed in response to 30 a medical emergency. The bill provides that the prohibition on 31 dispensing of abortion-inducing drugs shall not be construed 32 to impose civil or criminal liability on a woman upon whom 33 a chemical abortion has been performed. Under the bill, 34 a physician who fails to comply with the informed consent 35 -8- LSB 5778HZ (2) 91 ak/ko 8/ 11

H.F. 2788 requirements is subject to licensee discipline. The bill 1 requires the board of medicine to adopt rules to administer 2 this division of the bill. The bill defines “abortion-inducing 3 drug”, “chemical abortion”, “dispense”, “medical emergency”, 4 and “pregnant” or “pregnancy”. 5 DIVISION III —— DISPENSING AND REPORTING —— 6 ABORTION-INDUCING DRUGS. The bill defines “abortion-inducing 7 drug”, “abortion-inducing drug complication”, “chemical 8 abortion”, “dispense”, “health care setting”, “interested 9 party”, “medical emergency”, “physician”, “postfertilization 10 age”, and “rural emergency hospital”. 11 The bill prohibits a person from dispensing an 12 abortion-inducing drug in this state unless the drug is 13 dispensed in a health care setting directly to the woman 14 prescribed the drug, and the person dispensing the drug is 15 authorized to do so pursuant to Code section 147.107 (drug 16 dispensing, supplying, and prescribing —— limitations). These 17 requirements do not apply to a medical emergency. 18 The bill requires a hospital, rural emergency hospital, or 19 the attending physician to file a report with the department 20 of health and human services (HHS) using a prescribed form 21 within 30 days of discharge or death of a woman who presented 22 with or was treated for an abortion-inducing drug complication. 23 The form must be signed and completed by the attending 24 physician and contain the age of the woman experiencing the 25 abortion-inducing drug complication, the woman’s state and 26 county of residence, the date the abortion-inducing drug was 27 used by the woman, and the probable postfertilization age 28 of the unborn child at the time of the abortion-inducing 29 drug complication. The report must identify the physician 30 who performed the chemical abortion, the facility where the 31 chemical abortion was performed, the referring physician, 32 agency, or service, if any, and the specific complication or 33 complications that led to the treatment performed along with 34 the most recent international classification of diseases code 35 -9- LSB 5778HZ (2) 91 ak/ko 9/ 11

H.F. 2788 for each, if applicable. The report shall be confidential and 1 not subject to disclosure under Code chapter 22 (open records). 2 The bill also requires HHS to prepare annually on or 3 before December 31 a comprehensive statistical report based 4 upon the aggregated data gathered from the reports filed on 5 abortion-inducing drug complications. Under the bill, the data 6 gathered by HHS must be anonymized to prevent public disclosure 7 of either the physician or hospital that filed a report, or the 8 woman about whom a report is filed. HHS is required to make the 9 anonymized data publicly available in a downloadable format on 10 its internet site. 11 This division of the bill imposes civil liabilities on any 12 person who dispenses an abortion-inducing drug in violation 13 of this division of the bill for all damages caused by the 14 abortion-inducing drug suffered by a woman upon whom a chemical 15 abortion was performed or was attempted or the personal 16 representative of the woman upon whom a chemical abortion was 17 performed or was attempted. A licensed pharmacist or physician 18 is immune from civil liability. The bill defines “personal 19 representative” as an administrator or an executor, or if there 20 is no such personal representative appointed, then a person 21 legally authorized to perform substantially the same functions. 22 A prevailing plaintiff in an action brought under this division 23 of the bill, in addition to compensatory and punitive damages, 24 is entitled to court costs and reasonable attorney fees. In 25 an action brought under this division of the bill, the name 26 and other identifying characteristics of a woman who sought or 27 obtained an abortion-inducing drug shall be redacted from all 28 pleadings and documents filed in the action without a court 29 order, and the court may make further orders as necessary to 30 protect the identity and privacy of the woman who sought or 31 obtained an abortion-inducing drug. This division of the bill 32 is not to be construed to impose civil or criminal liability 33 upon a woman upon whom a chemical abortion is performed. 34 Under the bill, a licensed pharmacist or physician that 35 -10- LSB 5778HZ (2) 91 ak/ko 10/ 11

H.F. 2788 fails to comply with this division of the bill is subject to 1 licensee discipline. 2 DIVISION IV —— ABORTION-RELATED PROVISIONS. The bill amends 3 Code section 144.29A (termination of pregnancy reporting —— 4 legislative intent) to require a health care provider that 5 diagnoses or induces a spontaneous termination of pregnancy 6 to include in the required report to HHS if mifepristone or 7 misoprostol was used to induce a spontaneous termination of 8 pregnancy. Current law requires the health care provider to 9 only disclose if mifepristone was used to induce a spontaneous 10 termination of pregnancy. The bill also requires the health 11 care provider to disclose whether mifepristone or misoprostol 12 were ingested by the patient within 14 days prior to the 13 spontaneous termination of pregnancy. 14 -11- LSB 5778HZ (2) 91 ak/ko 11/ 11