Amends TCA Title 4; Title 20; Title 37; Title 39; Title 49; Title 53; Title 56; Title 63; Title 68 and Title 71.

As described below, this bill amends and removes various law relative to abortions and reproductive matters.<br /> <br /> FUNDAMENTAL RIGHT<br /> <br /> This bill provides that every person has a fundamental right to make decisions about the person's reproductive health care, including the fundamental right to use or refuse contraceptive procedures or contraceptive supplies. Additionally, this bill provides that a pregnant person has a fundamental right to continue a pregnancy and give birth, or to have an abortion and to make decisions about how to exercise such right. Finally, this bill provides that a fertilized egg, embryo, or fetus does not have independent or derivative rights under the laws of this state.<br /> <br /> STATE INTERFERENCE PROHIBITED<br /> <br /> This bill prohibits this state, or a department, agency, entity, or political subdivision of this state, from doing any of the following:<br /> <br /> (1) Denying, restricting, interfering with, or discriminating against a person's fundamental rights described in this bill in the regulation or provision of benefits, facilities, services, or information;<br /> <br /> (2) Criminalizing an action taken by a person in the exercise of the person's fundamental rights described in this bill; or<br /> <br /> (3) Depriving, through prosecution, punishment, or other means, an individual of the right to act or refrain from acting during the individual's own pregnancy based on the potential, actual, or perceived impact on the pregnancy, the pregnancy's outcomes, or the pregnant individual's health.<br /> <br /> MONUMENT TO UNBORN CHILDREN<br /> <br /> Present law provides that the general assembly calls for a monument to be erected on the capitol campus as a reminder of unborn children. The monument must be in memory of the victims of abortion, babies, women, and men. Upon completion of the monument, the state capitol commission must name the monument the “Tennessee Monument to Unborn Children, In Memory of the Victims of Abortion: Babies, Women, and Men.” This bill deletes all provisions in present law relative to this monument.<br /> <br /> SURVIVAL ACTION<br /> <br /> Present law provides that a person who dies from injuries received from another, or whose death is caused by the wrongful act, omission, or killing by another, would have had against the wrongdoer, if death had not ensued, does not abate or be extinguished by the person's death but passes to the person's surviving spouse and, if there is no surviving spouse, to the person's next of kin; to the person's natural parents or parent or next of kin if at the time of death the decedent was in the custody of natural parents or parent and had not been legally surrendered or abandoned by them pursuant to any court order removing such person from the custody of such parents or parent; or otherwise to the person's legally adoptive parents or parent, or to the administrator for the use and benefit of the adoptive parents or parent; the funds recovered in either case to be free from creditors.<br /> <br /> Present law further provides that in any case involving a beneficiary who is a minor or who is legally incompetent, if the court finds it is in the best interest of the beneficiary, the court in its discretion to authorize all or any portion of the funds recovered for the beneficiary to be added to any trust or trusts established for the benefit of the beneficiary, wherever situated, whether the trust was created by the person whose death was caused by the wrongful action or omission or by any other person. The funds recovered are for the benefit of the beneficiary and are free from claims of creditors.<br /> <br /> Present law provides that the word "person," as used in the provisions above, includes an unborn child at any state of gestation in utero. This bill deletes this definition of person entirely.<br /> <br /> PARENTAL CONSENT FOR ABORTIONS BY MINORS<br /> <br /> Present law prohibits a person from performing an abortion on an unemancipated minor unless such person or such person's agent first obtains the written consent of one parent or legal guardian of the minor. The consent must be signed. The person is required to obtain some written documentation, other than the written consent itself, that purports to establish the relationship of the parent or guardian to the minor and the documentation, along with the signed consent, must be retained by the person for at least one year. Failure of the person performing the abortion to obtain or retain the documentation and consent is a Class B misdemeanor, punishable only by a fine, unless the failure of the person performing the abortion to retain the required documentation was due to a bona fide, imminent medical emergency to the minor, in which case there is no violation. A person commits a Class A misdemeanor who impersonates the parent or legal guardian of an unemancipated minor for the purpose of circumventing the requirements of this law. However, if a criminal charge of incest is pending against a parent of such minor, then the written consent of such parent is not required.<br /> <br /> If neither a parent nor a legal guardian is available to the person performing the abortion or such person's agent, or the party from whom consent must be obtained refuses to consent to the performance of an abortion, or the minor elects not to seek consent of the parent or legal guardian whose consent is required, then the minor may petition, on the minor's own behalf, or by next friend, the juvenile court of any county of this state for a waiver of the consent requirement pursuant to the provisions below.<br /> <br /> Present law provides that the consent requirements of the above provisions do not apply when, in the best medical judgment of the physician based on the facts of the case before the physician, a medical emergency exists that so complicates the pregnancy as to require an immediate abortion.<br /> <br /> Present law requires the court to ensure that the minor's identity is kept anonymous. The minor must be allowed to proceed under a pseudonym and must be allowed to sign all documents, including the petition, by that pseudonym. In any proceedings involving the use of a pseudonym by the minor, the court must require one copy of the petition to be filed, under seal, that contains the true name of the minor. This copy of the petition must be kept in a separate file, under seal, and is prohibited from inspection by anyone, except for when the supreme court by rule requires or allows statistical summaries of these proceedings to be compiled for reporting purposes.<br /> <br /> Present law authorizes the minor to participate in proceedings in the court on the minor's own behalf or through a next friend. The court is required to advise the minor that the minor has a right to court-appointed counsel and must provide the minor with such counsel upon the minor's request. The state must provide a court-appointed advocate in each judicial district to give information regarding the legal process to the minor and to coordinate with the court-appointed counsel. Such court-appointed advocates must be compensated from funds appropriated for the reimbursement of court-appointed counsel.<br /> <br /> Present law requires that the court proceedings mentioned above must be given such precedence over the other pending matters as is necessary to ensure that the court may reach a decision promptly, but in no case should the court fail to rule within 48 hours of the time of application; however, the minor is authorized to extend that 48 hour limitation. If, for any reason except the request of the minor, the court has not ruled within 48 hours, the minor is authorized to deem the petition denied and immediately appeal the denial as provided in a provision below.<br /> <br /> Present law requires the consent requirement to be waived if the court finds either of following:<br /> <br /> (1) The minor is mature and well-informed enough to make the abortion decision of the minor's own; or<br /> <br /> (2) The performance of the abortion would be in the minor's best interest.<br /> <br /> Present law requires a court that conducts proceedings under this present law to issue written and specific factual findings and legal conclusions supporting its decision and must order that a confidential record of evidence be maintained.<br /> <br /> Present law requires that an expedited, anonymous appeal be available to any minor. The appeal must be de novo to the circuit court for the county in which the juvenile court is located. The appeal is authorized to be heard by the circuit court judge sitting in another county if necessary to meet the limitations of this law. A notice of appeal must be filed within 24 hours of the decision by the juvenile court, but may be filed at any time, if the juvenile court has not ruled within 48 hours of the filing of the petition. The record from the juvenile court must be received in the circuit court and the appeal docketed there within five calendar days of the filing of the notice of appeal. The appeal must be heard and a decision rendered by the circuit court within five calendar days from when the case is docketed in the circuit court. The Tennessee supreme court is authorized to reduce the time requirements of this appeal process in order to ensure an expedited appeal. The decision of the circuit court is appealable to the Tennessee supreme court in an anonymous and expedited manner as provided by the rules of the Tennessee supreme court.<br /> <br /> Present law requires all court files, documents, exhibits, and all other records lodged in or subject to the control of the court to be kept confidential and under seal. Statistical summaries of these proceedings may be compiled for such reporting purposes as the supreme court may by rule require or allow. However, existing law prohibits any information to be released for these purposes that would tend to identify any minor who has made use of these provisions.<br /> <br /> Present law prohibits any fees for any minor who makes use of the procedures provided by the provisions above.<br /> <br /> Present law provides that the requirements and procedures of the above provisions are available and apply to minors, whether or not they are residents of this state.<br /> <br /> Finally, present law provides that failure to obtain consent pursuant to the requirements of the above provisions is prima facie evidence of failure to obtain informed consent and of interference with family relations in appropriate civil actions. Present law prohibits the law of this state to be construed to preclude the award of exemplary damages in any appropriate civil action relevant to violations of the above provisions. Nothing in the above provisions should be construed to limit the common law rights of parents. Additionally, present law requires that if a person or entity that fails to comply with the notice requirements of existing law, then they must be subject to the penalties and action provided for in existing law.<br /> <br /> This bill deletes all of the provisions above. <br /> <br /> FETUS AS VICTIM<br /> <br /> Present law provides that for purposes of assaultive offenses and criminal homicide offense against persons, "another," "individuals," and "another person" include a human embryo or fetus at any stage of gestation in utero, when any such term refers to the victim of any act made criminal as an assaultive offense. However, this provision does not apply to any act or omission by a pregnant woman with respect to an embryo or fetus with which she is pregnant, or to any lawful medical or surgical procedure to which a pregnant woman consents, performed by a healthcare professional who is licensed to perform such procedure. <br /> <br /> This bill deletes the provisions above.<br /> <br /> ABORTION FINDINGS <br /> <br /> Present law provides several findings concerning case law and medical standards regarding abortion. Present law also provides that the purpose of these findings is to provide legislative intent and reasoning underlying the enactment of laws to protect maternal health, and to preserve, promote, and protect life and potential life throughout pregnancy. Finally, present law provides that this state has a legitimate, substantial, and compelling interest in protecting unborn children that warrants the restriction of abortion in cases where the heartbeat is detectable. <br /> <br /> This bill deletes all of the legislative findings in the present law.<br /> <br /> ASSISTANCE IN TEACHING FAMILY LIFE<br /> <br /> Present law prohibits a public school or open-enrollment public charter school to knowingly enter into a transaction to assist in teaching family life with an individual or entity that: performs abortion, induces abortions, provides abortion referrals, or provides funding, advocacy, or other support for abortion. A violation of this provision is a violation to an educator's obligation to the education profession. This bill deletes these provisions.<br /> <br /> LEGEND DRUGS<br /> <br /> Present law prohibits a nurse practitioner who has met the additional requirements sufficient to prepare such person to write and sign prescriptions and/or issue drugs to write and sign prescriptions or issue drugs, nor a physician assistant working under a physician's supervision, be delegated the authority to prescribe drugs, whose sole purpose is to cause or perform an abortion, that involve (i) the writing or signing a prescription for any drug or medication; (ii) the dispensing or administration of any prescribed or legend drug or medication; or (iii) the performing of any procedure that involves the use of a legend drug or medication. This bill deletes these provisions.<br /> <br /> INSURANCE<br /> <br /> Present law prohibits healthcare plans required to be established in this state through an exchange pursuant to federal health care reform legislation to offer coverage for prohibited abortion services as described in existing law. This bill requires that healthcare plans required to be established in this state through an exchange pursuant to federal healthcare reform legislation must offer coverage for reproductive health care.<br /> <br /> As used in this bill, "reproductive health care" means health care and other medical services related to the reproductive processes, functions, and systems at all stages of life and includes, but is not limited to, family planning and contraceptive care; abortion care; prenatal, postnatal, and delivery care; fertility care; sterilization services; and treatments for sexually transmitted infections and reproductive cancers.<br /> <br /> TENNESSEE ABORTION-INDUCING DRUG RISK PROTOCOL ACT<br /> <br /> Present law authorizes an abortion-inducing drug to be provided only by a qualified physician following the procedures set forth in state law. Additionally, present law prohibits a manufacturer, supplier, pharmacy, physician, qualified physician, or other person from providing an abortion-inducing drug to a patient via courier, delivery, or mail service. Present law requires a qualified physician providing an abortion-inducing drug to examine the patient in person and, prior to providing an abortion-inducing drug a qualified physician must do the following:<br /> <br /> (1) Independently verify that a pregnancy exists;<br /> <br /> (2) Determine the patient's blood type, and, if the patient is Rh negative, offer to administer RhoGAM at the time of the abortion;<br /> <br /> (3) Inform the patient that the patient may see the remains of the unborn child in the process of completing the abortion; and<br /> <br /> (4) Document, in the patient's medical chart, the gestational age and intrauterine location of the pregnancy, and whether the patient received treatment for Rh negativity, as diagnosed by the most accurate standard of medical care.<br /> <br /> Present law requires a qualified physician providing an abortion-inducing drug to be credentialed and competent to handle complication management, including emergency transfer, or must have a signed agreement with an associated physician who is credentialed to handle complications and be able to produce the signed agreement on demand by the patient or the department. The qualified physician providing an abortion-inducing drug to a patient is required to provide the patient with the name and phone number of the associated physician.<br /> <br /> Additionally, present law requires a qualified physician providing an abortion-inducing drug, or an agent of the qualified physician, to schedule a follow-up visit for the patient at approximately seven to 14 days after administration of the abortion-inducing drug to confirm that the pregnancy is completely terminated and to assess the degree of bleeding. The qualified physician must make all reasonable efforts to ensure that the patient returns for the scheduled appointment. A brief description of the efforts made to comply with this provision, including the date, time, and identification by name of the individual making the efforts, must be included in the patient's medical record.<br /> <br /> Present law provides that an individual who intentionally, knowingly, or recklessly violates the above provisions commits a Class E felony and, upon conviction, may be fined not more than $50,000. However, a criminal penalty must not be assessed against a patient upon whom a chemical abortion is attempted or performed.<br /> <br /> Furthermore, present law provides that failure to comply with the above provision results in the following:<br /> <br /> (1) Provides a basis for a civil malpractice action for actual and punitive damages;<br /> <br /> (2) Provides a basis for professional disciplinary action under existing law for the suspension or revocation of the license of a healthcare provider or facility;<br /> <br /> (3) Provides a basis for recovery for the patient's survivors for the wrongful death of the patient under a wrongful death action; and<br /> <br /> (4) Provides a basis for a cause of action for injunctive relief against an individual who has provided an abortion-inducing drug in violation of this part to prevent the enjoined defendant from providing further abortion-inducing drugs in violation of this part. <br /> <br /> Present law prevents civil liability from being imposed against a patient on whom a chemical abortion is attempted or performed.<br /> <br /> Present law requires that when requested, the court must allow a patient to proceed using solely the patient's initials or a pseudonym and may close any proceedings in the case and enter other protective orders to preserve the privacy of the patient on whom the chemical abortion was attempted or performed. If judgment is rendered in favor of the plaintiff, the court must also render judgment for reasonable attorney fees in favor of the plaintiff against the defendant. If judgment is rendered in favor of the defendant and the court finds that the plaintiff's suit was frivolous and brought in bad faith, the court is authorized to render judgment for reasonable attorney fees in favor of the defendant against the plaintiff.<br /> <br /> This bill deletes all of the provisions above. <br /> <br /> OFFICE OF VITAL RECORDS<br /> <br /> Existing law requires the department of health to make and amend rules and regulations necessary for the tracking and disposition of an aborted fetus or aborted fetal tissue resulting from surgical abortions. This bill deletes this provision.<br /> <br /> REPORTS OF ABORTIONS<br /> <br /> Present law requires each induced termination of pregnancy that occurs in this state to be reported to the office of vital records within 10 days after the procedure by the person in charge of the institution in which the induced termination of pregnancy was performed. If the induced termination of pregnancy was performed outside an institution, the attending physician is required to prepare and file the report. Each such report must indicate whether the abortion involved a surgical procedure and, if so, which method was employed, and must indicate which method authorized by existing law was employed to dispose of the aborted fetus or aborted fetal tissue. If the aborted fetus or aborted fetal tissue was transferred to a third party for disposition, then the report must indicate the name and address of the third party and the date of the transfer. Additionally, the individual undergoing the induced termination of pregnancy must not be identified by name on the report, although some means of identification must be used to provide retrieval of further information if necessary. This bill deletes these provisions.<br /> <br /> AUTHORIZATION FOR FINAL DISPOSITION OF A DEAD FETUS<br /> <br /> Present law requires that prior to final disposition of fetal remains in accordance with existing law, the funeral director, the person in charge of the institution, or other person assuming responsibility for final disposition of the fetus, must obtain from the mother authorization for final disposition on a form prescribed and furnished, or approved by the state registrar, regardless of the duration of pregnancy.<br /> <br /> Additionally, present law requires that when the demise of the fetus is the result of a surgical abortion, a copy of the mother's authorization for disposition, specifying the means of the disposition, must be appended to the informed consent signed by the mother prior to the procedure pursuant to existing law. After final disposition, the authorization must be retained for a period of three years by the funeral director, the person in charge of the institution, or other person making the final disposition.<br /> <br /> This bill deletes all of the provisions above.<br /> <br /> AMBULATORY SURGICAL TREATMENT CENTER<br /> <br /> As used in present law, “ambulatory surgical treatment center” means any institution, place, or building devoted primarily to the maintenance and operation of a facility for the performance of surgical procedures or any facility in which a surgical procedure is utilized to terminate a pregnancy. Such facilities must not provide beds or other accommodations for the stay of a patient to exceed 12 hours duration; however, the length of stay may be extended for an additional 12 hours in the event such stay is deemed necessary by the attending physician, the facility medical director, or the anesthesiologist for observation or recovery, but in no event can the length of stay exceed 24 hours. No patient for whom a surgical procedure is utilized to terminate a pregnancy is allowed to stay at such a facility for a period exceeding 12 hours. Individual patients must be discharged in an ambulatory condition without danger to the continued well-being of the patients or must be transferred to a hospital. Excluded from this definition are private physicians' office practices where a total of 50 or fewer surgical abortions are performed in any calendar year.<br /> <br /> This bill removes the language above and provides, instead, that "ambulatory surgical treatment center" means any institution, place, or building devoted primarily to the maintenance and operation of a facility for the performance of surgical procedures. Such facilities must not provide beds or other accommodations for the stay of a patient to exceed 12 hours' duration; however, the length of stay may be extended for an additional 12 hours in the event such stay is deemed necessary by the attending physician, the facility medical director, or the anesthesiologist for observation or recovery, but in no event can the length of stay exceed 24 hours. Individual patients must be discharged in an ambulatory condition without danger to the continued well-being of the patients or transferred to a hospital.<br /> <br /> RECORD OF DISPOSITION<br /> <br /> Present law requires each facility in which a surgical abortion is performed to make and maintain a record of the disposition of the aborted fetus or aborted fetal tissue as required in existing law and must produce such records at the time of an inspection of the facility and upon request from the commission. This bill deletes this provision. <br /> <br /> REQUIREMENTS FOR AMBULATORY SURGICAL TREATMENT CENTERS<br /> <br /> Under present law, the general assembly finds and declares as fact, with regard to ambulatory surgical treatment centers that terminate pregnancies, that over 21,000 abortions are performed annually in this state, the majority of these abortions are performed in ambulatory surgical treatment centers, and gross negligence, unethical conduct and unprofessional administration of some centers have been documented by the commission.<br /> <br /> Present law further provides that such centers are the only medical facilities in the state that regularly perform surgery on minors without the knowledge or consent of the parents, guardian or custodian; and yet the parents, guardian or custodian are not relieved of their financial liability and familial responsibilities. Such centers should be held to similarly applicable standards as other health care related facilities. The state has a legitimate interest in protecting its citizens from exploitation, the spread of infectious diseases, and ensuring that its citizens utilizing such centers are provided with quality health care as is required in all health care facilities licensed and regulated by the state. Many such centers do not carry or maintain adequate health care liability insurance, if any, and the state has an interest in ensuring that those persons utilizing such centers have an adequate recourse to recover financially if a health care liability action arises from the use of such facilities.<br /> <br /> Present law provides that in addition to complying with the rules promulgated by the board for ambulatory surgical treatment centers, no ambulatory surgical treatment center that terminates pregnancies will be granted a license, renewal of a license or be authorized to continue operation, unless it complies with all of the following requirements:<br /> <br /> (1) Maintenance of at least $2,000,000 of health care liability insurance in force, annually submitting to the commission proof of such insurance coverage;<br /> <br /> (2) Satisfaction of all applicable regulations and requirements of the board for compliance with state and local building codes, including electrical, plumbing, fire and other building and safety codes, except where the board determines that a waiver is appropriate;<br /> <br /> (3) Is not in violation of commission regulations that directly impact the health care of multiple patients with such scope and magnitude as to clearly show consistent and willful neglect of the regulations, fundamental flaws in the facility's operation, or knowing failure to comply with the commission's rules;<br /> <br /> (4) The administrator of such facility must be a licensed physician, licensed practical nurse, registered nurse, or have a college degree from a four-year accredited institution and experience in a health-related field and of good moral character;<br /> <br /> (5) No employee providing direct patient care, officer, director, or owner of the facility, or if a corporation, a stockholder who owns 51 percent or more of the stock in the corporation, can have been convicted of or pleaded nolo contendere to a felony or any crime involving moral turpitude within five years immediately preceding the date of application; and<br /> <br /> (6) No employee providing direct patient care, officer, director, or owner of the facility, or if a corporation, a stockholder who owns 51 percent or more of the stock in the corporation, can have been convicted of or pleaded nolo contendere to any violation of this chapter.<br /> <br /> Present law requires the board to suspend or revoke a license of such center if a violation of this law occurs following the issuance or renewal of a license. In addition to any other lawful disciplinary action under this law, the board may assess a civil penalty not exceeding $2,000 for each violation of this law.<br /> <br /> This bill deletes all of these provisions.<br /> <br /> HOSPITAL RECORDS<br /> <br /> Present law requires all hospitals, their officers or employees, and medical and nursing personnel practicing in the hospitals, to with reasonable promptness prepare, make and maintain true and accurate hospital records, including records pertaining to abortions as provided in existing law, complying with the methods, minimum standards, and contents thereof as may be prescribed by rules adopted by the board. This bill removes records pertaining to abortion from this provision.<br /> <br /> POLICY TO AVOID USE OF STATE FUNDS FOR ELECTIVE ABORTIONS<br /> <br /> Present law provides that it is the policy of the state to favor childbirth as integral to the health and welfare of the citizens of the state and therefore to favor family planning services that do not include elective abortions or the promotion of elective abortions within the continuum of care or services offered by the provider and to avoid the direct or indirect use of state funds to promote or support elective abortions. In furtherance of this state policy, a waiver amendment to the existing TennCare II waiver that requires elective abortion providers be excluded from participation as providers in the TennCare program must be submitted to the federal centers for medicare and medicaid services for approval. The waiver amendment shall be implemented within 10 business days of approval. This bill deletes these provisions.<br />