Bill Text: MI SB1283 | 2009-2010 | 95th Legislature | Engrossed

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Bill Title: Health; abortion; ultrasound equipment used on woman seeking an abortion; require use of most technologically advanced equipment on site. Amends sec. 17015 of 1978 PA 368 (MCL 333.17015).

Spectrum: Moderate Partisan Bill (Republican 4-1)

Status: (Engrossed - Dead) 2010-09-29 - Referred To Committee On Judiciary [SB1283 Detail]

Download: Michigan-2009-SB1283-Engrossed.html

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SB-1283, As Passed Senate, September 29, 2010

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SUBSTITUTE FOR

 

SENATE BILL NO. 1283

 

 

 

 

 

 

 

 

 

 

     A bill to amend 1978 PA 368, entitled

 

"Public health code,"

 

by amending section 17015 (MCL 333.17015), as amended by 2006 PA

 

77.

 

THE PEOPLE OF THE STATE OF MICHIGAN ENACT:

 

     Sec. 17015. (1) Subject to subsection (10), a physician shall

 

not perform an abortion otherwise permitted by law without the

 

patient's informed written consent, given freely and without

 

coercion.

 

     (2) For purposes of this section:

 

     (a) "Abortion" means the intentional use of an instrument,

 

drug, or other substance or device to terminate a woman's pregnancy

 

for a purpose other than to increase the probability of a live

Senate Bill No. 1283 as amended September 28, 2010

 

birth, to preserve the life or health of the child after live

 

birth, or to remove a dead fetus. Abortion does not include the use

 

or prescription of a drug or device intended as a contraceptive.

 

     (b) "Fetus" means an individual organism of the species homo

 

sapiens in utero.

 

     (c) "Local health department representative" means a person,

 

who meets 1 or more of the licensing requirements listed in

 

subdivision (f) and who is employed by, or under contract to

 

provide services on behalf of, a local health department.

 

     (d) "Medical emergency" means that condition which, on the

 

basis of the physician's good faith clinical judgment, so

 

complicates the medical condition of a pregnant woman as to

 

necessitate the immediate abortion of her pregnancy to avert her

 

death or for which a delay will create serious risk of substantial

 

and irreversible impairment of a major bodily function.

 

     (e) "Medical service" means the provision of a treatment,

 

procedure, medication, examination, diagnostic test, assessment, or

 

counseling, including, but not limited to, a pregnancy test,

ultrasound, pelvic examination, or an abortion.

     <<(f) "Most technologically advanced ultrasound equipment available at that location" means ultrasound imaging equipment that meets both of the following requirements:

     (i) Is capable of providing the most visibly clear image of the gross anatomical development of the fetus.

     (ii) Is present in the clinical area within a building where the patient counseling, preoperative procedures, and abortion are to be performed and that is under the supervision and discretion of the attending physician or qualified person assisting the physician to utilize for diagnostic or operative purposes.

     (G)(f)>> "Qualified person assisting the physician" means

another

physician or a physician's assistant licensed under this part or

part 175, a fully licensed or limited licensed psychologist

licensed under part 182, a professional counselor licensed under

part 181, a registered professional nurse or a licensed practical

nurse licensed under part 172, or a social worker licensed under

part 185.

     <<(H)(g)>> "Probable gestational age of the fetus" means the

 

Senate Bill No. 1283 as amended September 28, 2010

 

gestational age of the fetus at the time an abortion is planned to

 

be performed.

 

     <<(I)(h)>> "Provide the patient with a physical copy" means

 

confirming that the patient accessed the internet website described

 

in subsection (5) and received a printed valid confirmation form

 

from the website and including that form in the patient's medical

 

record or giving a patient a copy of a required document by 1 or

 

more of the following means:

 

     (i) In person.

 

     (ii) By registered mail, return receipt requested.

 

     (iii) By parcel delivery service that requires the recipient to

 

provide a signature in order to receive delivery of a parcel.

 

     (iv) By facsimile transmission.

 

     (3) Subject to subsection (10), a physician or a qualified

 

person assisting the physician shall do all of the following not

 

less than 24 hours before that physician performs an abortion upon

 

a patient who is a pregnant woman:

 

     (a) Confirm that, according to the best medical judgment of a

 

physician, the patient is pregnant, and determine the probable

 

gestational age of the fetus.

 

     (b) Orally describe, in language designed to be understood by

 

the patient, taking into account her age, level of maturity, and

 

intellectual capability, each of the following:

 

     (i) The probable gestational age of the fetus she is carrying.

 

     (ii) Information about what to do and whom to contact should

 

medical complications arise from the abortion.

 

     (iii) Information about how to obtain pregnancy prevention

 

information through the department of community health.

 

     (c) Provide the patient with a physical copy of the written

 

summary described in subsection (11)(b) that corresponds to the

 

procedure the patient will undergo and is provided by the

 

department of community health. If the procedure has not been

 

recognized by the department, but is otherwise allowed under

 

Michigan law, and the department has not provided a written summary

 

for that procedure, the physician shall develop and provide a

 

written summary that describes the procedure, any known risks or

 

complications of the procedure, and risks associated with live

 

birth and meets the requirements of subsection (11)(b)(iii) through

 

(vii).

 

     (d) Provide the patient with a physical copy of a medically

 

accurate depiction, illustration, or photograph and description of

 

a fetus supplied by the department of community health pursuant to

 

subsection (11)(a) at the gestational age nearest the probable

 

gestational age of the patient's fetus.

 

     (e) Provide the patient with a physical copy of the prenatal

 

care and parenting information pamphlet distributed by the

 

department of community health under section 9161.

 

     (4) The requirements of subsection (3) may be fulfilled by the

 

physician or a qualified person assisting the physician at a

 

location other than the health facility where the abortion is to be

 

performed. The requirement of subsection (3)(a) that a patient's

 

pregnancy be confirmed may be fulfilled by a local health

 

department under subsection (18). The requirements of subsection

 

(3) cannot be fulfilled by the patient accessing an internet

 

website other than the internet website described in subsection (5)

 

that is maintained through the department.

 

     (5) The requirements of subsection (3)(c) through (e) may be

 

fulfilled by a patient accessing the internet website maintained

 

and operated through the department and receiving a printed, valid

 

confirmation form from the website that the patient has reviewed

 

the information required in subsection (3)(c) through (e) at least

 

24 hours before an abortion being performed on the patient. The

 

website shall not require any information be supplied by the

 

patient. The department shall not track, compile, or otherwise keep

 

a record of information that would identify a patient who accesses

 

this website. The patient shall supply the valid confirmation form

 

to the physician or qualified person assisting the physician to be

 

included in the patient's medical record to comply with this

 

subsection.

 

     (6) Subject to subsection (10), before obtaining the patient's

 

signature on the acknowledgment and consent form, a physician

 

personally and in the presence of the patient shall do all of the

 

following:

 

     (a) Provide the patient with the physician's name and inform

 

the patient of her right to withhold or withdraw her consent to the

 

abortion at any time before performance of the abortion.

 

     (b) Orally describe, in language designed to be understood by

 

the patient, taking into account her age, level of maturity, and

 

intellectual capability, each of the following:

 

     (i) The specific risk, if any, to the patient of the

 

complications that have been associated with the procedure the

 

patient will undergo, based on the patient's particular medical

 

condition and history as determined by the physician.

 

     (ii) The specific risk of complications, if any, to the patient

 

if she chooses to continue the pregnancy based on the patient's

 

particular medical condition and history as determined by a

 

physician.

 

     (7) To protect a patient's privacy, the information set forth

 

in subsection (3) and subsection (6) shall not be disclosed to the

 

patient in the presence of another patient.

 

     (8) If at any time prior to before the performance of an

 

abortion, a patient undergoes an ultrasound examination, or a

 

physician determines that ultrasound imaging will be used during

 

the course of a patient's abortion, the physician or qualified

 

person assisting the physician shall provide the patient with the

 

opportunity to view or decline to view an active ultrasound image

 

of the fetus, and offer to provide the patient with a physical

 

picture of the ultrasound image of the fetus prior to the

 

performance of the abortion. Before the patient signs the consent

 

form described in subsection (11)(c) and before any preoperative

 

sedative or anesthetic medications are administered to the patient.

 

In complying with this subsection, the physician or person

 

assisting the physician shall ensure that the most technologically

 

advanced ultrasound equipment available at that location is used

 

for the ultrasound examination, for the patient's viewing an active

 

ultrasound image, and for creating the physical picture of the

 

ultrasound image and that the ultrasound image of the fetus is of a

 

quality consistent with the current medical standard of care for

Senate Bill No. 1283 as amended September 29, 2010

 

prenatal diagnostic purposes given the patient's gestational stage

of pregnancy and the equipment used. <<However, if, in the best

medical judgment of the physician, the use of the most technologically advanced ultrasound equipment available at that location would

jeopardize the patient's physical health or otherwise harm the best interests of the patient or the fetus, or both, the physician or

person assisting the physician may use alternative ultrasound equipment.>> Before performing an abortion

on a patient who is a pregnant woman, a physician or a qualified

 

person assisting the physician shall do all of the following:

 

     (a) Obtain the patient's signature on the acknowledgment and

 

consent form described in subsection (11)(c) confirming that she

 

has received the information required under subsection (3).

 

     (b) Provide the patient with a physical copy of the signed

 

acknowledgment and consent form described in subsection (11)(c).

 

     (c) Retain a copy of the signed acknowledgment and consent

 

form described in subsection (11)(c) and, if applicable, a copy of

 

the pregnancy certification form completed under subsection

 

(18)(b), in the patient's medical record.

 

     (9) This subsection does not prohibit notifying the patient

 

that payment for medical services will be required or that

 

collection of payment in full for all medical services provided or

 

planned may be demanded after the 24-hour period described in this

 

subsection has expired. A physician or an agent of the physician

 

shall not collect payment, in whole or in part, for a medical

 

service provided to or planned for a patient before the expiration

 

of 24 hours from the time the patient has done either or both of

 

the following, except in the case of a physician or an agent of a

 

physician receiving capitated payments or under a salary

 

arrangement for providing those medical services:

 

     (a) Inquired about obtaining an abortion after her pregnancy

 

is confirmed and she has received from that physician or a

 

qualified person assisting the physician the information required

 

under subsection (3)(c) and (d).

 

     (b) Scheduled an abortion to be performed by that physician.

 

     (10) If the attending physician, utilizing his or her

 

experience, judgment, and professional competence, determines that

 

a medical emergency exists and necessitates performance of an

 

abortion before the requirements of subsections (1), (3), and (6)

 

can be met, the physician is exempt from the requirements of

 

subsections (1), (3), and (6), may perform the abortion, and shall

 

maintain a written record identifying with specificity the medical

 

factors upon which the determination of the medical emergency is

 

based.

 

     (11) The department of community health shall do each of the

 

following:

 

     (a) Produce medically accurate depictions, illustrations, or

 

photographs of the development of a human fetus that indicate by

 

scale the actual size of the fetus at 2-week intervals from the

 

fourth week through the twenty-eighth week of gestation. Each

 

depiction, illustration, or photograph shall be accompanied by a

 

printed description, in nontechnical English, Arabic, and Spanish,

 

of the probable anatomical and physiological characteristics of the

 

fetus at that particular state of gestational development.

 

     (b) Subject to subdivision (g), develop, draft, and print, in

 

nontechnical English, Arabic, and Spanish, written standardized

 

summaries, based upon the various medical procedures used to abort

 

pregnancies, that do each of the following:

 

     (i) Describe, individually and on separate documents, those

 

medical procedures used to perform abortions in this state that are

 

recognized by the department.

 

     (ii) Identify the physical complications that have been

 

associated with each procedure described in subparagraph (i) and

 

with live birth, as determined by the department. In identifying

 

these complications, the department shall consider the annual

 

statistical report required under section 2835(6) 2835, and shall

 

consider studies concerning complications that have been published

 

in a peer review medical journal, with particular attention paid to

 

the design of the study, and shall consult with the federal centers

 

for disease control and prevention, the American college congress

 

of obstetricians and gynecologists, the Michigan state medical

 

society, or any other source that the department determines

 

appropriate for the purpose.

 

     (iii) State that as the result of an abortion, some women may

 

experience depression, feelings of guilt, sleep disturbance, loss

 

of interest in work or sex, or anger, and that if these symptoms

 

occur and are intense or persistent, professional help is

 

recommended.

 

     (iv) State that not all of the complications listed in

 

subparagraph (ii) may pertain to that particular patient and refer

 

the patient to her physician for more personalized information.

 

     (v) Identify services available through public agencies to

 

assist the patient during her pregnancy and after the birth of her

 

child, should she choose to give birth and maintain custody of her

 

child.

 

     (vi) Identify services available through public agencies to

 

assist the patient in placing her child in an adoptive or foster

 

home, should she choose to give birth but not maintain custody of

 

her child.

 

     (vii) Identify services available through public agencies to

 

assist the patient and provide counseling should she experience

 

subsequent adverse psychological effects from the abortion.

 

     (c) Develop, draft, and print, in nontechnical English,

 

Arabic, and Spanish, an acknowledgment and consent form that

 

includes only the following language above a signature line for the

 

patient:

 

     "I, _____________________________ , hereby authorize Dr.

 

__________________ ("the physician") and any assistant designated

 

by the physician to perform upon me the following operation(s) or

 

procedure(s):

 

     ______________________________________________________________

 

     (Name of operation(s) or procedure(s))

 

     ______________________________________________________________

 

     A. I understand that I am approximately _____ weeks pregnant.

 

I consent to an abortion procedure to terminate my pregnancy. I

 

understand that I have the right to withdraw my consent to the

 

abortion procedure at any time prior to performance of that

 

procedure.

 

     B. I acknowledge that at least 24 hours before the scheduled

 

abortion I have received a physical copy of each of the following:

 

     1. (a) A medically accurate depiction, illustration, or

 

photograph of a fetus at the probable gestational age of the fetus

 

I am carrying.

 

     2. (b) A written description of the medical procedure that

 

will be used to perform the abortion.

 

     3. (c) A prenatal care and parenting information pamphlet. If

 

any of the above listed documents were transmitted by facsimile, I

 

certify that the documents were clear and legible.

 

     C. I acknowledge that the physician who will perform the

 

abortion has orally described all of the following to me:

 

     1. (i) The specific risk to me, if any, of the complications

 

that have been associated with the procedure I am scheduled to

 

undergo.

 

     2. (ii) The specific risk to me, if any, of the complications

 

if I choose to continue the pregnancy.

 

     D. I acknowledge that I have received all of the following

 

information:

 

     1. (d) Information about what to do and whom to contact in the

 

event that complications arise from the abortion.

 

     2. (e) Information pertaining to available pregnancy related

 

services.

 

     E. I acknowledge that the physician or qualified person

 

assisting the physician has informed me of the following [select 1

 

of the following by placing your initials after the applicable

 

sentence]:

 

     1. An ultrasound examination or imaging will be performed

 

before or used during the abortion. ____

 

     2. An ultrasound examination or imaging will not be performed

 

before or used during the abortion. ____

 

     F. If I have selected paragraph E1 above indicating that an

 

ultrasound examination or imaging will be performed before or used

 

during the abortion, I acknowledge that the physician or qualified

 

person assisting the physician has done all of the following:

 

     1. Provided me with an opportunity to view or decline to view

 

an active ultrasound image of the fetus.

 

     2. Offered to provide me with a physical picture of the

 

ultrasound image of the fetus.

 

     3. Offered an explanation of the ultrasound image of the

 

fetus.

 

     G. I have been given an opportunity to ask questions about the

 

operation(s) or procedure(s). I certify that I have not been

 

required to make any payments for an abortion or any medical

 

service before the expiration of 24 hours after I received the

 

written materials listed in paragraphs (a), (b), and (c) paragraph

 

B above, or 24 hours after the time and date listed on the

 

confirmation form if paragraphs (a), (b), and (c) were the

 

information described in paragraph B was viewed from the state of

 

Michigan internet website.".

 

     (d) Make available to physicians through the Michigan board of

 

medicine and the Michigan board of osteopathic medicine and

 

surgery, and any person upon request the copies of medically

 

accurate depictions, illustrations, or photographs described in

 

subdivision (a), the standardized written summaries described in

 

subdivision (b), the acknowledgment and consent form described in

 

subdivision (c), the prenatal care and parenting information

 

pamphlet described in section 9161, and the pregnancy certification

 

form described in subdivision (f).

 

     (e) The department shall not develop written summaries for

 

abortion procedures under subdivision (b) that utilize medication

 

that has not been approved by the United States food and drug

 

administration for use in performing an abortion.

 

     (f) Develop, draft, and print a certification form to be

 

signed by a local health department representative at the time and

 

place a patient has a pregnancy confirmed, as requested by the

 

patient, verifying the date and time the pregnancy is confirmed.

 

     (g) Develop and maintain an internet website that allows a

 

patient considering an abortion to review the information required

 

in subsection (3)(c) through (e). After the patient reviews the

 

required information, the department shall assure that a

 

confirmation form can be printed by the patient from the internet

 

website that will verify the time and date the information was

 

reviewed. A confirmation form printed under this subdivision

 

becomes invalid 14 days after the date and time printed on the

 

confirmation form.

 

     (h) Include on the informed consent website developed under

 

subdivision (g) a list of health care providers, facilities, and

 

clinics that offer to perform ultrasounds free of charge. The list

 

shall be organized geographically and shall include the name,

 

address, and telephone number of each health care provider,

 

facility, and clinic.

 

     (12) A physician's duty to inform the patient under this

 

section does not require disclosure of information beyond what a

 

reasonably well-qualified physician licensed under this article

 

would possess.

 

     (13) A written consent form meeting the requirements set forth

 

in this section and signed by the patient is presumed valid. The

 

presumption created by this subsection may be rebutted by evidence

 

that establishes, by a preponderance of the evidence, that consent

 

was obtained through fraud, negligence, deception,

 

misrepresentation, coercion, or duress.

 

     (14) A completed certification form described in subsection

 

(11)(f) that is signed by a local health department representative

 

is presumed valid. The presumption created by this subsection may

 

be rebutted by evidence that establishes, by a preponderance of the

 

evidence, that the physician who relied upon the certification had

 

actual knowledge that the certificate contained a false or

 

misleading statement or signature.

 

     (15) This section does not create a right to abortion.

 

     (16) Notwithstanding any other provision of this section, a

 

person shall not perform an abortion that is prohibited by law.

 

     (17) If any portion of this act or the application of this act

 

to any person or circumstances is found invalid by a court, that

 

invalidity does not affect the remaining portions or applications

 

of the act that can be given effect without the invalid portion or

 

application, if those remaining portions are not determined by the

 

court to be inoperable.

 

     (18) Upon a patient's request, each local health department

 

shall:

 

     (a) Provide a pregnancy test for that patient to confirm the

 

pregnancy as required under subsection (3)(a) and determine the

 

probable gestational stage of the fetus. The local health

 

department need not comply with this subdivision if the

 

requirements of subsection (3)(a) have already been met.

 

     (b) If a pregnancy is confirmed, ensure that the patient is

 

provided with a completed pregnancy certification form described in

 

subsection (11)(f) at the time the information is provided.

 

     (19) The identity and address of a patient who is provided

 

information or who consents to an abortion pursuant to this section

 

is confidential and is subject to disclosure only with the consent

 

of the patient or by judicial process.

 

     (20) A local health department with a file containing the

 

identity and address of a patient described in subsection (19) who

 

has been assisted by the local health department under this section

 

shall do both of the following:

 

     (a) Only release the identity and address of the patient to a

 

physician or qualified person assisting the physician in order to

 

verify the receipt of the information required under this section.

 

     (b) Destroy the information containing the identity and

 

address of the patient within 30 days after assisting the patient

 

under this section.