RELATING TO HEALTH CARE FOR MINORS.

HB2513

HOUSE OF REPRESENTATIVES

H.B. NO.

2513

THIRTY-THIRD LEGISLATURE, 2026

STATE OF HAWAII

A BILL FOR AN ACT

relating
to Health care for minors
.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF HAWAII:

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SECTION
1.
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The legislature finds that minors are
not at a fully completed mature state and still undergoing physical, mental,
and emotional development.
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Accordingly,
minors are prohibited by law from voting, owning a firearm, getting a tattoo,
and being drafted into military service prior to the age of eighteen.
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Permanent medical alterations to a minor's
body are very significant decisions that should be based on the best available
evidence.
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Further, recent studies have
demonstrated that gender affirming care for minors may not be best medical
practices.
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Countries such as the United
Kingdom, Finland, and Sweden have taken efforts to reverse their previous
policies that allowed minors to access gender affirming care, casting doubt on
the Dutch Protocol.
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The United
Kingdom restricted the prescription of puberty blockers to minors in 2024 after
the Commission on Human Medicines reported that experts had identified safety
risks and the Cass Review noted that uncertainties related to the medical
intervention remain.
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Finland and Sweden
imposed similar restrictions on the use of hormone treatments in 2020 and 2022
respectively, noting the ongoing risks and continued need for scientific
research.

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The
legislature further finds that the legal landscape of the United States has
recently recognized the legitimacy of laws which prevent youth access to gender
affirming care.
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On June 18, 2025, the
Supreme Court of the United States issued a decision upholding a Tennessee law
which prohibited minors from receiving puberty blockers or other similar
medical interventions.
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The decision validates
twenty-five existing state bans across the nation.
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The State has an interest in protecting
minors from making risky, life-altering permanent decisions that they may come
to regret as adults.
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Accordingly,
the purpose of this Act is to prohibit medical procedures from being
administered to or performed on minors when the purpose of the medical
procedure is to:

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(1)
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Enable a minor to identify with, or live as, a
purported identity inconsistent with the minor's sex; or

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(2)
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Treat purported discomfort or distress from a
discordance between the minor's sex and asserted identity.

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SECTION
2.
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Chapter 453, Hawaii Revised Statutes,
is amended by adding a new part to be appropriately designated and to read as
follows:

"
Part
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Gender affirming care

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453-A
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Definitions.
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As used in this part:

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"Congenital
defect" means a physical or chemical abnormality present in a minor that
is inconsistent with the normal development of a human being of the minor's
sex, including abnormalities caused by a medically verifiable disorder of sex
development, but does not include gender dysphoria, gender identity disorder,
gender incongruence, or any mental condition, disorder, disability, or
abnormality.

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"Healthcare
provider" means a healthcare professional, establishment, or facility
licensed, registered, certified, or permitted pursuant to this chapter or
chapter 465 and under the regulatory authority of the following:

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(1)
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The department of health;

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(2)
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An agency, board, council, or committee
attached to the department of commerce and consumer affairs; or

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(3)
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The office of health care assurance.

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"Hormone"
means an androgen or estrogen.

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"Knowing"
and "knowingly" have the same meaning as the term "knowingly"
is defined in section 702-206.

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"Medical
procedure" means:

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(1)
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Surgically removing, modifying, altering, or
entering into tissues, cavities, or organs of a human being; or

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(2)
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Prescribing, administering, or dispensing any
puberty blocker or hormone to a human being.

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"Minor"
means an individual under eighteen years of age.

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"Parent"
means any biological, legal, or adoptive parent or parents of the minor or any
legal guardian of the minor.

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"Puberty
blocker" means a drug or device that suppresses the production of hormones
in a minor's body to stop, delay, or suppress pubertal development.

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"Sex"
means a person's immutable characteristics of the reproductive system that
define the individual as male or female, as determined by anatomy and genetics
existing at the time of birth.

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453-B
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Prohibitions.
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(a)
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A
healthcare provider shall not knowingly perform or offer to perform on a minor,
or administer or offer to administer to a minor, a medical procedure if the
performance or administration of the procedure is for the purpose of:

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(1)
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Enabling a minor to identify with, or live as,
a purported identity inconsistent with the minor's sex; or

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(2)
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Treating purported discomfort or distress from
a discordance between the minor's sex and asserted identity.

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(b)
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This section applies to medical procedures
that are:

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(1)
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Performed or administered in the state; or

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(2)
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Performed or administered on a minor located
in this state, including via telehealth, as defined in
section 453-1.3.

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(c)
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It is not a violation of this section if a healthcare provider knowingly
performs, or offers to perform, a medical procedure on or administers, or
offers to administer, a medical procedure to a minor or if:

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(1)
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The performance or administration of the
medical procedure is to treat a minor's congenital defect, precocious puberty,
disease, or physical injury; or

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(2)
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The performance or administration of the
medical procedure on the minor began prior to the effective date of this Act
and concludes on or before January 1, 2027.

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(d)
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For the purposes of subsection (c)(1), "disease" does not
include gender dysphoria, gender identity disorder, gender incongruence, or any
mental condition, disorder, disability, or abnormality.

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(e)
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For the exception in subsection (c)(2) to apply, the minor's treating
physician must certify in writing that, in the physician's good-faith medical
judgment, based upon the facts known to the physician at the time, ending the
medical procedure would be harmful to the minor.
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The certification must include the findings
supporting the certification and must be made a part of the minor's medical
record.

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(f)
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The exception in subsection (c)(2) does not allow a healthcare provider
to perform or administer a medical procedure that is different from the medical
procedure performed prior to the effective date of this Act when the sole
purpose of the subsequent medical procedure is to:

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(1)
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Enable the minor to identify with, or live as,
a purported identity inconsistent with the minor's sex; or

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(2)
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Treat purported discomfort or distress from a
discordance between the minor's sex and asserted identity.

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(g)
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It is not a defense to any legal liability incurred as the result of a
violation of this section that the minor, or a parent of the minor, consented
to the conduct that constituted the violation.

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(h)
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This section supersedes any common law rule regarding a minor's ability
to consent to a medical procedure that is performed or administered for the
purpose of:

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(1)
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Enabling the minor to identify with, or live
as, a purported identity inconsistent with the minor's sex; or

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(2)
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Treating purported discomfort or distress from
a discordance between the minor's sex and asserted identity.

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453-C
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Distribution of hormones or puberty blockers
to minors.
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A person shall not
knowingly provide a hormone or puberty blocker by any means to a minor if the
provision of the hormone or puberty blocker is not in compliance with this
chapter.

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453-D
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Private right of action.
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(a)
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Except as otherwise provided in subsection (b), a minor, or the parent
of a minor, injured as a result of a violation of this part, may bring a civil
cause of action to recover compensatory damages, punitive damages, and
reasonable attorney's fees, court costs, and expenses against the healthcare
provider or any person alleged to have violated this part.

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(b)
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The parent of a minor injured as a result of
a violation of this part shall not bring a civil cause of action against a
healthcare provider or another person if the parent consented to the conduct
that constituted the violation on behalf of the minor.

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(c)
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The parent or next of kin of a minor may
bring a wrongful death action, pursuant to section 663-3, against a healthcare
provider alleged to have violated section 453-B, if the injured minor is
deceased and:

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(1)
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The minor's death is the result of the
physical or emotional harm inflicted upon on the minor by the violation; and

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(2)
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The parent of the minor did not consent to the
conduct that constituted the violation on behalf of the minor.

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(d)
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If a court in any civil action brought
pursuant to this section finds that the healthcare provider knowingly violated
section 453-B, then the court shall notify the appropriate regulatory authority
and the attorney general by mailing a certified copy of the court's order to
the regulatory authority and the attorney general.
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Notification pursuant to this section shall
be made upon the judgment of the court being made final.

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(e)
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For purposes of this section, compensatory
damages may include:

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(1)
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Reasonable economic losses caused by the
emotional, mental or physical effects of the violation, including but not
limited to:

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(A)
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The cost of counseling, hospitalization, and
any other medical expenses connected with treating the harm caused by the
violation;

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(B)
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Any out-of-pocket costs of the minor paid to
the healthcare provider for the prohibited medical procedure; and

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(C)
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Loss of income caused by the violation; and

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(2)
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Noneconomic damages caused by the violation,
including but not limited to, psychological and emotional anguish.

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(f)
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Notwithstanding any law to the contrary, an
action commenced under this section must be brought:

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(1)
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Within thirty years from the date the minor
reaches eighteen years of age; or

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(2)
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Within ten years of the minor's death if the
minor dies.

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(g)
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This section is declared to be remedial in
nature, and this section must be liberally construed to effectuate its purpose.

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453-E
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State right of action.
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(a)
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The attorney general shall establish a process by which violations of
this part may be reported.

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(b)
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The attorney general may bring an action
against a healthcare provider or any person that knowingly violates this
chapter, within twenty years of the violation, to enjoin further violations, to
disgorge any profits received due to the medical procedure, and to recover a
civil penalty of twenty-five thousand dollars per violation.
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Each time a healthcare provider performs or
administers a medical procedure in violation of section 453-B constitutes a
separate violation.

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(c)
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A civil penalty collected pursuant to this
section must be paid into the general fund of the State.

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(d)
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The attorney general is entitled to
reasonable attorney's fees, court costs, and expenses if the attorney general
prevails in an action brought pursuant to this section.

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(e)
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Jurisdiction for an action brought pursuant
to this section is in the circuit court in the county where the violation
occurred.

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453-F
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Healthcare provider licensing sanctions.
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A violation of section 453-B constitutes
a potential threat to public health, safety, and welfare and requires emergency
action by an alleged violator's appropriate regulatory authority.
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Upon receiving notification pursuant to
section 453-D, or upon otherwise becoming aware of an alleged violation of
section 453-B, the appropriate regulatory authority shall proceed pursuant this
chapter or chapter 465, as applicable.

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453-G
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Minor immunity.
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A minor upon whom a medical procedure is
performed or administered must not be held liable for violating this chapter.

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453-H
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Application.
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This part does not prohibit or restrict psychological practice
regulated pursuant to chapter 465; the practice of professional counseling
regulated pursuant to chapter 453D; or the practice of social work regulated
pursuant to chapter 467E.

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SECTION 3.
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If any provision of this Act, or the
application thereof to any person or circumstance, is held invalid, the
invalidity does not affect other provisions or applications of the Act that can
be given effect without the invalid provision or application, and to this end
the provisions of this Act are severable.

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SECTION 4.
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In codifying the new sections added by
section 2 of this Act, the revisor of statutes shall substitute appropriate
section numbers for the letters used in designating the new sections in this
Act.

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SECTION 5.
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This Act shall take effect upon its approval.

INTRODUCED BY:

_____________________________

Report Title:

Minors;
Health Care; Gender; Puberty Blockers; Prohibitions

Description:

Prohibits
medical procedures and the distribution of hormones or puberty blockers for the
purpose of allowing a minor to change their sex to correlate with an identified
gender.
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Allows for certain
exceptions.
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Creates both a private and
state right of action.
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Outlines
sanctions through the proper licensing authority for violations.

The summary description
of legislation appearing on this page is for informational purposes only and is
not legislation or evidence of legislative intent.