Read the full stored bill text
Senate
File
220
-
Introduced
SENATE
FILE
220
BY
TAYLOR
A
BILL
FOR
An
Act
relating
to
protections
for
medical
practitioners,
1
health
care
institutions,
and
health
care
payors
including
2
those
related
to
the
exercise
of
conscience,
whistleblower
3
activities,
and
free
speech,
and
providing
penalties.
4
BE
IT
ENACTED
BY
THE
GENERAL
ASSEMBLY
OF
THE
STATE
OF
IOWA:
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Section
1.
SHORT
TITLE.
This
Act
shall
be
known
and
may
be
1
cited
as
the
“Medical
Ethics
Defense
Act”.
2
Sec.
2.
NEW
SECTION
.
135S.1
Definitions.
3
As
used
in
this
chapter,
unless
the
context
otherwise
4
requires:
5
1.
a.
“Conscience”
means
the
ethical,
moral,
or
religious
6
beliefs
or
principles
held
by
a
medical
practitioner,
health
7
care
institution,
or
health
care
payor.
8
b.
With
respect
to
persons
who
are
institutions,
9
corporations,
or
other
legal
entities,
“conscience”
is
10
determined
by
reference
to
that
entity’s
governing
documents
11
including
but
not
limited
to
published
ethical,
moral,
or
12
religious
guidelines
or
directives,
mission
statements,
13
constitutions,
articles
of
incorporation,
bylaws,
policies,
or
14
regulations.
15
2.
“Discrimination”
means
an
adverse
action,
including
but
16
not
limited
to
any
penalty,
disciplinary,
or
retaliatory
action
17
taken
against,
or
a
threat
of
adverse
action
communicated
to,
a
18
medical
practitioner,
health
care
institution,
or
health
care
19
payor
as
a
result
of
the
refusal
of
the
medical
practitioner,
20
health
care
institution,
or
health
care
payor
to
participate
21
in
a
health
care
service
on
the
basis
of
conscience.
22
“
Discrimination”
not
does
include
the
negotiation
or
purchase
of
23
insurance
or
a
health
care
service
by
a
nongovernmental
entity
24
or
individual,
the
refusal
to
use
or
purchase
insurance
or
a
25
health
care
service
by
a
nongovernmental
entity
or
individual,
26
or
a
health
care
institution’s
good-faith
effort
to
accommodate
27
a
medical
practitioner’s,
health
care
institution’s,
or
health
28
care
payor’s
exercise
of
conscience.
29
3.
“Health
care
institution”
means
an
organization,
30
corporation,
partnership,
association,
agency,
network,
sole
31
proprietorship,
joint
venture,
or
other
entity
that
provides
32
a
health
care
service.
33
4.
“Health
care
payor”
means
an
employer;
a
health
plan;
34
a
management
services
organization;
any
entity,
including
a
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health
service
corporation,
health
maintenance
organization,
1
or
any
similar
corporation
or
organization,
or
an
employer
2
offering
self-insurance,
that
provides
a
health
benefit
plan;
3
or
any
other
entity
that
pays
for
or
arranges
for
payment,
in
4
whole
or
in
part,
for
a
health
care
service.
5
5.
“Health
care
service”
means
medical
research
and
medical
6
care
provided
to
a
patient
or
client
at
any
time
during
the
7
patient’s
or
client’s
course
of
treatment,
including
but
8
not
limited
to
testing;
diagnosis;
record
making;
referral;
9
prescribing,
dispensing,
or
administering
any
drug,
medication,
10
or
device;
therapy
or
counseling;
and
preparation
or
11
arrangement
for
a
surgical
procedure.
12
6.
“Medical
practitioner”
means
a
person
who
facilitates
13
or
participates,
or
who
is
asked
to
facilitate
or
participate
14
in
a
health
care
service,
including
but
not
limited
to
a
15
health-related
professional
licensed
by
a
board
designated
in
16
section
147.13,
and
any
other
person
licensed,
certified,
or
17
otherwise
authorized
or
permitted
by
the
laws
of
this
state
18
to
administer
a
health
care
service
in
the
ordinary
course
19
of
business
or
in
the
practice
of
a
profession.
“Medical
20
practitioner”
includes
any
student
enrolled
in
an
educational
21
institution
who
is
a
prospective
medical
practitioner.
22
7.
“Participate
in
a
health
care
service”
means
to
provide,
23
perform,
assist
with,
facilitate,
refer
for,
provide
counseling
24
for,
advise
with
regard
to,
admit
for
the
purposes
of
25
providing,
or
take
part
in
a
health
care
service
in
any
way.
26
Sec.
3.
NEW
SECTION
.
135S.2
Exercise
of
conscience
for
27
health
care
institutions,
health
care
payors,
and
medical
28
practitioners
——
exception.
29
1.
a.
A
medical
practitioner,
health
care
institution,
30
or
health
care
payor
has
the
right
not
to
participate
in
31
or
pay
for
a
health
care
service
that
violates
the
medical
32
practitioner’s,
health
care
institution’s,
or
health
care
33
payor’s
conscience.
This
paragraph
shall
not
be
construed
to
34
waive
or
modify
a
duty
a
medical
practitioner,
health
care
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institution,
or
health
care
payor
may
have
to
participate
in
or
1
pay
for
a
health
care
service
that
does
not
violate
the
medical
2
practitioner’s
conscience.
3
b.
A
medical
practitioner,
health
care
institution,
or
4
health
care
payor
who
refuses
to
participate
in
a
health
care
5
service
under
this
section
shall
not
be
discriminated
against
6
for
the
medical
practitioner’s,
health
care
institution’s,
or
7
health
care
payor’s
exercise
of
conscience.
8
2.
A
health
care
payor
shall
not
decline
to
pay
for
a
health
9
care
service
due
to
a
medical
practitioner’s,
health
care
10
institution’s,
or
health
care
payor’s
refusal
to
participate
11
in
a
health
care
service
under
this
section
if
the
health
care
12
payor
is
contractually
obligated
to
pay
for
the
health
care
13
service.
14
3.
This
section
shall
not
be
construed
to
relieve
a
health
15
care
institution
of
the
requirement
to
provide
emergency
16
medical
services
to
individuals
as
required
under
42
U.S.C.
17
§1395dd.
18
4.
Notwithstanding
any
other
provision
of
this
chapter
to
19
the
contrary,
a
medical
practitioner,
health
care
institution,
20
or
health
care
payor
that
holds
itself
out
to
the
public
as
21
religion-based,
states
in
the
entity’s
governing
documents
22
that
the
entity
has
a
religious
purpose
or
mission,
and
that
23
has
internal
operating
policies
or
procedures
that
implement
24
the
entity’s
religious
beliefs,
shall
have
the
right
to
make
25
employment,
staffing,
contracting,
and
admitting
privilege
26
decisions
consistent
with
the
entity’s
religious
beliefs.
27
Sec.
4.
NEW
SECTION
.
135S.3
Exercise
of
conscience
——
28
immunity.
29
1.
A
medical
practitioner,
health
care
institution,
30
or
health
care
payor
shall
not
be
civilly,
criminally,
or
31
administratively
liable
for
the
medical
practitioner’s,
32
health
care
institution’s,
or
health
care
payor’s
exercise
of
33
conscience.
34
2.
A
health
care
institution
shall
not
be
civilly,
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criminally,
or
administratively
liable
for
the
exercise
of
1
conscience
by
a
medical
practitioner
employed,
contracted,
or
2
granted
admitting
privileges
by
the
health
care
institution.
3
Sec.
5.
NEW
SECTION
.
135S.4
Whistleblower
protections.
4
1.
A
medical
practitioner,
health
care
institution,
or
5
health
care
payor
shall
not
be
discriminated
against
because
6
the
medical
practitioner,
health
care
institution,
or
health
7
care
payor
does
any
of
the
following:
8
a.
Provides,
causes
to
be
provided,
or
intends
to
provide
9
or
cause
to
be
provided
information
relating
to
a
suspected
10
violation
of
this
chapter
to
the
medical
practitioner’s,
11
health
care
institution’s,
or
health
care
payor’s
employer,
12
the
attorney
general,
any
state
agency
charged
with
protecting
13
health
care
rights
of
conscience,
the
United
States
department
14
of
health
and
human
services,
the
United
States
commission
15
on
civil
rights,
or
any
other
federal
agency
charged
with
16
protecting
health
care
rights
of
conscience.
17
b.
Testifies
or
intends
to
testify
in
a
proceeding
18
concerning
a
violation
of
this
chapter.
19
c.
Assists
or
participates,
or
intends
to
assist
or
20
participate,
in
a
proceeding
under
this
chapter.
21
2.
It
shall
be
unlawful
to
discriminate
against
a
medical
22
practitioner,
health
care
institution,
or
health
care
payor
23
because
the
medical
practitioner,
health
care
institution,
24
or
health
care
payor
discloses
information
that
the
medical
25
practitioner,
health
care
institution,
or
health
care
payor
26
reasonably
believes
evidences
any
of
the
following:
27
a.
A
violation
of
any
law
or
rule.
28
b.
A
violation
of
any
standard
of
care
or
ethical
guidelines
29
for
the
provision
of
any
health
care
service.
30
c.
Gross
mismanagement,
a
gross
waste
of
funds,
an
abuse
31
of
authority,
practices
or
methods
of
treatment
that
may
put
32
patient
or
client
health
at
risk,
or
a
substantial
and
specific
33
danger
to
public
health
or
safety.
34
3.
This
section
shall
not
be
construed
to
exempt
a
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person
from
the
requirements
of
the
federal
Health
Insurance
1
Portability
and
Accountability
Act
of
1996,
Pub.
L.
No.
2
104-191,
including
amendments
thereto
and
regulations
3
promulgated
thereunder,
or
any
other
applicable
confidentiality
4
and
patient
or
client
privacy
requirements.
5
Sec.
6.
NEW
SECTION
.
135S.5
Free
speech
protections
——
6
notification
of
complaints
——
penalty.
7
1.
The
department
of
health
and
human
services,
a
licensing
8
board
designated
under
chapter
147,
or
any
other
state
9
licensing
or
certifying
entity
of
a
medical
practitioner
shall
10
not
reprimand,
sanction,
or
revoke
or
threaten
to
revoke
a
11
license
or
certification
of
a
medical
practitioner,
health
care
12
institution,
or
health
care
payor
who
is
licensed
or
certified
13
by
the
department,
licensing
board,
or
other
licensing
or
14
certifying
entity,
for
engaging
in
speech,
expressive
activity,
15
or
association
protected
under
the
first
amendment
to
the
16
Constitution
of
the
United
States,
unless
the
department,
17
licensing
board,
or
other
licensing
or
certifying
entity
18
demonstrates
by
clear
and
convincing
evidence
that
the
medical
19
practitioner’s,
health
care
institution’s,
or
health
care
20
payor’s
speech,
expressive
activity,
or
association
was
the
21
direct
cause
of
physical
harm
to
a
person
with
whom
the
medical
22
practitioner,
health
care
institution,
or
health
care
payor
had
23
a
medical
practitioner-patient
or
medical
practitioner-client
24
relationship
within
the
three
years
immediately
preceding
the
25
incident
of
physical
harm.
26
2.
a.
Within
twenty-one
days
of
receipt
of
a
complaint
27
that
alleges
a
violation
of
speech,
expressive
activity,
or
28
association
protected
under
subsection
1
that
may
result
29
in
revocation
of
a
medical
practitioner’s,
health
care
30
institution’s,
or
health
care
payor’s
license,
certification,
31
or
registration,
the
department,
licensing
board,
or
other
32
licensing
or
certifying
entity
shall
provide
the
medical
33
practitioner,
health
care
institution,
or
health
care
payor
34
with
a
copy
of
the
complaint.
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b.
If
the
department,
licensing
board,
or
other
licensing
or
1
certifying
entity
fails
to
provide
a
copy
of
the
complaint
to
2
the
medical
practitioner,
health
care
institution,
or
health
3
care
payor
within
twenty-one
days
of
receipt,
the
department,
4
licensing
board,
or
other
certifying
entity
shall
pay
the
5
medical
practitioner,
health
care
institution,
or
health
care
6
payor
an
administrative
penalty
of
five
hundred
dollars
for
7
each
day
of
noncompliance.
8
3.
The
state
shall
not
contract
with,
recognize,
approve,
9
or
require
a
medical
practitioner,
health
care
institution,
10
or
health
care
payor
to
obtain
a
certification
or
credential
11
issued
or
approved
by
the
department
of
health
and
human
12
services,
a
licensing
board
designated
under
chapter
147,
13
or
any
other
licensing
or
certifying
entity
of
a
medical
14
practitioner,
health
care
institution,
or
health
care
payor
15
that
revokes
or
refuses
to
issue
a
certification
or
credential
16
to
the
medical
practitioner,
health
care
institution,
or
17
health
care
payor
if
the
medical
practitioner,
health
care
18
institution,
or
health
care
payor
is
in
compliance
with
this
19
chapter
and
did
not
provide
medical
advice
or
treatment
to
a
20
patient
or
client.
21
Sec.
7.
NEW
SECTION
.
135S.6
Unlawful
interference
——
22
relief.
23
1.
It
is
unlawful
for
a
person
to
interfere
or
attempt
to
24
interfere
with
the
exercise
of
conscience
not
to
participate
in
25
a
health
care
service,
or
in
the
whistleblower
or
free
speech
26
rights
and
protections
under
this
chapter,
whether
by
duress,
27
coercion,
or
any
other
means.
28
2.
A
health
care
institution,
health
care
payor,
or
medical
29
practitioner
that
alleges
injury
by
unlawful
interference
30
by
a
person
under
this
chapter
may
bring
a
civil
action
in
31
a
court
of
competent
jurisdiction.
If
a
court
of
competent
32
jurisdiction
finds
a
person
liable
under
this
section,
the
33
court
may
order
any
of
the
following:
34
a.
Injunctive
relief,
when
appropriate,
including
but
not
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limited
to
reinstatement
of
a
medical
practitioner
to
the
1
medical
practitioner’s
previous
position,
or
reinstatement
2
or
reactivation
of
licensure
or
certification
of
a
medical
3
practitioner,
or
reactivation
or
reinstatement
of
licensure
of
4
a
health
care
institution
or
a
health
care
payor.
5
b.
Monetary
damages
for
injuries
suffered.
6
c.
Reasonable
costs
and
attorney
fees.
7
3.
The
rights,
remedies,
and
prohibitions
contained
in
this
8
chapter
shall
be
in
addition
to
and
cumulative
of
any
other
9
right,
remedy,
or
prohibition
accorded
by
common
law
or
state
10
or
federal
law.
This
chapter
shall
not
be
construed
to
deny,
11
abrogate,
or
impair
any
such
common
law
or
statutory
right,
12
remedy,
or
prohibition.
13
4.
Any
additional
burden
or
expense
to
another
medical
14
practitioner,
health
care
institution,
or
health
care
payor
15
arising
from
the
exercise
of
conscience
pursuant
to
this
16
chapter
shall
not
be
a
defense
to
a
violation
of
this
chapter.
17
5.
A
person
shall
not
bring
a
civil
action
against
a
person
18
who
declines
to
use
or
purchase
a
health
care
service
from
19
a
medical
practitioner,
health
care
institution,
or
health
20
care
payor
because
of
the
medical
practitioner’s,
health
care
21
institution’s,
or
health
care
payor’s
exercise
of
conscience
22
under
this
chapter.
23
Sec.
8.
NEW
SECTION
.
135S.7
Severability.
24
If
any
provision
of
this
chapter
or
its
application
to
any
25
person
or
circumstance
is
held
invalid,
the
invalidity
shall
26
not
affect
other
provisions
or
applications
of
this
chapter
27
which
can
be
given
effect
without
the
invalid
provision
or
28
application,
and
to
this
end
the
provisions
of
this
chapter
are
29
severable.
30
EXPLANATION
31
The
inclusion
of
this
explanation
does
not
constitute
agreement
with
32
the
explanation’s
substance
by
the
members
of
the
general
assembly.
33
This
bill
relates
to
protections
for
medical
practitioners
34
(practitioner),
health
care
institutions
(institution),
and
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health
care
payors
(payor),
involving
exercise
of
conscience,
1
whistleblower
activities,
and
free
speech.
2
The
bill
provides
definitions
for
“conscience”,
3
“discrimination”,
“health
care
institution”,
“health
care
4
payor”,
“health
care
services”,
“medical
practitioner”,
and
5
“participate
in
a
health
care
service”.
6
The
bill
provides
that
a
practitioner,
institution,
or
7
payor
has
the
right
not
to
participate
in
or
pay
for
a
health
8
care
service
(service)
that
violates
the
practitioner’s,
9
institution’s,
or
payor’s
conscience.
A
practitioner,
10
institution,
or
payor
who
refuses
to
participate
in
a
service
11
due
to
exercise
of
conscience
shall
not
be
discriminated
12
against
for
refusing
to
participate.
13
The
bill
is
not
to
be
construed
to
relieve
a
practitioner,
14
institution,
or
payor
of
the
requirement
under
federal
law
to
15
provide
emergency
medical
services
to
certain
individuals.
16
The
bill
provides
that
a
practitioner,
institution,
or
payor
17
that
holds
itself
out
to
the
public
as
religion-based,
as
18
described
in
the
bill,
shall
have
the
right
to
make
employment,
19
staffing,
contracting,
and
admitting
privilege
decisions
20
consistent
with
the
entity’s
religious
beliefs.
21
The
bill
provides
that
a
practitioner,
institution,
or
payor
22
shall
not
be
civilly,
criminally,
or
administratively
liable
23
for
the
practitioner’s,
institution’s,
or
payor’s
exercise
of
24
conscience.
An
institution
shall
not
be
civilly,
criminally,
25
or
administratively
liable
for
the
excise
of
conscience
by
26
a
practitioner
employed,
contracted,
or
granted
admitting
27
privileges
by
the
institution.
28
The
bill
provides
whistleblower
protections
by
providing
29
that
a
practitioner,
institution,
or
payor
shall
not
be
30
discriminated
against
because
the
practitioner,
institution,
or
31
payor
takes
certain
actions,
as
described
in
the
bill,
relating
32
to
a
suspected
violation
of
the
bill.
The
bill
prohibits
33
discrimination
against
a
practitioner,
institution,
or
payor
34
because
the
practitioner,
institution,
or
payor
discloses
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information
as
described
in
the
bill.
The
bill
is
not
to
1
be
construed
to
exempt
a
person
from
the
requirements
of
the
2
federal
Health
Insurance
Portability
and
Accountability
Act.
3
The
bill
also
provides
that
the
department
of
health
4
and
human
services
(HHS),
a
health
professional
licensing
5
board,
or
any
other
state
licensing
or
certifying
entity
of
6
a
practitioner,
institution,
or
payor
shall
not
reprimand,
7
sanction,
or
revoke
or
threaten
to
revoke
a
license
or
8
certification
of
a
practitioner,
institution,
or
payor
9
for
engaging
in
speech,
expressive
activity
(activity),
10
or
association
protected
under
the
first
amendment
unless
11
HHS,
the
licensing
board,
or
other
licensing
or
certifying
12
entity
demonstrates
by
clear
and
convincing
evidence
that
13
the
speech,
activity,
or
association
was
the
direct
cause
14
of
physical
harm
to
a
person
with
whom
the
practitioner,
15
institution,
or
payor
had
a
medical
practitioner-patient
or
16
medical
practitioner-client
relationship
within
the
three
17
years
immediately
preceding
the
incident
of
physical
harm.
18
Within
21
days
of
receiving
a
complaint
alleging
a
violation
19
of
speech,
activity,
or
association
as
described
in
the
bill,
20
HHS,
a
licensing
board,
or
other
licensing
or
certifying
entity
21
shall
provide
the
practitioner,
institution,
or
payor
with
a
22
copy
of
the
complaint.
If
HHS,
a
licensing
board,
or
other
23
licensing
or
certifying
entity
fails
to
provide
the
complaint
24
within
21
days,
HHS,
the
licensing
board,
or
other
certifying
25
entity
shall
pay
the
practitioner,
institution,
or
payor
an
26
administrative
penalty
of
$500
for
each
day
of
noncompliance.
27
If
HHS,
a
licensing
board,
or
other
licensing
or
certifying
28
entity
revokes
or
refuses
to
issue
a
certification
or
29
credential
to
a
practitioner,
institution,
or
payor
who
is
in
30
compliance
with
the
bill
and
did
not
provide
medical
advice
or
31
treatment
to
a
patient
or
client,
the
state
shall
not
contract
32
with,
recognize,
approve,
or
require
the
certification
or
33
credential
issued
or
approved
by
HHS,
the
licensing
board,
or
34
other
licensing
or
certifying
entity.
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The
bill
provides
that
it
is
unlawful
for
a
person
to
1
interfere
or
attempt
to
interfere
with
the
right
not
to
2
participate
in
or
pay
for
a
service,
or
with
the
whistleblower
3
or
free
speech
rights
and
protections
authorized
under
the
4
bill.
An
institution,
payor,
or
practitioner
injured
by
5
unlawful
interference
under
the
bill
is
entitled
to
bring
a
6
civil
action
that,
if
successful,
may
result
in
relief
as
7
detailed
in
the
bill.
The
bill
shall
not
be
construed
to
deny,
8
abrogate,
or
impair
a
common
law
or
statutory
right,
remedy,
9
or
prohibition.
An
additional
burden
or
expense
arising
from
10
another
practitioner’s,
institution’s,
or
payor’s
exercise
11
of
conscience
is
not
a
defense
to
a
violation
of
the
bill.
12
The
bill
prohibits
a
person
from
bringing
a
civil
action
13
against
a
person
who
declines
to
use
or
purchase
a
service
14
from
a
practitioner,
institution,
or
payor
exercising
their
15
conscience.
16
The
bill
includes
a
severability
clause.
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