Modifies provisions relating to abortion

EXPLANATION-Matter enclosed in bold-faced brackets [thus] in this bill is not enacted
and is intended to be omitted in the law.
SECOND REGULAR SESSION
SENATE BILL NO. 1692
103RD GENERAL ASSEMBLY
INTRODUCED BY SENATOR LEWIS.
4584S.01I KRISTINA MARTIN, Secretary
AN ACT
To repeal sections 188.015, 188.017, 188.020, 188.021, 188.027, 188.030, 188.033, 188.038,
188.039, 188.047, 188.052, 188.056, 188.057, 188.058, 188.075, 188.080, 188.230,
188.375, 192.665, 192.667, 197.150, 197.152, 197.158, 197.160, 197.165, 197.200,
197.205, 197.215, 197.220, 197.225, 197.230, 197.235, 197.240, 197.285, 197.287,
197.289, 197.293, 197.295, 334.100, 334.245, 334.735, 574.200, and 595.027, RSMo,
and to enact in lieu thereof twenty-four new sections relating to abortion.

Be it enacted by the General Assembly of the State of Missouri, as follows:
Section A. Sections 188.015, 188.017, 188.020, 188.021, 1
188.027, 188.030, 188.033, 188.038, 188.039, 188.047, 188.052, 2
188.056, 188.057, 188.058, 188.075, 188.080, 188.230, 188.375, 3
192.665, 192.667, 197.150, 197.152, 197.158, 197.160, 197.165, 4
197.200, 197.205, 197.215, 197.220, 197.225, 197.230, 197.235, 5
197.240, 197.285, 197.287, 197.289, 197.293, 197.295, 334.100, 6
334.245, 334.735, 574.200, and 595.027, RSMo, are repealed and 7
twenty-four new sections enacted in lieu thereof, to be known 8
as sections 188.015, 192.665, 192.667, 197.150, 197.152, 9
197.158, 197.160, 197.165, 197.200, 197.205, 197.215, 197.220, 10
197.225, 197.230, 197.235, 197.240, 197.285, 197.287, 197.289, 11
197.293, 197.295, 334.100, 334.735, and 595.027, to read as 12
follows:13
188.015. As used in this chapter, the following terms 1
mean: 2
(1) "Abortion": 3
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(a) The act of using or prescribing any instrument, 4
device, medicine, drug, or any other means or substance with 5
the intent to destroy the life of an embryo or fetus in his 6
or her mother's womb; or 7
(b) The intentional termination of the pregnancy of a 8
mother by using or prescribing any instrument, device, 9
medicine, drug, or other means or substance with an 10
intention other than to increase the probability of a live 11
birth or to remove a dead unborn child; 12
(2) "Abortion facility", a clinic, physician's office, 13
or any other place or facility in which abortions are 14
performed or induced other than a hospital; 15
(3) "Affiliate", a person who or entity that enters 16
into, with an abortion facility, a legal relationship 17
created or governed by at least one written instrument, 18
including a certificate of formation, a franchise agreement, 19
standards of affiliation, bylaws, or a license, that 20
demonstrates: 21
(a) Common ownership, management, or control between 22
the parties to the relationship; 23
(b) A franchise granted by the person or entity to the 24
affiliate; or 25
(c) The granting or extension of a license or other 26
agreement authorizing the affiliate to use the other 27
person's or entity's brand name, trademark, service mark, or 28
other registered identification mark; 29
(4) "Conception", the fertilization of the ovum of a 30
female by a sperm of a male; 31
(5) "Department", the department of health and senior 32
services; 33
(6) ["Down Syndrome", the same meaning as defined in 34
section 191.923; 35
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(7)] "Gestational age", length of pregnancy as 36
measured from the first day of the woman's last menstrual 37
period; 38
[(8)] (7) "Medical emergency", a condition which, 39
based on reasonable medical judgment, so complicates the 40
medical condition of a pregnant woman as to necessitate the 41
immediate abortion of her pregnancy to avert the death of 42
the pregnant woman or for which a delay will create a 43
serious risk of substantial and irreversible physical 44
impairment of a major bodily function of the pregnant woman; 45
[(9)] (8) "Physician", any person licensed to practice 46
medicine in this state by the state board of registration 47
for the healing arts; 48
[(10)] (9) "Reasonable medical judgment", a medical 49
judgment that would be made by a reasonably prudent 50
physician, knowledgeable about the case and the treatment 51
possibilities with respect to the medical conditions 52
involved; 53
[(11)] (10) "Unborn child", the offspring of human 54
beings from the moment of conception until birth and at 55
every stage of its biological development, including the 56
human conceptus, zygote, morula, blastocyst, embryo, and 57
fetus[; 58
(12) "Viability" or "viable", that stage of fetal 59
development when the life of the unborn child may be 60
continued indefinitely outside the womb by natural or 61
artificial life-supportive systems; 62
(13) "Viable pregnancy" or "viable intrauterine 63
pregnancy", in the first trimester of pregnancy, an 64
intrauterine pregnancy that can potentially result in a 65
liveborn baby]. 66
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192.665. As used in this section, section 192.667, and 1
sections 197.150 to 197.165, the following terms mean: 2
(1) "Charge data", information submitted by health 3
care providers on current charges for leading procedures and 4
diagnoses; 5
(2) "Charges by payer", information submitted by 6
hospitals on amount billed to Medicare, Medicaid, other 7
government sources and all nongovernment sources combined as 8
one data element; 9
(3) "Department", the department of health and senior 10
services; 11
(4) "Financial data", information submitted by 12
hospitals drawn from financial statements which includes the 13
balance sheet, income statement, charity care and bad debt 14
and charges by payer, prepared in accordance with generally 15
accepted accounting principles; 16
(5) "Health care provider", hospitals as defined in 17
section 197.020 and ambulatory surgical centers [and 18
abortion facilities] as defined in section 197.200; 19
(6) "Nosocomial infection", as defined by the federal 20
Centers for Disease Control and Prevention and applied to 21
infections within hospitals, ambulatory surgical centers, 22
[abortion facilities,] and other facilities; 23
(7) "Nosocomial infection incidence rate", a risk- 24
adjusted measurement of new cases of nosocomial infections 25
by procedure or device within a population over a given 26
period of time, with such measurements defined by rule of 27
the department pursuant to subsection 3 of section 192.667 28
for use by all hospitals, ambulatory surgical centers, 29
[abortion facilities,] and other facilities in complying 30
with the requirements of the Missouri nosocomial infection 31
control act of 2004; 32
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(8) "Other facility", a type of facility determined to 33
be a source of infections and designated by rule of the 34
department pursuant to subsection 11 of section 192.667; 35
(9) "Patient abstract data", data submitted by 36
hospitals which includes but is not limited to date of 37
birth, sex, race, zip code, county of residence, admission 38
date, discharge date, principal and other diagnoses, 39
including external causes, principal and other procedures, 40
procedure dates, total billed charges, disposition of the 41
patient and expected source of payment with sources 42
categorized according to Medicare, Medicaid, other 43
government, workers' compensation, all commercial payors 44
coded with a common code, self-pay, no charge and other. 45
192.667. 1. All health care providers shall at least 1
annually provide to the department charge data as required 2
by the department. All hospitals shall at least annually 3
provide patient abstract data and financial data as required 4
by the department. Hospitals as defined in section 197.020 5
shall report patient abstract data for outpatients and 6
inpatients. Ambulatory surgical centers [and abortion 7
facilities] as defined in section 197.200 shall provide 8
patient abstract data to the department. The department 9
shall specify by rule the types of information which shall 10
be submitted and the method of submission. 11
2. The department shall collect data on the incidence 12
of health care-associated infections from hospitals, 13
ambulatory surgical centers, [abortion facilities,] and 14
other facilities as necessary to generate the reports 15
required by this section. Hospitals, ambulatory surgical 16
centers, [abortion facilities,] and other facilities shall 17
provide such data in compliance with this section. In order 18
to streamline government and to eliminate duplicative 19
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reporting requirements, if the Centers for Medicare and 20
Medicaid Services, or its successor entity, requires 21
hospitals to submit health care-associated infection data, 22
then hospitals and the department shall not be required to 23
comply with the health care-associated infection data 24
reporting requirements of subsections 2 to 17 of this 25
section applicable to hospitals, except that the department 26
shall post a link on its website to publicly reported data 27
by hospitals on the Centers for Medicare and Medicaid 28
Services' Hospital Compare website, or its successor. 29
3. The department shall promulgate rules specifying 30
the standards and procedures for the collection, analysis, 31
risk adjustment, and reporting of the incidence of health 32
care-associated infections and the types of infections and 33
procedures to be monitored pursuant to subsection 13 of this 34
section. In promulgating such rules, the department shall: 35
(1) Use methodologies and systems for data collection 36
established by the federal Centers for Disease Control and 37
Prevention's National Healthcare Safety Network, or its 38
successor; and 39
(2) Consider the findings and recommendations of the 40
infection control advisory panel established pursuant to 41
section 197.165. 42
4. By January 1, 2017, the infection control advisory 43
panel created by section 197.165 shall make recommendations 44
to the department regarding the Centers for Medicare and 45
Medicaid Services' health care-associated infection data 46
collection, analysis, and public reporting requirements for 47
hospitals, ambulatory surgical centers, and other facilities 48
in the federal Centers for Disease Control and Prevention's 49
National Healthcare Safety Network, or its successor, in 50
lieu of all or part of the data collection, analysis, and 51
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public reporting requirements of this section. The advisory 52
panel recommendations shall address which hospitals shall be 53
required as a condition of licensure to use the National 54
Healthcare Safety Network for data collection; the use of 55
the National Healthcare Safety Network for risk adjustment 56
and analysis of hospital submitted data; and the use of the 57
Centers for Medicare and Medicaid Services' Hospital Compare 58
website, or its successor, for public reporting of the 59
incidence of health care-associated infection metrics. The 60
advisory panel shall consider the following factors in 61
developing its recommendation: 62
(1) Whether the public is afforded the same or greater 63
access to facility-specific infection control indicators and 64
metrics; 65
(2) Whether the data provided to the public is subject 66
to the same or greater accuracy of risk adjustment; 67
(3) Whether the public is provided with the same or 68
greater specificity of reporting of infections by type of 69
facility infections and procedures; 70
(4) Whether the data is subject to the same or greater 71
level of confidentiality of the identity of an individual 72
patient; 73
(5) Whether the National Healthcare Safety Network, or 74
its successor, has the capacity to receive, analyze, and 75
report the required data for all facilities; 76
(6) Whether the cost to implement the National 77
Healthcare Safety Network infection data collection and 78
reporting system is the same or less. 79
5. After considering the recommendations of the 80
infection control advisory panel, and provided that the 81
requirements of subsection 13 of this section can be met, 82
the department shall implement guidelines from the federal 83
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Centers for Disease Control and Prevention's National 84
Healthcare Safety Network, or its successor. It shall be a 85
condition of licensure for hospitals that meet the minimum 86
public reporting requirements of the National Healthcare 87
Safety Network and the Centers for Medicare and Medicaid 88
Services to participate in the National Healthcare Safety 89
Network, or its successor. Such hospitals shall permit the 90
National Healthcare Safety Network, or its successor, to 91
disclose facility-specific infection data to the department 92
as required under this section, and as necessary to provide 93
the public reports required by the department. It shall be 94
a condition of licensure for any ambulatory surgical center 95
[or abortion facility] which does not voluntarily 96
participate in the National Healthcare Safety Network, or 97
its successor, to submit facility-specific data to the 98
department as required under this section, and as necessary 99
to provide the public reports required by the department. 100
6. The department shall not require the resubmission 101
of data which has been submitted to the department of health 102
and senior services or the department of social services 103
under any other provision of law. The department of health 104
and senior services shall accept data submitted by 105
associations or related organizations on behalf of health 106
care providers by entering into binding agreements 107
negotiated with such associations or related organizations 108
to obtain data required pursuant to section 192.665 and this 109
section. A health care provider shall submit the required 110
information to the department of health and senior services: 111
(1) If the provider does not submit the required data 112
through such associations or related organizations; 113
(2) If no binding agreement has been reached within 114
ninety days of August 28, 1992, between the department of 115
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health and senior services and such associations or related 116
organizations; or 117
(3) If a binding agreement has expired for more than 118
ninety days. 119
7. Information obtained by the department under the 120
provisions of section 192.665 and this section shall not be 121
public information. Reports and studies prepared by the 122
department based upon such information shall be public 123
information and may identify individual health care 124
providers. The department of health and senior services may 125
authorize the use of the data by other research 126
organizations pursuant to the provisions of section 127
192.067. The department shall not use or release any 128
information provided under section 192.665 and this section 129
which would enable any person to determine any health care 130
provider's negotiated discounts with specific preferred 131
provider organizations or other managed care organizations. 132
The department shall not release data in a form which could 133
be used to identify a patient. Any violation of this 134
subsection is a class A misdemeanor. 135
8. The department shall undertake a reasonable number 136
of studies and publish information, including at least an 137
annual consumer guide, in collaboration with health care 138
providers, business coalitions and consumers based upon the 139
information obtained pursuant to the provisions of section 140
192.665 and this section. The department shall allow all 141
health care providers and associations and related 142
organizations who have submitted data which will be used in 143
any publication to review and comment on the publication 144
prior to its publication or release for general use. The 145
publication shall be made available to the public for a 146
reasonable charge. 147
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9. Any health care provider which continually and 148
substantially, as these terms are defined by rule, fails to 149
comply with the provisions of this section shall not be 150
allowed to participate in any program administered by the 151
state or to receive any moneys from the state. 152
10. A hospital, as defined in section 197.020, 153
aggrieved by the department's determination of ineligibility 154
for state moneys pursuant to subsection 9 of this section 155
may appeal as provided in section 197.071. An ambulatory 156
surgical center [or abortion facility] as defined in section 157
197.200 aggrieved by the department's determination of 158
ineligibility for state moneys pursuant to subsection 9 of 159
this section may appeal as provided in section 197.221. 160
11. The department of health may promulgate rules 161
providing for collection of data and publication of the 162
incidence of health care-associated infections for other 163
types of health facilities determined to be sources of 164
infections; except that, physicians' offices shall be exempt 165
from reporting and disclosure of such infections. 166
12. By January 1, 2017, the advisory panel shall 167
recommend and the department shall adopt in regulation with 168
an effective date of no later than January 1, 2018, the 169
requirements for the reporting of the following types of 170
infections as specified in this subsection: 171
(1) Infections associated with a minimum of four 172
surgical procedures for hospitals and a minimum of two 173
surgical procedures for ambulatory surgical centers that 174
meet the following criteria: 175
(a) Are usually associated with an elective surgical 176
procedure. An "elective surgical procedure" is a planned, 177
nonemergency surgical procedure that may be either medically 178
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required such as a hip replacement or optional such as 179
breast augmentation; 180
(b) Demonstrate a high priority aspect such as 181
affecting a large number of patients, having a substantial 182
impact for a smaller population, or being associated with 183
substantial cost, morbidity, or mortality; or 184
(c) Are infections for which reports are collected by 185
the National Healthcare Safety Network or its successor; 186
(2) Central line-related bloodstream infections; 187
(3) Health care-associated infections specified for 188
reporting by hospitals, ambulatory surgical centers, and 189
other health care facilities by the rules of the Centers for 190
Medicare and Medicaid Services to the federal Centers for 191
Disease Control and Prevention's National Healthcare Safety 192
Network, or its successor; and 193
(4) Other categories of infections that may be 194
established by rule by the department. 195
The department, in consultation with the advisory panel, 196
shall be authorized to collect and report data on subsets of 197
each type of infection described in this subsection. 198
13. In consultation with the infection control 199
advisory panel established pursuant to section 197.165, the 200
department shall develop and disseminate to the public 201
reports based on data compiled for a period of twelve 202
months. Such reports shall be updated quarterly and shall 203
show for each hospital, ambulatory surgical center, 204
[abortion facility,] and other facility metrics on risk- 205
adjusted health care-associated infections under this 206
section. 207
14. The types of infections under subsection 12 of 208
this section to be publicly reported shall be determined by 209
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the department by rule and shall be consistent with the 210
infections tracked by the National Healthcare Safety 211
Network, or its successor. 212
15. Reports published pursuant to subsection 13 of 213
this section shall be published and readily accessible on 214
the department's internet website. The reports shall be 215
distributed at least annually to the governor and members of 216
the general assembly. The department shall make such 217
reports available to the public for a period of at least two 218
years. 219
16. The Hospital Industry Data Institute shall publish 220
a report of Missouri hospitals'[,] and ambulatory surgical 221
centers'[, and abortion facilities'] compliance with 222
standardized quality of care measures established by the 223
federal Centers for Medicare and Medicaid Services for 224
prevention of infections related to surgical procedures. If 225
the Hospital Industry Data Institute fails to do so by July 226
31, 2008, and annually thereafter, the department shall be 227
authorized to collect information from the Centers for 228
Medicare and Medicaid Services or from hospitals[,] and 229
ambulatory surgical centers[, and abortion facilities] and 230
publish such information in accordance with this section. 231
17. The data collected or published pursuant to this 232
section shall be available to the department for purposes of 233
licensing hospitals[,] and ambulatory surgical centers[, and 234
abortion facilities] pursuant to chapter 197. 235
18. The department shall promulgate rules to implement 236
the provisions of section 192.131 and sections 197.150 to 237
197.160. Any rule or portion of a rule, as that term is 238
defined in section 536.010, that is created under the 239
authority delegated in this section shall become effective 240
only if it complies with and is subject to all of the 241
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provisions of chapter 536 and, if applicable, section 242
536.028. This section and chapter 536 are nonseverable and 243
if any of the powers vested with the general assembly 244
pursuant to chapter 536 to review, to delay the effective 245
date, or to disapprove and annul a rule are subsequently 246
held unconstitutional, then the grant of rulemaking 247
authority and any rule proposed or adopted after August 28, 248
2004, shall be invalid and void. 249
19. No later than August 28, 2017, each hospital, 250
excluding mental health facilities as defined in section 251
632.005, and each ambulatory surgical center [and abortion 252
facility] as defined in section 197.200, shall in 253
consultation with its medical staff establish an 254
antimicrobial stewardship program for evaluating the 255
judicious use of antimicrobials, especially antibiotics that 256
are the last line of defense against resistant infections. 257
The hospital's stewardship program and the results of the 258
program shall be monitored and evaluated by hospital quality 259
improvement departments and shall be available upon 260
inspection to the department. At a minimum, the 261
antimicrobial stewardship program shall be designed to 262
evaluate that hospitalized patients receive, in accordance 263
with accepted medical standards of practice, the appropriate 264
antimicrobial, at the appropriate dose, at the appropriate 265
time, and for the appropriate duration. 266
20. Hospitals described in subsection 19 of this 267
section shall meet the National Healthcare Safety Network 268
requirements for reporting antimicrobial usage or resistance 269
by using the Centers for Disease Control and Prevention's 270
Antimicrobial Use and Resistance (AUR) Module when 271
conditions of participation promulgated by the Centers for 272
Medicare and Medicaid Services requiring the electronic 273
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reporting of antibiotic use or antibiotic resistance by 274
hospitals become effective. When such antimicrobial usage 275
or resistance reporting takes effect, hospitals shall 276
authorize the National Healthcare Safety Network, or its 277
successor, to disclose to the department facility-specific 278
information reported to the AUR Module. Facility-specific 279
data on antibiotic usage and resistance collected under this 280
subsection shall not be disclosed to the public, but the 281
department may release case-specific information to other 282
facilities, physicians, and the public if the department 283
determines on a case-by-case basis that the release of such 284
information is necessary to protect persons in a public 285
health emergency. Nothing in this section shall prohibit a 286
hospital from voluntarily reporting antibiotic use or 287
antibiotic resistance data through the National Healthcare 288
Safety Network, or its successor, prior to the effective 289
date of the conditions of participation requiring the 290
reporting. 291
21. The department shall make a report to the general 292
assembly beginning January 1, 2018, and on every January 293
first thereafter on the incidence, type, and distribution of 294
antimicrobial-resistant infections identified in the state 295
and within regions of the state. 296
197.150. The department shall require that each 1
hospital, ambulatory surgical center, [abortion facility,] 2
and other facility have in place procedures for monitoring 3
and enforcing compliance with infection control regulations 4
and standards. Such procedures shall be coordinated with 5
administrative staff, personnel staff, and the quality 6
improvement program. Such procedures shall include, at a 7
minimum, requirements for the facility's infection control 8
program to conduct surveillance of personnel with a portion 9
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of the surveillance to be done in such manner that employees 10
and medical staff are observed without their knowledge of 11
such observation, provided that this unobserved surveillance 12
requirement shall not be considered to be grounds for 13
licensure enforcement action by the department until the 14
department establishes clear and verifiable criteria for 15
determining compliance. Such surveillance also may include 16
monitoring of the rate of use of hand hygiene products. 17
197.152. 1. Infection control officers as defined in 1
federal regulation and other hospital[,] and ambulatory 2
surgical center[, and abortion facility] employees shall be 3
protected against retaliation by the hospital[,] or 4
ambulatory surgical center[, or abortion facility] for 5
reporting infection control concerns pursuant to section 6
197.285 and shall be entitled to the full benefits of that 7
section. Such infection control officers shall report any 8
interference in the performance of their duties by their 9
supervisors to the hospital[,] or ambulatory surgical 10
center[, or abortion facility] compliance officer 11
established by and empowered to act pursuant to section 12
197.285. 13
2. Infection control officers as defined in federal 14
regulation shall also have the authority to order the 15
cessation of a practice that falls outside accepted 16
practices as defined by appropriate state and federal 17
regulatory agencies, accreditation organizations, or the 18
standards adopted by the Centers for Disease Control and 19
Prevention or the Association of Professionals in Infection 20
Control and Epidemiology. The hospital[,] or ambulatory 21
surgical center[, or abortion facility] may require that 22
such a cessation order of an infection control officer be 23
endorsed by the hospital[,] or ambulatory surgical center[, 24
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or abortion facility] chief executive officer or his or her 25
designee before taking effect. The hospital[,] or 26
ambulatory surgical center[, or abortion facility] infection 27
control committee shall convene as soon as possible to 28
review such cessation order and may overrule or sustain the 29
directive of the infection control officer. The department 30
shall promulgate rules governing documentation of such 31
events. 32
3. Members of the medical staff who report in good 33
faith infection control concerns to the hospital[,] or 34
ambulatory surgical center[, or abortion facility] 35
administration or medical staff leadership shall not be 36
subject to retaliation or discrimination for doing so. 37
Nothing in this section shall prevent or shield medical 38
staff members from being subject to professional review 39
actions for substandard care or breach of standards 40
established in hospital policy, rules, or medical staff 41
bylaws. 42
197.158. Every hospital[,] and ambulatory surgery 1
center[, and abortion facility] shall, beginning June 1, 2
2006, provide each patient an opportunity to submit to the 3
hospital, ambulatory surgical center, or abortion facility 4
administration complaints, comments, and suggestions related 5
to the care they received or their personal observations 6
related to the quality of care provided. The department 7
shall promulgate rules to implement this section. 8
197.160. The department of health and senior services 1
shall have access to all data and information held by 2
hospitals, ambulatory surgical centers, [abortion 3
facilities,] and other facilities related to their infection 4
control practices, rates, or treatments of infections. 5
Failure to provide such access shall be grounds for full or 6
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partial licensure suspension or revocation pursuant to 7
section 197.293, sections 197.010 to 197.100, or sections 8
197.200 to 197.240. If the department determines that the 9
hospital, ambulatory surgical center, [abortion facility,] 10
or other facility is willfully impeding access to such 11
information, the department shall be authorized to direct 12
all state agencies to suspend all or a portion of state 13
payments to such entity until such time as the desired 14
information is obtained by the department. 15
197.165. 1. The department shall appoint an 1
"Infection Control Advisory Panel" for the purposes of 2
implementing sections 192.131 and 192.667. 3
2. Members of the infection control advisory panel 4
shall include: 5
(1) Two public members; 6
(2) Three board-certified or board-eligible physicians 7
licensed pursuant to chapter 334 who are affiliated with a 8
Missouri hospital or medical school, active members of the 9
Society for Health Care Epidemiology of America, and have 10
demonstrated interest and expertise in health facility 11
infection control; 12
(3) One physician licensed pursuant to chapter 334 who 13
is active in the practice of medicine in Missouri and who 14
holds medical staff privileges at a Missouri hospital; 15
(4) Four infection control practitioners certified by 16
the certification board of infection control and 17
epidemiology, at least two of whom shall be practicing in a 18
rural hospital or setting and at least two of whom shall be 19
registered professional nurses licensed under chapter 335; 20
(5) A medical statistician with an advanced degree in 21
such specialty; 22
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(6) A clinical microbiologist with an advanced degree 23
in such specialty; 24
(7) Three employees of the department, representing 25
the functions of hospital[,] and ambulatory surgical 26
center[, and abortion facility] licensure, epidemiology and 27
health data analysis, who shall serve as ex officio 28
nonvoting members of the panel. 29
3. Reasonable expenses of the panel shall be paid from 30
private donations made specifically for that purpose to the 31
"Infection Control Advisory Panel Fund", which is hereby 32
created in the state treasury. If such donations are not 33
received from private sources, then the provisions of this 34
act shall be implemented without the advisory panel. 35
197.200. As used in sections 197.200 to 197.240, 1
unless the context clearly indicates otherwise, the 2
following terms mean: 3
(1) ["Abortion facility", as such term is defined in 4
section 188.015; 5
(2)] "Ambulatory surgical center", any public or 6
private establishment operated primarily for the purpose of 7
performing surgical procedures or primarily for the purpose 8
of performing childbirths, and which does not provide 9
services or other accommodations for patients to stay more 10
than twenty-three hours within the establishment, provided, 11
however, that nothing in this definition shall be construed 12
to include the offices of dentists currently licensed 13
pursuant to chapter 332; 14
[(3)] (2) "Dentist", any person currently licensed to 15
practice dentistry pursuant to chapter 332; 16
[(4)] (3) "Department", the department of health and 17
senior services; 18
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[(5)] (4) "Governmental unit", any city, county or 19
other political subdivision of this state, or any 20
department, division, board or other agency of any political 21
subdivision of this state; 22
[(6)] (5) "Person", any individual, firm, partnership, 23
corporation, company, or association and the legal 24
successors thereof; 25
[(7)] (6) "Physician", any person currently licensed 26
to practice medicine pursuant to chapter 334; 27
[(8)] (7) "Podiatrist", any person currently licensed 28
to practice podiatry pursuant to chapter 330. 29
197.205. 1. No person or governmental unit acting 1
severally or jointly with any other person or governmental 2
unit shall establish, conduct or maintain an ambulatory 3
surgical center [or abortion facility] in this state without 4
a license under sections 197.200 to 197.240 issued by the 5
department of health and senior services. 6
2. Nothing in sections 197.200 to 197.240 shall be 7
construed to impair or abridge the authority of a 8
governmental unit to license ambulatory surgical centers [or 9
abortion facilities], provided that any ordinance of a 10
governmental unit shall require compliance with all rules, 11
regulations, and standards adopted by the department to 12
implement the provisions of sections 197.200 to 197.240. 13
197.215. 1. Upon receipt of an application for a 1
license, the department of health and senior services shall 2
issue a license if the applicant and ambulatory surgical 3
center facilities [or abortion facilities] meet the 4
requirements established under sections 197.200 to 197.240, 5
and have provided affirmative evidence that: 6
(1) Each member of the surgical staff is a physician, 7
dentist or podiatrist currently licensed to practice in 8
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Missouri[, and each person authorized to perform or induce 9
abortions is a physician currently licensed to practice in 10
Missouri]; 11
(2) Surgical procedures in ambulatory surgical centers 12
shall be performed only by physicians, dentists or 13
podiatrists, who at the time are privileged to perform 14
surgical procedures in at least one licensed hospital in the 15
community in which the ambulatory surgical center is 16
located, thus providing assurance to the public that 17
patients treated in the center shall receive continuity of 18
care should the services of a hospital be required; 19
alternatively, applicant shall submit a copy of a current 20
working agreement with at least one licensed hospital in the 21
community in which the ambulatory surgical center is 22
located, guaranteeing the transfer and admittance of 23
patients for emergency treatment whenever necessary; 24
(3) Continuous physician services or registered 25
professional nursing services are provided whenever a 26
patient is in the facility; 27
(4) Adequate medical records for each patient are to 28
be maintained. 29
2. Upon receipt of an application for a license, or 30
the renewal thereof, the department shall issue or renew the 31
license if the applicant and program meet the requirements 32
established under sections 197.200 to 197.240. Each license 33
shall be issued only for the persons and premises named in 34
the application. A license, unless sooner suspended or 35
revoked, shall be issued for a period of one year. 36
3. Each license shall be issued only for the premises 37
and persons or governmental units named in the application, 38
and shall not be transferable or assignable except with the 39
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written consent of the department. Licenses shall be posted 40
in a conspicuous place on the licensed premises. 41
4. If, during the period in which an ambulatory 42
surgical center license [or an abortion facility license] is 43
in effect, the license holder or operator legally transfers 44
operational responsibilities by any process to another 45
person as defined in section 197.200, an application shall 46
be made for the issuance of a new license to become 47
effective on the transfer date. 48
197.220. The department of health and senior services 1
may deny, suspend or revoke a license in any case in which 2
the department finds that there has been a substantial 3
failure to comply with the requirements of sections 197.200 4
to 197.240, or in any case in which the director of the 5
department makes a finding that: 6
(1) The applicant, or if the applicant is a firm, 7
partnership or association, any of its members, or if a 8
corporation, any of its officers or directors, or the person 9
designated to manage or supervise the facility, has been 10
finally adjudicated and found guilty, or entered a plea of 11
guilty or nolo contendere, in a criminal prosecution under 12
the laws of any state or of the United States, for any 13
offense reasonably related to the qualifications, functions, 14
or duties of an ambulatory surgical center [or of an 15
abortion facility], or for any offense an essential element 16
of which is fraud, dishonesty, or an act of violence, or for 17
any offense involving moral turpitude, whether or not 18
sentence is imposed; 19
(2) The licensure status or record of the applicant, 20
or if the applicant is a firm, partnership or association, 21
of any of its members, or if a corporation, of any of its 22
officers or directors, or of the person designated to manage 23
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or supervise the facility, from any other state, federal 24
district or land, territory or commonwealth of the United 25
States, or of any foreign country where the applicant has 26
done business in a similar capacity indicates that granting 27
a license to the applicant would be detrimental to the 28
interests of the public. 29
197.225. 1. The department of health and senior 1
services may adopt such reasonable rules, regulations, and 2
standards for the types of services provided as are 3
necessary to carry out the provisions of sections 197.200 to 4
197.240, and to assure quality patient care and patient 5
safety, which shall include, but not be limited to: 6
(1) Construction of the facility including, but not 7
limited to, plumbing, heating, lighting, and ventilation 8
which should insure the health, safety, comfort, and privacy 9
of patients and protection from fire hazard; 10
(2) Number, qualifications, and organization of all 11
personnel, having responsibility for any part of the care 12
provided to the patients; 13
(3) Equipment essential to the health, welfare, and 14
safety of the patients; 15
(4) Facilities, programs, and services to be provided 16
in connection with the care of patients in ambulatory 17
surgical centers; and 18
(5) Procedures for peer review and for receiving and 19
investigating complaints regarding any ambulatory surgical 20
center or any physician, dentist, podiatrist, nurse, 21
assistant, manager, supervisor, or employee practicing or 22
working in any such facility. 23
2. The department of health and senior services may 24
adopt separate rules, regulations, or standards to apply to 25
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ambulatory surgical centers [and to apply to abortion 26
facilities]. 27
[3. Abortion facilities shall be required to maintain 28
a written protocol for managing medical emergencies and the 29
transfer of patients requiring further emergency care to a 30
hospital within a reasonable distance from the abortion 31
facility.] 32
197.230. 1. The department of health and senior 1
services shall make, or cause to be made, such inspections 2
and investigations as it deems necessary. The department 3
may delegate its powers and duties to investigate and 4
inspect ambulatory surgical centers [or abortion facilities] 5
to an official of a political subdivision having a 6
population of at least four hundred fifty thousand if such 7
political subdivision is deemed qualified by the department 8
to inspect and investigate ambulatory surgical centers. The 9
official so designated shall submit a written report of his 10
or her findings to the department and the department may 11
accept the recommendations of such official if it determines 12
that the facility inspected meets minimum standards 13
established pursuant to sections 197.200 to 197.240. 14
2. [In the case of any abortion facility, the 15
department shall make or cause to be made an unannounced on- 16
site inspection and investigation at least annually. Such 17
on-site inspection and investigation shall include, but not 18
be limited to, the following areas: 19
(1) Compliance with all statutory and regulatory 20
requirements for an abortion facility, including 21
requirements that the facility maintain adequate staffing 22
and equipment to respond to medical emergencies; 23
(2) Compliance with the provisions of chapter 188; and 24
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(3) Compliance with the requirement in section 197.215 25
that continuous physician services or registered 26
professional nursing services be provided whenever a patient 27
is in the facility. 28
3.] Inspection, investigation, and quality assurance 29
reports shall be made available to the public. Any portion 30
of a report may be redacted when made publicly available if 31
such portion would disclose information that is not subject 32
to disclosure under the law. 33
197.235. 1. Any person operating, conducting, 1
managing, or establishing an ambulatory surgical center [or 2
abortion facility] without a license required by sections 3
197.200 to 197.240 is guilty of a class A misdemeanor and, 4
upon conviction, shall be subject to a fine of not more than 5
five hundred dollars. Each day of continuing violation 6
shall constitute a separate offense. 7
2. The attorney general shall represent the department 8
of health and senior services and shall institute an action 9
in the name of the state for injunctive or other relief 10
against any person or governmental unit to restrain or 11
prevent the establishment, conduct, management, or operation 12
of an ambulatory surgical center [or abortion facility] 13
without a license issued pursuant to the provisions of 14
sections 197.200 to 197.240. 15
3. Any person operating, conducting, managing, or 16
establishing an ambulatory surgical center [or abortion 17
facility] who, in the course of advertising, promoting, or 18
otherwise publicizing the activities, business, location, or 19
any other matter concerning the operations of said 20
ambulatory surgical center [or abortion facility], uses or 21
employs in any manner the words "State, Missouri, State of 22
Missouri, Department of Health and Senior Services, the 23
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initials 'Mo.'," or any emblem of the state of Missouri or 24
the department of health and senior services, for the 25
purpose of conveying or in any manner reasonably calculated 26
to convey the false impression that the state of Missouri or 27
any department, agency, bureau, or instrumentality thereof 28
is involved in the business of said ambulatory surgical 29
center [or abortion facility], or took part in said 30
advertisement, promotion, publicity, or other statement, 31
shall be subject to a fine of one hundred dollars per day 32
for each day during the period beginning with the day said 33
advertisement, promotion, publication, or statement first 34
appears and ending on the day on which it is withdrawn. 35
197.240. After September 28, 1975, no individual or 1
group health insurance policy of insurance providing 2
coverage on an expense incurred basis, nor individual or 3
group service or indemnity type contract issued by a 4
nonprofit corporation, nor any self-insured group health 5
benefit plan or trust, of any kind or description, shall be 6
issued or payment accepted therefor in renewal or 7
continuation thereof unless coverage for any service 8
performed in an ambulatory surgical center [or abortion 9
facility] is provided for therein if such service would have 10
been covered under the terms of the policy or contract as an 11
eligible inpatient service, except as provided in section 12
376.805. Nothing in this section shall apply to a group 13
contract, plan or trust which provides health care and 14
surgical care directly to its members and their dependents. 15
Nothing in this section shall be construed to mandate 16
coverage under an individual or group health insurance 17
policy of insurance providing coverage on an expense- 18
incurred basis, or an individual or group service or 19
indemnity type contract issued by a nonprofit corporation, 20
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or any self-insured group health benefit plan or trust, of 21
any kind or description, to provide health insurance for 22
services which are usually performed in a physician's office. 23
197.285. 1. Hospitals[,] and ambulatory surgical 1
centers[, and abortion facilities] shall establish and 2
implement a written policy adopted by each hospital[,] and 3
ambulatory surgical center[, and abortion facility] relating 4
to the protections for employees who disclose information 5
pursuant to subsection 2 of this section. This policy shall 6
include a time frame for completion of investigations 7
related to complaints, not to exceed thirty days, and a 8
method for notifying the complainant of the disposition of 9
the investigation. This policy shall be submitted to the 10
department of health and senior services to verify 11
implementation. At a minimum, such policy shall include the 12
following provisions: 13
(1) No supervisor or individual with authority to hire 14
or fire in a hospital[,] or ambulatory surgical center[, or 15
abortion facility] shall prohibit employees from disclosing 16
information pursuant to subsection 2 of this section; 17
(2) No supervisor or individual with authority to hire 18
or fire in a hospital[,] or ambulatory surgical center[, or 19
abortion facility] shall use or threaten to use his or her 20
supervisory authority to knowingly discriminate against, 21
dismiss, penalize or in any way retaliate against or harass 22
an employee because the employee in good faith reported or 23
disclosed any information pursuant to subsection 2 of this 24
section, or in any way attempt to dissuade, prevent or 25
interfere with an employee who wishes to report or disclose 26
such information; 27
(3) Establish a program to identify a compliance 28
officer who is a designated person responsible for 29
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administering the reporting and investigation process and an 30
alternate person should the primary designee be implicated 31
in the report. 32
2. This section shall apply to information disclosed 33
or reported in good faith by an employee concerning: 34
(1) Alleged facility mismanagement or fraudulent 35
activity; 36
(2) Alleged violations of applicable federal or state 37
laws or administrative rules concerning patient care, 38
patient safety or facility safety; or 39
(3) The ability of employees to successfully perform 40
their assigned duties. 41
All information disclosed, collected and maintained pursuant 42
to this subsection and pursuant to the written policy 43
requirements of this section shall be accessible to the 44
department of health and senior services at all times and 45
shall be reviewed by the department of health and senior 46
services at least annually. Complainants shall be notified 47
of the department of health and senior services' access to 48
such information and of the complainant's right to notify 49
the department of health and senior services of any 50
information concerning alleged violations of applicable 51
federal or state laws or administrative rules concerning 52
patient care, patient safety or facility safety. 53
3. Prior to any disclosure to individuals or agencies 54
other than the department of health and senior services, 55
employees wishing to make a disclosure pursuant to the 56
provisions of this section shall first report to the 57
individual or individuals designated by the hospital[,] or 58
ambulatory surgical center[, or abortion facility] pursuant 59
to subsection 1 of this section. 60
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4. If the compliance officer, compliance committee or 61
management official discovers credible evidence of 62
misconduct from any source and, after a reasonable inquiry, 63
has reason to believe that the misconduct may violate 64
criminal, civil or administrative law, then the hospital[,] 65
or ambulatory surgical center[, or abortion facility] shall 66
report the existence of misconduct to the appropriate 67
governmental authority within a reasonable period, but not 68
more than seven days after determining that there is 69
credible evidence of a violation. 70
5. Reports made to the department of health and senior 71
services shall be subject to the provisions of section 72
197.477, provided that the restrictions of section 197.477 73
shall not be construed to limit the employee's ability to 74
subpoena from the original source the information reported 75
to the department pursuant to this section. 76
6. Each written policy shall allow employees making a 77
report who wish to remain anonymous to do so, and shall 78
include safeguards to protect the confidentiality of the 79
employee making the report, the confidentiality of patients 80
and the integrity of data, information and medical records. 81
7. Each hospital[,] and ambulatory surgical center[, 82
and abortion facility] shall, within forty-eight hours of 83
the receipt of a report, notify the employee that his or her 84
report has been received and is being reviewed. 85
197.287. By July 1, 2001, all hospitals and ambulatory 1
surgical centers[, and by July 1, 2018, all abortion 2
facilities] shall provide training programs, with measurable 3
minimal training outcomes relating to quality of patient 4
care and patient safety, to all unlicensed staff providing 5
patient care in their facility within ninety days of the 6
beginning date of employment. Standards for such training 7
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shall be established by the department of health and senior 8
services by rule. It shall be a requirement of hospital[,] 9
and ambulatory surgical center[, and abortion facility] 10
licensure pursuant to this chapter that all hospitals[,] and 11
ambulatory surgical centers[, and abortion facilities] 12
submit documentation to the department of health and senior 13
services on the training program used. 14
197.289. 1. All hospitals[,] and ambulatory surgical 1
centers[, and abortion facilities] shall develop and 2
implement a methodology which ensures adequate nurse 3
staffing that will meet the needs of patients. At a 4
minimum, there shall be on duty at all times a sufficient 5
number of licensed registered nurses to provide patient care 6
requiring the judgment and skills of a licensed registered 7
nurse and to oversee the activities of all nursing personnel. 8
2. There shall be sufficient licensed and ancillary 9
nursing personnel on duty on each nursing unit to meet the 10
needs of each patient in accordance with accepted standards 11
of quality patient care. 12
197.293. 1. In addition to the powers established in 1
sections 197.070 and 197.220, the department of health and 2
senior services shall use the following standards for 3
enforcing hospital[,] and ambulatory surgical center[, and 4
abortion facility] licensure regulations promulgated to 5
enforce the provisions of sections 197.010 to 197.120, 6
sections 197.150 to 197.165, and sections 197.200 to 197.240: 7
(1) Upon notification of a deficiency in meeting 8
regulatory standards, the hospital[,] or ambulatory surgical 9
center[, or abortion facility] shall develop and implement a 10
plan of correction approved by the department which 11
includes, but is not limited to, the specific type of 12
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corrective action to be taken and an estimated time to 13
complete such action; 14
(2) If the plan as implemented does not correct the 15
deficiency, the department may either: 16
(a) Direct the hospital[,] or ambulatory surgical 17
center[, or abortion facility] to develop and implement a 18
plan of correction pursuant to subdivision (1) of this 19
subsection; or 20
(b) Require the hospital[,] or ambulatory surgical 21
center[, or abortion facility] to implement a plan of 22
correction developed by the department; 23
(3) If there is a continuing deficiency after 24
implementation of the plan of correction pursuant to 25
subdivision (2) of this subsection and the hospital[,] or 26
ambulatory surgical center[, or abortion facility] has had 27
an opportunity to correct such deficiency, the department 28
may restrict new inpatient admissions or outpatient entrants 29
to the service or services affected by such deficiency; 30
(4) If there is a continuing deficiency after the 31
department restricts new inpatient admissions or outpatient 32
entrants to the service or services pursuant to subdivision 33
(3) of this subsection and the hospital[,] or ambulatory 34
surgical center[, or abortion facility] has had an 35
opportunity to correct such deficiency, the department may 36
suspend operations in all or part of the service or services 37
affected by such deficiency; 38
(5) If there is a continuing deficiency after 39
suspension of operations pursuant to subdivision (4) of this 40
subsection, the department may deny, suspend or revoke the 41
hospital's[,] or ambulatory surgical center's[, or abortion 42
facility's] license pursuant to section 197.070 or section 43
197.220. 44
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2. Notwithstanding the provisions of subsection 1 of 45
this section to the contrary, if a deficiency in meeting 46
licensure standards presents an immediate and serious threat 47
to the patients' health and safety, the department may, 48
based on the scope and severity of the deficiency, restrict 49
access to the service or services affected by the deficiency 50
until the hospital[,] or ambulatory surgical center[, or 51
abortion facility] has developed and implemented an approved 52
plan of correction. Decisions as to whether a deficiency 53
constitutes an immediate and serious threat to the patients' 54
health and safety shall be made in accordance with 55
guidelines established pursuant to regulation of the 56
department of health and senior services and such decisions 57
shall be approved by the bureau of health facility licensing 58
in the department of health and senior services, or its 59
successor agency, or by a person authorized by the 60
regulations to approve such decisions in the absence of the 61
director. 62
197.295. 1. A hospital[,] or ambulatory surgical 1
center[, or abortion facility] aggrieved by a decision of 2
the department pursuant to the provisions of paragraph (b) 3
of subdivision (2) and subdivisions (3), (4) and (5) of 4
subsection 1 of section 197.293 may appeal such decision to 5
the administrative hearing commission pursuant to section 6
197.071 or section 197.221, and seek judicial review 7
pursuant to section 621.145. An appeal of an action to 8
restrict new inpatient admissions or outpatient entrants, 9
suspend operations or revoke a license shall be heard on an 10
expedited basis by the administrative hearing commission. 11
The hospital[,] or ambulatory surgical center[, or abortion 12
facility] may apply to the administrative hearing commission 13
for an order to stay or suspend any such departmental action 14
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pending the commission's findings and ruling as authorized 15
by section 621.035. 16
2. If both the department and the hospital[,] or 17
ambulatory surgical center[, or abortion facility] agree to 18
do so, prior to an appeal to the administrative hearing 19
commission pursuant to section 197.071 or section 197.221, 20
an official action of the department made pursuant to 21
sections 197.010 to 197.120 or sections 197.200 to 197.240 22
may be appealed to a departmental hearing officer. The 23
department of health and senior services shall promulgate 24
rules specifying the qualifications of such a hearing 25
officer, establish procedures to ensure impartial decisions 26
and provide for comparable appeal remedies when a 27
departmental hearing officer is unavailable. 28
334.100. 1. The board may refuse to issue or renew 1
any certificate of registration or authority, permit or 2
license required pursuant to this chapter for one or any 3
combination of causes stated in subsection 2 of this 4
section. The board shall notify the applicant in writing of 5
the reasons for the refusal and shall advise the applicant 6
of the applicant's right to file a complaint with the 7
administrative hearing commission as provided by chapter 8
621. As an alternative to a refusal to issue or renew any 9
certificate, registration or authority, the board may, at 10
its discretion, issue a license which is subject to 11
probation, restriction or limitation to an applicant for 12
licensure for any one or any combination of causes stated in 13
subsection 2 of this section. The board's order of 14
probation, limitation or restriction shall contain a 15
statement of the discipline imposed, the basis therefor, the 16
date such action shall become effective, and a statement 17
that the applicant has thirty days to request in writing a 18
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hearing before the administrative hearing commission. If 19
the board issues a probationary, limited or restricted 20
license to an applicant for licensure, either party may file 21
a written petition with the administrative hearing 22
commission within thirty days of the effective date of the 23
probationary, limited or restricted license seeking review 24
of the board's determination. If no written request for a 25
hearing is received by the administrative hearing commission 26
within the thirty-day period, the right to seek review of 27
the board's decision shall be considered as waived. 28
2. The board may cause a complaint to be filed with 29
the administrative hearing commission as provided by chapter 30
621 against any holder of any certificate of registration or 31
authority, permit or license required by this chapter or any 32
person who has failed to renew or has surrendered the 33
person's certificate of registration or authority, permit or 34
license for any one or any combination of the following 35
causes: 36
(1) Use of any controlled substance, as defined in 37
chapter 195, or alcoholic beverage to an extent that such 38
use impairs a person's ability to perform the work of any 39
profession licensed or regulated by this chapter; 40
(2) The person has been finally adjudicated and found 41
guilty, or entered a plea of guilty or nolo contendere, in a 42
criminal prosecution under the laws of any state or of the 43
United States, for any offense reasonably related to the 44
qualifications, functions or duties of any profession 45
licensed or regulated pursuant to this chapter, for any 46
offense involving fraud, dishonesty or an act of violence, 47
or for any offense involving moral turpitude, whether or not 48
sentence is imposed; 49
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(3) Use of fraud, deception, misrepresentation or 50
bribery in securing any certificate of registration or 51
authority, permit or license issued pursuant to this chapter 52
or in obtaining permission to take any examination given or 53
required pursuant to this chapter; 54
(4) Misconduct, fraud, misrepresentation, dishonesty, 55
unethical conduct or unprofessional conduct in the 56
performance of the functions or duties of any profession 57
licensed or regulated by this chapter, including, but not 58
limited to, the following: 59
(a) Obtaining or attempting to obtain any fee, charge, 60
tuition or other compensation by fraud, deception or 61
misrepresentation; willfully and continually overcharging or 62
overtreating patients; or charging for visits to the 63
physician's office which did not occur unless the services 64
were contracted for in advance, or for services which were 65
not rendered or documented in the patient's records; 66
(b) Attempting, directly or indirectly, by way of 67
intimidation, coercion or deception, to obtain or retain a 68
patient or discourage the use of a second opinion or 69
consultation; 70
(c) Willfully and continually performing inappropriate 71
or unnecessary treatment, diagnostic tests or medical or 72
surgical services; 73
(d) Delegating professional responsibilities to a 74
person who is not qualified by training, skill, competency, 75
age, experience or licensure to perform such 76
responsibilities; 77
(e) Misrepresenting that any disease, ailment or 78
infirmity can be cured by a method, procedure, treatment, 79
medicine or device; 80
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(f) Performing or prescribing medical services which 81
have been declared by board rule to be of no medical or 82
osteopathic value; 83
(g) Final disciplinary action by any professional 84
medical or osteopathic association or society or licensed 85
hospital or medical staff of such hospital in this or any 86
other state or territory, whether agreed to voluntarily or 87
not, and including, but not limited to, any removal, 88
suspension, limitation, or restriction of the person's 89
license or staff or hospital privileges, failure to renew 90
such privileges or license for cause, or other final 91
disciplinary action, if the action was in any way related to 92
unprofessional conduct, professional incompetence, 93
malpractice or any other violation of any provision of this 94
chapter; 95
(h) Signing a blank prescription form; or dispensing, 96
prescribing, administering or otherwise distributing any 97
drug, controlled substance or other treatment without 98
sufficient examination including failing to establish a 99
valid physician-patient relationship pursuant to section 100
334.108, or for other than medically accepted therapeutic or 101
experimental or investigative purposes duly authorized by a 102
state or federal agency, or not in the course of 103
professional practice, or not in good faith to relieve pain 104
and suffering, or not to cure an ailment, physical infirmity 105
or disease, except as authorized in section 334.104; 106
(i) Exercising influence within a physician-patient 107
relationship for purposes of engaging a patient in sexual 108
activity; 109
(j) Being listed on any state or federal sexual 110
offender registry; 111
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(k) Terminating the medical care of a patient without 112
adequate notice or without making other arrangements for the 113
continued care of the patient; 114
(l) Failing to furnish details of a patient's medical 115
records to other treating physicians or hospitals upon 116
proper request; or failing to comply with any other law 117
relating to medical records; 118
(m) Failure of any applicant or licensee to cooperate 119
with the board during any investigation; 120
(n) Failure to comply with any subpoena or subpoena 121
duces tecum from the board or an order of the board; 122
(o) Failure to timely pay license renewal fees 123
specified in this chapter; 124
(p) Violating a probation agreement, order, or other 125
settlement agreement with this board or any other licensing 126
agency; 127
(q) Failing to inform the board of the physician's 128
current residence and business address; 129
(r) Advertising by an applicant or licensee which is 130
false or misleading, or which violates any rule of the 131
board, or which claims without substantiation the positive 132
cure of any disease, or professional superiority to or 133
greater skill than that possessed by any other physician. 134
An applicant or licensee shall also be in violation of this 135
provision if the applicant or licensee has a financial 136
interest in any organization, corporation or association 137
which issues or conducts such advertising; 138
(s) Any other conduct that is unethical or 139
unprofessional involving a minor; 140
(5) Any conduct or practice which is or might be 141
harmful or dangerous to the mental or physical health of a 142
patient or the public; or incompetency, gross negligence or 143
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repeated negligence in the performance of the functions or 144
duties of any profession licensed or regulated by this 145
chapter. For the purposes of this subdivision, "repeated 146
negligence" means the failure, on more than one occasion, to 147
use that degree of skill and learning ordinarily used under 148
the same or similar circumstances by the member of the 149
applicant's or licensee's profession; 150
(6) Violation of, or attempting to violate, directly 151
or indirectly, or assisting or enabling any person to 152
violate, any provision of this chapter or chapter 324, or of 153
any lawful rule or regulation adopted pursuant to this 154
chapter or chapter 324; 155
(7) Impersonation of any person holding a certificate 156
of registration or authority, permit or license or allowing 157
any person to use his or her certificate of registration or 158
authority, permit, license or diploma from any school; 159
(8) Revocation, suspension, restriction, modification, 160
limitation, reprimand, warning, censure, probation or other 161
final disciplinary action against the holder of or applicant 162
for a license or other right to practice any profession 163
regulated by this chapter by another state, territory, 164
federal agency or country, whether or not voluntarily agreed 165
to by the licensee or applicant, including, but not limited 166
to, the denial of licensure, surrender of the license, 167
allowing the license to expire or lapse, or discontinuing or 168
limiting the practice of medicine while subject to an 169
investigation or while actually under investigation by any 170
licensing authority, medical facility, branch of the Armed 171
Forces of the United States of America, insurance company, 172
court, agency of the state or federal government, or 173
employer; 174
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(9) A person is finally adjudged incapacitated or 175
disabled by a court of competent jurisdiction; 176
(10) Assisting or enabling any person to practice or 177
offer to practice any profession licensed or regulated by 178
this chapter who is not registered and currently eligible to 179
practice pursuant to this chapter; or knowingly performing 180
any act which in any way aids, assists, procures, advises, 181
or encourages any person to practice medicine who is not 182
registered and currently eligible to practice pursuant to 183
this chapter. A physician who works in accordance with 184
standing orders or protocols or in accordance with the 185
provisions of section 334.104 shall not be in violation of 186
this subdivision; 187
(11) Issuance of a certificate of registration or 188
authority, permit or license based upon a material mistake 189
of fact; 190
(12) Failure to display a valid certificate or license 191
if so required by this chapter or any rule promulgated 192
pursuant to this chapter; 193
(13) Violation of the drug laws or rules and 194
regulations of this state, including but not limited to any 195
provision of chapter 195, any other state, or the federal 196
government; 197
(14) Knowingly making, or causing to be made, or 198
aiding, or abetting in the making of, a false statement in 199
any birth, death or other certificate or document executed 200
in connection with the practice of the person's profession; 201
(15) Knowingly making a false statement, orally or in 202
writing to the board; 203
(16) Soliciting patronage in person or by agents or 204
representatives, or by any other means or manner, under the 205
person's own name or under the name of another person or 206
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concern, actual or pretended, in such a manner as to 207
confuse, deceive, or mislead the public as to the need or 208
necessity for or appropriateness of health care services for 209
all patients, or the qualifications of an individual person 210
or persons to diagnose, render, or perform health care 211
services; 212
(17) Using, or permitting the use of, the person's 213
name under the designation of "Doctor", "Dr.", "M.D.", or 214
"D.O.", or any similar designation with reference to the 215
commercial exploitation of any goods, wares or merchandise; 216
(18) Knowingly making or causing to be made a false 217
statement or misrepresentation of a material fact, with 218
intent to defraud, for payment pursuant to the provisions of 219
chapter 208 or chapter 630 or for payment from Title XVIII 220
or Title XIX of the Social Security Act; 221
(19) Failure or refusal to properly guard against 222
contagious, infectious or communicable diseases or the 223
spread thereof; maintaining an unsanitary office or 224
performing professional services under unsanitary 225
conditions; or failure to report the existence of an 226
unsanitary condition in the office of a physician or in any 227
health care facility to the board, in writing, within thirty 228
days after the discovery thereof; 229
(20) Any candidate for licensure or person licensed to 230
practice as a physical therapist, paying or offering to pay 231
a referral fee or evaluating or treating a patient in a 232
manner inconsistent with section 334.506; 233
(21) Any candidate for licensure or person licensed to 234
practice as a physical therapist, treating or attempting to 235
treat ailments or other health conditions of human beings 236
other than by professional physical therapy and as 237
authorized by sections 334.500 to 334.620; 238
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(22) Any person licensed to practice as a physician or 239
surgeon, requiring, as a condition of the physician-patient 240
relationship, that the patient receive prescribed drugs, 241
devices or other professional services directly from 242
facilities of that physician's office or other entities 243
under that physician's ownership or control. A physician 244
shall provide the patient with a prescription which may be 245
taken to the facility selected by the patient and a 246
physician knowingly failing to disclose to a patient on a 247
form approved by the advisory commission for professional 248
physical therapists as established by section 334.625 which 249
is dated and signed by a patient or guardian acknowledging 250
that the patient or guardian has read and understands that 251
the physician has a pecuniary interest in a physical therapy 252
or rehabilitation service providing prescribed treatment and 253
that the prescribed treatment is available on a competitive 254
basis. This subdivision shall not apply to a referral by 255
one physician to another physician within a group of 256
physicians practicing together; 257
(23) A pattern of personal use or consumption of any 258
controlled substance unless it is prescribed, dispensed or 259
administered by another physician who is authorized by law 260
to do so; 261
(24) Habitual intoxication or dependence on alcohol, 262
evidence of which may include more than one alcohol-related 263
enforcement contact as defined by section 302.525; 264
(25) Failure to comply with a treatment program or an 265
aftercare program entered into as part of a board order, 266
settlement agreement or licensee's professional health 267
program; 268
(26) Revocation, suspension, limitation, probation, or 269
restriction of any kind whatsoever of any controlled 270
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substance authority, whether agreed to voluntarily or not, 271
or voluntary termination of a controlled substance authority 272
while under investigation[; 273
(27) For a physician to operate, conduct, manage, or 274
establish an abortion facility, or for a physician to 275
perform an abortion in an abortion facility, if such 276
facility comes under the definition of an ambulatory 277
surgical center pursuant to sections 197.200 to 197.240, and 278
such facility has failed to obtain or renew a license as an 279
ambulatory surgical center]. 280
3. Collaborative practice arrangements, protocols and 281
standing orders shall be in writing and signed and dated by 282
a physician prior to their implementation. 283
4. After the filing of such complaint before the 284
administrative hearing commission, the proceedings shall be 285
conducted in accordance with the provisions of chapter 621. 286
Upon a finding by the administrative hearing commission that 287
the grounds, provided in subsection 2 of this section, for 288
disciplinary action are met, the board may, singly or in 289
combination, warn, censure or place the person named in the 290
complaint on probation on such terms and conditions as the 291
board deems appropriate for a period not to exceed ten 292
years, or may suspend the person's license, certificate or 293
permit for a period not to exceed three years, or restrict 294
or limit the person's license, certificate or permit for an 295
indefinite period of time, or revoke the person's license, 296
certificate, or permit, or administer a public or private 297
reprimand, or deny the person's application for a license, 298
or permanently withhold issuance of a license or require the 299
person to submit to the care, counseling or treatment of 300
physicians designated by the board at the expense of the 301
individual to be examined, or require the person to attend 302
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such continuing educational courses and pass such 303
examinations as the board may direct. 304
5. In any order of revocation, the board may provide 305
that the person may not apply for reinstatement of the 306
person's license for a period of time ranging from two to 307
seven years following the date of the order of revocation. 308
All stay orders shall toll this time period. 309
6. Before restoring to good standing a license, 310
certificate or permit issued pursuant to this chapter which 311
has been in a revoked, suspended or inactive state for any 312
cause for more than two years, the board may require the 313
applicant to attend such continuing medical education 314
courses and pass such examinations as the board may direct. 315
7. In any investigation, hearing or other proceeding 316
to determine a licensee's or applicant's fitness to 317
practice, any record relating to any patient of the licensee 318
or applicant shall be discoverable by the board and 319
admissible into evidence, regardless of any statutory or 320
common law privilege which such licensee, applicant, record 321
custodian or patient might otherwise invoke. In addition, 322
no such licensee, applicant, or record custodian may 323
withhold records or testimony bearing upon a licensee's or 324
applicant's fitness to practice on the ground of privilege 325
between such licensee, applicant or record custodian and a 326
patient. 327
8. The act of lawfully dispensing, prescribing, 328
administering, or otherwise distributing ivermectin tablets 329
or hydroxychloroquine sulfate tablets for human use shall 330
not be grounds for denial, suspension, revocation, or other 331
disciplinary action by the board. 332
334.735. 1. As used in sections 334.735 to 334.749, 1
the following terms mean: 2
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(1) "Applicant", any individual who seeks to become 3
licensed as a physician assistant; 4
(2) "Certification" or "registration", a process by a 5
certifying entity that grants recognition to applicants 6
meeting predetermined qualifications specified by such 7
certifying entity; 8
(3) "Certifying entity", the nongovernmental agency or 9
association which certifies or registers individuals who 10
have completed academic and training requirements; 11
(4) "Collaborative practice arrangement", written 12
agreements, jointly agreed upon protocols, or standing 13
orders, all of which shall be in writing, for the delivery 14
of health care services; 15
(5) "Department", the department of commerce and 16
insurance or a designated agency thereof; 17
(6) "License", a document issued to an applicant by 18
the board acknowledging that the applicant is entitled to 19
practice as a physician assistant; 20
(7) "Physician assistant", a person who has graduated 21
from a physician assistant program accredited by the 22
Accreditation Review Commission on Education for the 23
Physician Assistant or its successor agency, prior to 2001, 24
or the Committee on Allied Health Education and 25
Accreditation or the Commission on Accreditation of Allied 26
Health Education Programs, who has passed the certifying 27
examination administered by the National Commission on 28
Certification of Physician Assistants and has active 29
certification by the National Commission on Certification of 30
Physician Assistants who provides health care services 31
delegated by a licensed physician. A person who has been 32
employed as a physician assistant for three years prior to 33
August 28, 1989, who has passed the National Commission on 34
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Certification of Physician Assistants examination, and has 35
active certification of the National Commission on 36
Certification of Physician Assistants; 37
(8) "Recognition", the formal process of becoming a 38
certifying entity as required by the provisions of sections 39
334.735 to 334.749. 40
2. The scope of practice of a physician assistant 41
shall consist only of the following services and procedures: 42
(1) Taking patient histories; 43
(2) Performing physical examinations of a patient; 44
(3) Performing or assisting in the performance of 45
routine office laboratory and patient screening procedures; 46
(4) Performing routine therapeutic procedures; 47
(5) Recording diagnostic impressions and evaluating 48
situations calling for attention of a physician to institute 49
treatment procedures; 50
(6) Instructing and counseling patients regarding 51
mental and physical health using procedures reviewed and 52
approved by a collaborating physician; 53
(7) Assisting the supervising physician in 54
institutional settings, including reviewing of treatment 55
plans, ordering of tests and diagnostic laboratory and 56
radiological services, and ordering of therapies, using 57
procedures reviewed and approved by a licensed physician; 58
(8) Assisting in surgery; and 59
(9) Performing such other tasks not prohibited by law 60
under the collaborative practice arrangement with a licensed 61
physician as the physician assistant has been trained and is 62
proficient to perform. 63
3. [Physician assistants shall not perform or 64
prescribe abortions. 65
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4.] Physician assistants shall not prescribe any drug, 66
medicine, device or therapy unless pursuant to a 67
collaborative practice arrangement in accordance with the 68
law, nor prescribe lenses, prisms or contact lenses for the 69
aid, relief or correction of vision or the measurement of 70
visual power or visual efficiency of the human eye, nor 71
administer or monitor general or regional block anesthesia 72
during diagnostic tests, surgery or obstetric procedures. 73
Prescribing of drugs, medications, devices or therapies by a 74
physician assistant shall be pursuant to a collaborative 75
practice arrangement which is specific to the clinical 76
conditions treated by the supervising physician and the 77
physician assistant shall be subject to the following: 78
(1) A physician assistant shall only prescribe 79
controlled substances in accordance with section 334.747; 80
(2) The types of drugs, medications, devices or 81
therapies prescribed by a physician assistant shall be 82
consistent with the scopes of practice of the physician 83
assistant and the collaborating physician; 84
(3) All prescriptions shall conform with state and 85
federal laws and regulations and shall include the name, 86
address and telephone number of the physician assistant; 87
(4) A physician assistant, or advanced practice 88
registered nurse as defined in section 335.016 may request, 89
receive and sign for noncontrolled professional samples and 90
may distribute professional samples to patients; and 91
(5) A physician assistant shall not prescribe any 92
drugs, medicines, devices or therapies the collaborating 93
physician is not qualified or authorized to prescribe. 94
[5.] 4. A physician assistant shall clearly identify 95
himself or herself as a physician assistant and shall not 96
use or permit to be used in the physician assistant's behalf 97
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the terms "doctor", "Dr." or "doc" nor hold himself or 98
herself out in any way to be a physician or surgeon. No 99
physician assistant shall practice or attempt to practice 100
without physician collaboration or in any location where the 101
collaborating physician is not immediately available for 102
consultation, assistance and intervention, except as 103
otherwise provided in this section, and in an emergency 104
situation, nor shall any physician assistant bill a patient 105
independently or directly for any services or procedure by 106
the physician assistant; except that, nothing in this 107
subsection shall be construed to prohibit a physician 108
assistant from enrolling with a third-party plan or the 109
department of social services as a MO HealthNet or Medicaid 110
provider while acting under a collaborative practice 111
arrangement between the physician and physician assistant. 112
[6.] 5. The licensing of physician assistants shall 113
take place within processes established by the state board 114
of registration for the healing arts through rule and 115
regulation. The board of healing arts is authorized to 116
establish rules pursuant to chapter 536 establishing 117
licensing and renewal procedures, collaboration, 118
collaborative practice arrangements, fees, and addressing 119
such other matters as are necessary to protect the public 120
and discipline the profession. An application for licensing 121
may be denied or the license of a physician assistant may be 122
suspended or revoked by the board in the same manner and for 123
violation of the standards as set forth by section 334.100, 124
or such other standards of conduct set by the board by rule 125
or regulation. Persons licensed pursuant to the provisions 126
of chapter 335 shall not be required to be licensed as 127
physician assistants. All applicants for physician 128
assistant licensure who complete a physician assistant 129
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training program after January 1, 2008, shall have a 130
master's degree from a physician assistant program. 131
[7.] 6. At all times the physician is responsible for 132
the oversight of the activities of, and accepts 133
responsibility for, health care services rendered by the 134
physician assistant. 135
[8.] 7. (1) A physician may enter into collaborative 136
practice arrangements with physician assistants. 137
Collaborative practice arrangements, which shall be in 138
writing, may delegate to a physician assistant the authority 139
to prescribe, administer, or dispense drugs and provide 140
treatment which is within the skill, training, and 141
competence of the physician assistant. Collaborative 142
practice arrangements may delegate to a physician assistant, 143
as defined in section 334.735, the authority to administer, 144
dispense, or prescribe controlled substances listed in 145
Schedules III, IV, and V of section 195.017, and Schedule 146
II - hydrocodone. Schedule III narcotic controlled 147
substances and Schedule II - hydrocodone prescriptions shall 148
be limited to a one hundred twenty-hour supply without 149
refill. Such collaborative practice arrangements shall be 150
in the form of a written arrangement, jointly agreed-upon 151
protocols, or standing orders for the delivery of health 152
care services. 153
(2) Notwithstanding any other provision of this 154
section to the contrary, a collaborative practice 155
arrangement may delegate to a physician assistant the 156
authority to administer, dispense, or prescribe Schedule II 157
controlled substances for hospice patients; provided, that 158
the physician assistant is employed by a hospice provider 159
certified pursuant to chapter 197 and the physician 160
assistant is providing care to hospice patients pursuant to 161
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a collaborative practice arrangement that designates the 162
certified hospice as a location where the physician 163
assistant is authorized to practice and prescribe. 164
[9.] 8. The written collaborative practice arrangement 165
shall contain at least the following provisions: 166
(1) Complete names, home and business addresses, zip 167
codes, and telephone numbers of the collaborating physician 168
and the physician assistant; 169
(2) A list of all other offices or locations, other 170
than those listed in subdivision (1) of this subsection, 171
where the collaborating physician has authorized the 172
physician assistant to prescribe; 173
(3) A requirement that there shall be posted at every 174
office where the physician assistant is authorized to 175
prescribe, in collaboration with a physician, a prominently 176
displayed disclosure statement informing patients that they 177
may be seen by a physician assistant and have the right to 178
see the collaborating physician; 179
(4) All specialty or board certifications of the 180
collaborating physician and all certifications of the 181
physician assistant; 182
(5) The manner of collaboration between the 183
collaborating physician and the physician assistant, 184
including how the collaborating physician and the physician 185
assistant will: 186
(a) Engage in collaborative practice consistent with 187
each professional's skill, training, education, and 188
competence; 189
(b) Maintain geographic proximity, as determined by 190
the board of registration for the healing arts; and 191
(c) Provide coverage during absence, incapacity, 192
infirmity, or emergency of the collaborating physician; 193
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(6) A list of all other written collaborative practice 194
arrangements of the collaborating physician and the 195
physician assistant; 196
(7) The duration of the written practice arrangement 197
between the collaborating physician and the physician 198
assistant; 199
(8) A description of the time and manner of the 200
collaborating physician's review of the physician 201
assistant's delivery of health care services. The 202
description shall include provisions that the physician 203
assistant shall submit a minimum of ten percent of the 204
charts documenting the physician assistant's delivery of 205
health care services to the collaborating physician for 206
review by the collaborating physician, or any other 207
physician designated in the collaborative practice 208
arrangement, every fourteen days. Reviews may be conducted 209
electronically; 210
(9) The collaborating physician, or any other 211
physician designated in the collaborative practice 212
arrangement, shall review every fourteen days a minimum of 213
twenty percent of the charts in which the physician 214
assistant prescribes controlled substances. The charts 215
reviewed under this subdivision may be counted in the number 216
of charts required to be reviewed under subdivision (8) of 217
this subsection; 218
(10) A statement that no collaboration requirements in 219
addition to the federal law shall be required for a 220
physician-physician assistant team working in a certified 221
community behavioral health clinic as defined by Pub.L. 113- 222
93, or a rural health clinic under the federal Rural Health 223
Services Act, Pub.L. 95-210, as amended, or a federally 224
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qualified health center as defined in 42 U.S.C. Section 225
1395x, as amended; and 226
(11) If a collaborative practice arrangement is used 227
in clinical situations where a collaborating physician 228
assistant provides health care services that include the 229
diagnosis and initiation of treatment for acutely or 230
chronically ill or injured persons, then the collaborating 231
physician or any other physician designated in the 232
collaborative practice arrangement shall be present for 233
sufficient periods of time, at least once every two weeks, 234
except in extraordinary circumstances that shall be 235
documented, to participate in a chart review and to provide 236
necessary medical direction, medical services, 237
consultations, and supervision of the health care staff. 238
[10.] 9. The state board of registration for the 239
healing arts under section 334.125 may promulgate rules 240
regulating the use of collaborative practice arrangements. 241
[11.] 10. The state board of registration for the 242
healing arts shall not deny, revoke, suspend, or otherwise 243
take disciplinary action against a collaborating physician 244
for health care services delegated to a physician assistant, 245
provided that the provisions of this section and the rules 246
promulgated thereunder are satisfied. 247
[12.] 11. Within thirty days of any change and on each 248
renewal, the state board of registration for the healing 249
arts shall require every physician to identify whether the 250
physician is engaged in any collaborative practice 251
arrangement, including collaborative practice arrangements 252
delegating the authority to prescribe controlled substances, 253
and also report to the board the name of each physician 254
assistant with whom the physician has entered into such 255
arrangement. The board may make such information available 256
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to the public. The board shall track the reported 257
information and may routinely conduct random reviews of such 258
arrangements to ensure that the arrangements are carried out 259
in compliance with this chapter. 260
[13.] 12. The collaborating physician shall determine 261
and document the completion of a period of time during which 262
the physician assistant shall practice with the 263
collaborating physician continuously present before 264
practicing in a setting where the collaborating physician is 265
not continuously present. This limitation shall not apply 266
to collaborative arrangements of providers of population- 267
based public health services as defined by 20 CSR 2150-5.100 268
as of April 30, 2009. 269
[14.] 13. No contract or other arrangement shall 270
require a physician to act as a collaborating physician for 271
a physician assistant against the physician's will. A 272
physician shall have the right to refuse to act as a 273
supervising physician, without penalty, for a particular 274
physician assistant. No contract or other agreement shall 275
limit the collaborating physician's ultimate authority over 276
any protocols or standing orders or in the delegation of the 277
physician's authority to any physician assistant. No 278
contract or other arrangement shall require any physician 279
assistant to collaborate with any physician against the 280
physician assistant's will. A physician assistant shall 281
have the right to refuse to collaborate, without penalty, 282
with a particular physician. 283
[15.] 14. Physician assistants shall file with the 284
board a copy of their collaborating physician form. 285
[16.] 15. No physician shall be designated to serve as 286
a collaborating physician for more than six full-time 287
equivalent licensed physician assistants, full-time 288
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equivalent advanced practice registered nurses, or full-time 289
equivalent assistant physicians, or any combination 290
thereof. This limitation shall not apply to physician 291
assistant collaborative practice arrangements of hospital 292
employees providing inpatient care service in hospitals as 293
defined in chapter 197, or to a certified registered nurse 294
anesthetist providing anesthesia services under the 295
supervision of an anesthesiologist or other physician, 296
dentist, or podiatrist who is immediately available if 297
needed as set out in subsection 7 of section 334.104. 298
[17.] 16. No arrangement made under this section shall 299
supercede current hospital licensing regulations governing 300
hospital medication orders under protocols or standing 301
orders for the purpose of delivering inpatient or emergency 302
care within a hospital, as defined in section 197.020, if 303
such protocols or standing orders have been approved by the 304
hospital's medical staff and pharmaceutical therapeutics 305
committee. 306
595.027. 1. Upon request by the department for 1
verification of injuries of victims, medical providers shall 2
submit the information requested by the department within 3
twenty working days of the request at no cost to the fund. 4
2. For purposes of this section, "medical providers" 5
means physicians, dentists, clinical psychologists, 6
optometrists, podiatrists, registered nurses, physician's 7
assistants, chiropractors, physical therapists, hospitals, 8
ambulatory surgical centers, [abortion facilities,] and 9
nursing homes. 10
3. Failure to submit the information as required by 11
this section shall be an infraction. 12
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[188.017. 1. This section shall be known 1
and may be cited as the "Right to Life of the 2
Unborn Child Act". 3
2. Notwithstanding any other provision of 4
law to the contrary, no abortion shall be 5
performed or induced upon a woman, except in 6
cases of medical emergency. Any person who 7
knowingly performs or induces an abortion of an 8
unborn child in violation of this subsection 9
shall be guilty of a class B felony, as well as 10
subject to suspension or revocation of his or 11
her professional license by his or her 12
professional licensing board. A woman upon whom 13
an abortion is performed or induced in violation 14
of this subsection shall not be prosecuted for a 15
conspiracy to violate the provisions of this 16
subsection. 17
3. It shall be an affirmative defense for 18
any person alleged to have violated the 19
provisions of subsection 2 of this section that 20
the person performed or induced an abortion 21
because of a medical emergency. The defendant 22
shall have the burden of persuasion that the 23
defense is more probably true than not. 24
4. The enactment of this section shall 25
only become effective upon notification to the 26
revisor of statutes by an opinion by the 27
attorney general of Missouri, a proclamation by 28
the governor of Missouri, or the adoption of a 29
concurrent resolution by the Missouri general 30
assembly that: 31
(1) The United States Supreme Court has 32
overruled, in whole or in part, Roe v. Wade, 410 33
U.S. 113 (1973), restoring or granting to the 34
state of Missouri the authority to regulate 35
abortion to the extent set forth in this 36
section, and that as a result, it is reasonably 37
probable that this section would be upheld by 38
the court as constitutional; 39
(2) An amendment to the Constitution of 40
the United States has been adopted that has the 41
effect of restoring or granting to the state of 42
Missouri the authority to regulate abortion to 43
the extent set forth in this section; or 44
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(3) The United States Congress has enacted 45
a law that has the effect of restoring or 46
granting to the state of Missouri the authority 47
to regulate abortion to the extent set forth in 48
this section.] 49
[188.020. No person shall perform or 1
induce an abortion except a physician.] 2
[188.021. 1. When RU-486 (mifepristone) 1
or any drug or chemical is used for the purpose 2
of inducing an abortion, the initial dose of the 3
drug or chemical shall be administered in the 4
same room and in the physical presence of the 5
physician who prescribed, dispensed, or 6
otherwise provided the drug or chemical to the 7
patient. The physician inducing the abortion, 8
or a person acting on such physician's behalf, 9
shall make all reasonable efforts to ensure that 10
the patient returns after the administration or 11
use of RU-486 or any drug or chemical for a 12
follow-up visit unless such termination of the 13
pregnancy has already been confirmed and the 14
patient's medical condition has been assessed by 15
a licensed physician prior to discharge. 16
2. When the Food and Drug Administration 17
label of any drug or chemical used for the 18
purpose of inducing an abortion includes any 19
clinical study in which more than one percent of 20
those administered the drug or chemical required 21
surgical intervention after its administration, 22
no physician may prescribe or administer such 23
drug or chemical to any patient without first 24
obtaining approval from the department of health 25
and senior services of a complication plan from 26
the physician for administration of the drug or 27
chemical to any patient. The complication plan 28
shall include any information deemed necessary 29
by the department to ensure the safety of any 30
patient suffering complications as a result of 31
the administration of the drug or chemical in 32
question. No complication plan shall be 33
required where the patient is administered the 34
drug in a medical emergency at a hospital and is 35
then treated as an inpatient at a hospital under 36
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medical monitoring by the hospital until the 37
abortion is completed. 38
3. The department may adopt rules, 39
regulations, and standards governing 40
complication plans to ensure that patients 41
undergoing abortions induced by drugs or 42
chemicals have access to safe and reliable 43
care. Any rule or portion of a rule, as that 44
term is defined in section 536.010, that is 45
created under the authority delegated in this 46
section shall become effective only if it 47
complies with and is subject to all of the 48
provisions of chapter 536 and, if applicable, 49
section 536.028. This section and chapter 536 50
are nonseverable and if any of the powers vested 51
with the general assembly pursuant to chapter 52
536 to review, to delay the effective date, or 53
to disapprove and annul a rule are subsequently 54
held unconstitutional, then the grant of 55
rulemaking authority and any rule proposed or 56
adopted after October 24, 2017, shall be invalid 57
and void.] 58
[188.027. 1. Except in cases of medical 1
emergency, no abortion shall be performed or 2
induced on a woman without her voluntary and 3
informed consent, given freely and without 4
coercion. Consent to an abortion is voluntary 5
and informed and given freely and without 6
coercion if, and only if, at least seventy-two 7
hours prior to the abortion: 8
(1) The physician who is to perform or 9
induce the abortion, a qualified professional, 10
or the referring physician has informed the 11
woman orally, reduced to writing, and in person, 12
of the following: 13
(a) The name of the physician who will 14
perform or induce the abortion; 15
(b) Medically accurate information that a 16
reasonable patient would consider material to 17
the decision of whether or not to undergo the 18
abortion, including: 19
a. A description of the proposed abortion 20
method; 21
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b. The immediate and long-term medical 22
risks to the woman associated with the proposed 23
abortion method including, but not limited to, 24
infection, hemorrhage, cervical tear or uterine 25
perforation, harm to subsequent pregnancies or 26
the ability to carry a subsequent child to term, 27
and possible adverse psychological effects 28
associated with the abortion; and 29
c. The immediate and long-term medical 30
risks to the woman, in light of the anesthesia 31
and medication that is to be administered, the 32
unborn child's gestational age, and the woman's 33
medical history and medical condition; 34
(c) Alternatives to the abortion which 35
shall include making the woman aware that 36
information and materials shall be provided to 37
her detailing such alternatives to the abortion; 38
(d) A statement that the physician 39
performing or inducing the abortion is available 40
for any questions concerning the abortion, 41
together with the telephone number that the 42
physician may be later reached to answer any 43
questions that the woman may have; 44
(e) The location of the hospital that 45
offers obstetrical or gynecological care located 46
within thirty miles of the location where the 47
abortion is performed or induced and at which 48
the physician performing or inducing the 49
abortion has clinical privileges and where the 50
woman may receive follow-up care by the 51
physician if complications arise; 52
(f) The gestational age of the unborn 53
child at the time the abortion is to be 54
performed or induced; and 55
(g) The anatomical and physiological 56
characteristics of the unborn child at the time 57
the abortion is to be performed or induced; 58
(2) The physician who is to perform or 59
induce the abortion or a qualified professional 60
has presented the woman, in person, printed 61
materials provided by the department, which 62
describe the probable anatomical and 63
physiological characteristics of the unborn 64
child at two-week gestational increments from 65
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conception to full term, including color 66
photographs or images of the developing unborn 67
child at two-week gestational increments. Such 68
descriptions shall include information about 69
brain and heart functions, the presence of 70
external members and internal organs during the 71
applicable stages of development and information 72
on when the unborn child is viable. The printed 73
materials shall prominently display the 74
following statement: "The life of each human 75
being begins at conception. Abortion will 76
terminate the life of a separate, unique, living 77
human being."; 78
(3) The physician who is to perform or 79
induce the abortion, a qualified professional, 80
or the referring physician has presented the 81
woman, in person, printed materials provided by 82
the department, which describe the various 83
surgical and drug-induced methods of abortion 84
relevant to the stage of pregnancy, as well as 85
the immediate and long-term medical risks 86
commonly associated with each abortion method 87
including, but not limited to, infection, 88
hemorrhage, cervical tear or uterine 89
perforation, harm to subsequent pregnancies or 90
the ability to carry a subsequent child to term, 91
and the possible adverse psychological effects 92
associated with an abortion; 93
(4) The physician who is to perform or 94
induce the abortion or a qualified professional 95
shall provide the woman with the opportunity to 96
view at least seventy-two hours prior to the 97
abortion an active ultrasound of the unborn 98
child and hear the heartbeat of the unborn child 99
if the heartbeat is audible. The woman shall be 100
provided with a geographically indexed list 101
maintained by the department of health care 102
providers, facilities, and clinics that perform 103
ultrasounds, including those that offer 104
ultrasound services free of charge. Such 105
materials shall provide contact information for 106
each provider, facility, or clinic including 107
telephone numbers and, if available, website 108
addresses. Should the woman decide to obtain an 109
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ultrasound from a provider, facility, or clinic 110
other than the abortion facility, the woman 111
shall be offered a reasonable time to obtain the 112
ultrasound examination before the date and time 113
set for performing or inducing an abortion. The 114
person conducting the ultrasound shall ensure 115
that the active ultrasound image is of a quality 116
consistent with standard medical practice in the 117
community, contains the dimensions of the unborn 118
child, and accurately portrays the presence of 119
external members and internal organs, if present 120
or viewable, of the unborn child. The 121
auscultation of fetal heart tone must also be of 122
a quality consistent with standard medical 123
practice in the community. If the woman chooses 124
to view the ultrasound or hear the heartbeat or 125
both at the abortion facility, the viewing or 126
hearing or both shall be provided to her at the 127
abortion facility at least seventy-two hours 128
prior to the abortion being performed or induced; 129
(5) The printed materials provided by the 130
department shall include information on the 131
possibility of an abortion causing pain in the 132
unborn child. This information shall include, 133
but need not be limited to, the following: 134
(a) Unborn children as early as eight 135
weeks gestational age start to show spontaneous 136
movements and unborn children at this stage in 137
pregnancy show reflex responses to touch; 138
(b) In the unborn child, the area around 139
his or her mouth and lips is the first part of 140
the unborn child's body to respond to touch and 141
by fourteen weeks gestational age most of the 142
unborn child's body is responsive to touch; 143
(c) Pain receptors on the unborn child's 144
skin develop around his or her mouth at around 145
seven to eight weeks gestational age, around the 146
palms of his or her hands at ten to ten and a 147
half weeks, on the abdominal wall at fifteen 148
weeks, and over all of his or her body at 149
sixteen weeks gestational age; 150
(d) Beginning at sixteen weeks gestational 151
age and later, it is possible for pain to be 152
transmitted from receptors to the cortex of the 153
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unborn child's brain, where thinking and 154
perceiving occur; 155
(e) When a physician performs a life- 156
saving surgery, he or she provides anesthesia to 157
unborn children as young as sixteen weeks 158
gestational age in order to alleviate the unborn 159
child's pain; and 160
(f) A description of the actual steps in 161
the abortion procedure to be performed or 162
induced and at which steps the abortion 163
procedure could be painful to the unborn child; 164
(6) The physician who is to perform or 165
induce the abortion or a qualified professional 166
has presented the woman, in person, printed 167
materials provided by the department explaining 168
to the woman alternatives to abortion she may 169
wish to consider. Such materials shall: 170
(a) Identify on a geographical basis 171
public and private agencies available to assist 172
a woman in carrying her unborn child to term, 173
and to assist her in caring for her dependent 174
child or placing her child for adoption, 175
including agencies commonly known and generally 176
referred to as pregnancy resource centers, 177
crisis pregnancy centers, maternity homes, and 178
adoption agencies. Such materials shall provide 179
a comprehensive list by geographical area of the 180
agencies, a description of the services they 181
offer, and the telephone numbers and addresses 182
of the agencies; provided that such materials 183
shall not include any programs, services, 184
organizations, or affiliates of organizations 185
that perform or induce, or assist in the 186
performing or inducing of, abortions or that 187
refer for abortions; 188
(b) Explain the Missouri alternatives to 189
abortion services program under section 188.325, 190
and any other programs and services available to 191
pregnant women and mothers of newborn children 192
offered by public or private agencies which 193
assist a woman in carrying her unborn child to 194
term and assist her in caring for her dependent 195
child or placing her child for adoption, 196
including but not limited to prenatal care; 197
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maternal health care; newborn or infant care; 198
mental health services; professional counseling 199
services; housing programs; utility assistance; 200
transportation services; food, clothing, and 201
supplies related to pregnancy; parenting skills; 202
educational programs; job training and placement 203
services; drug and alcohol testing and 204
treatment; and adoption assistance; 205
(c) Identify the state website for the 206
Missouri alternatives to abortion services 207
program under section 188.325, and any toll-free 208
number established by the state operated in 209
conjunction with the program; 210
(d) Prominently display the statement: 211
"There are public and private agencies willing 212
and able to help you carry your child to term, 213
and to assist you and your child after your 214
child is born, whether you choose to keep your 215
child or place him or her for adoption. The 216
state of Missouri encourages you to contact 217
those agencies before making a final decision 218
about abortion. State law requires that your 219
physician or a qualified professional give you 220
the opportunity to call agencies like these 221
before you undergo an abortion."; 222
(7) The physician who is to perform or 223
induce the abortion or a qualified professional 224
has presented the woman, in person, printed 225
materials provided by the department explaining 226
that the father of the unborn child is liable to 227
assist in the support of the child, even in 228
instances where he has offered to pay for the 229
abortion. Such materials shall include 230
information on the legal duties and support 231
obligations of the father of a child, including, 232
but not limited to, child support payments, and 233
the fact that paternity may be established by 234
the father's name on a birth certificate or 235
statement of paternity, or by court action. 236
Such printed materials shall also state that 237
more information concerning paternity 238
establishment and child support services and 239
enforcement may be obtained by calling the 240
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family support division within the Missouri 241
department of social services; and 242
(8) The physician who is to perform or 243
induce the abortion or a qualified professional 244
shall inform the woman that she is free to 245
withhold or withdraw her consent to the abortion 246
at any time without affecting her right to 247
future care or treatment and without the loss of 248
any state or federally funded benefits to which 249
she might otherwise be entitled. 250
2. All information required to be provided 251
to a woman considering abortion by subsection 1 252
of this section shall be presented to the woman 253
individually, in the physical presence of the 254
woman and in a private room, to protect her 255
privacy, to maintain the confidentiality of her 256
decision, to ensure that the information focuses 257
on her individual circumstances, to ensure she 258
has an adequate opportunity to ask questions, 259
and to ensure that she is not a victim of 260
coerced abortion. Should a woman be unable to 261
read materials provided to her, they shall be 262
read to her. Should a woman need an interpreter 263
to understand the information presented in the 264
written materials, an interpreter shall be 265
provided to her. Should a woman ask questions 266
concerning any of the information or materials, 267
answers shall be provided in a language she can 268
understand. 269
3. No abortion shall be performed or 270
induced unless and until the woman upon whom the 271
abortion is to be performed or induced certifies 272
in writing on a checklist form provided by the 273
department that she has been presented all the 274
information required in subsection 1 of this 275
section, that she has been provided the 276
opportunity to view an active ultrasound image 277
of the unborn child and hear the heartbeat of 278
the unborn child if it is audible, and that she 279
further certifies that she gives her voluntary 280
and informed consent, freely and without 281
coercion, to the abortion procedure. 282
4. No physician shall perform or induce an 283
abortion unless and until the physician has 284
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obtained from the woman her voluntary and 285
informed consent given freely and without 286
coercion. If the physician has reason to 287
believe that the woman is being coerced into 288
having an abortion, the physician or qualified 289
professional shall inform the woman that 290
services are available for her and shall provide 291
her with private access to a telephone and 292
information about such services, including but 293
not limited to the following: 294
(1) Rape crisis centers, as defined in 295
section 455.003; 296
(2) Shelters for victims of domestic 297
violence, as defined in section 455.200; and 298
(3) Orders of protection, pursuant to 299
chapter 455. 300
5. The physician who is to perform or 301
induce the abortion shall, at least seventy-two 302
hours prior to such procedure, inform the woman 303
orally and in person of: 304
(1) The immediate and long-term medical 305
risks to the woman associated with the proposed 306
abortion method including, but not limited to, 307
infection, hemorrhage, cervical tear or uterine 308
perforation, harm to subsequent pregnancies or 309
the ability to carry a subsequent child to term, 310
and possible adverse psychological effects 311
associated with the abortion; and 312
(2) The immediate and long-term medical 313
risks to the woman, in light of the anesthesia 314
and medication that is to be administered, the 315
unborn child's gestational age, and the woman's 316
medical history and medical conditions. 317
6. No physician shall perform or induce an 318
abortion unless and until the physician has 319
received and signed a copy of the form 320
prescribed in subsection 3 of this section. The 321
physician shall retain a copy of the form in the 322
patient's medical record. 323
7. In the event of a medical emergency, 324
the physician who performed or induced the 325
abortion shall clearly certify in writing the 326
nature and circumstances of the medical 327
emergency. This certification shall be signed 328
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by the physician who performed or induced the 329
abortion, and shall be maintained under section 330
188.060. 331
8. No person or entity shall require, 332
obtain, or accept payment for an abortion from 333
or on behalf of a patient until at least seventy- 334
two hours have passed since the time that the 335
information required by subsection 1 of this 336
section has been provided to the patient. 337
Nothing in this subsection shall prohibit a 338
person or entity from notifying the patient that 339
payment for the abortion will be required after 340
the seventy-two-hour period has expired if she 341
voluntarily chooses to have the abortion. 342
9. The term "qualified professional" as 343
used in this section shall refer to a physician, 344
physician assistant, registered nurse, licensed 345
practical nurse, psychologist, licensed 346
professional counselor, or licensed social 347
worker, licensed or registered under chapter 348
334, 335, or 337, acting under the supervision 349
of the physician performing or inducing the 350
abortion, and acting within the course and scope 351
of his or her authority provided by law. The 352
provisions of this section shall not be 353
construed to in any way expand the authority 354
otherwise provided by law relating to the 355
licensure, registration, or scope of practice of 356
any such qualified professional. 357
10. By November 30, 2010, the department 358
shall produce the written materials and forms 359
described in this section. Any written 360
materials produced shall be printed in a 361
typeface large enough to be clearly legible. 362
All information shall be presented in an 363
objective, unbiased manner designed to convey 364
only accurate scientific and medical 365
information. The department shall furnish the 366
written materials and forms at no cost and in 367
sufficient quantity to any person who performs 368
or induces abortions, or to any hospital or 369
facility that provides abortions. The 370
department shall make all information required 371
by subsection 1 of this section available to the 372
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public through its department website. The 373
department shall maintain a toll-free, twenty- 374
four-hour hotline telephone number where a 375
caller can obtain information on a regional 376
basis concerning the agencies and services 377
described in subsection 1 of this section. No 378
identifying information regarding persons who 379
use the website shall be collected or 380
maintained. The department shall monitor the 381
website on a regular basis to prevent tampering 382
and correct any operational deficiencies. 383
11. In order to preserve the compelling 384
interest of the state to ensure that the choice 385
to consent to an abortion is voluntary and 386
informed, and given freely and without coercion, 387
the department shall use the procedures for 388
adoption of emergency rules under section 389
536.025 in order to promulgate all necessary 390
rules, forms, and other necessary material to 391
implement this section by November 30, 2010. 392
12. If the provisions in subsections 1 and 393
8 of this section requiring a seventy-two-hour 394
waiting period for an abortion are ever 395
temporarily or permanently restrained or 396
enjoined by judicial order, then the waiting 397
period for an abortion shall be twenty-four 398
hours; provided, however, that if such temporary 399
or permanent restraining order or injunction is 400
stayed or dissolved, or otherwise ceases to have 401
effect, the waiting period for an abortion shall 402
be seventy-two hours.] 403
[188.030. 1. Except in the case of a 1
medical emergency, no abortion of a viable 2
unborn child shall be performed or induced 3
unless the abortion is necessary to preserve the 4
life of the pregnant woman whose life is 5
endangered by a physical disorder, physical 6
illness, or physical injury, including a life- 7
endangering physical condition caused by or 8
arising from the pregnancy itself, or when 9
continuation of the pregnancy will create a 10
serious risk of substantial and irreversible 11
physical impairment of a major bodily function 12
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of the pregnant woman. For purposes of this 13
section, "major bodily function" includes, but 14
is not limited to, functions of the immune 15
system, normal cell growth, digestive, bowel, 16
bladder, neurological, brain, respiratory, 17
circulatory, endocrine, and reproductive 18
functions. 19
2. Except in the case of a medical 20
emergency: 21
(1) Prior to performing or inducing an 22
abortion upon a woman, the physician shall 23
determine the gestational age of the unborn 24
child in a manner consistent with accepted 25
obstetrical and neonatal practices and 26
standards. In making such determination, the 27
physician shall make such inquiries of the 28
pregnant woman and perform or cause to be 29
performed such medical examinations, imaging 30
studies, and tests as a reasonably prudent 31
physician, knowledgeable about the medical facts 32
and conditions of both the woman and the unborn 33
child involved, would consider necessary to 34
perform and consider in making an accurate 35
diagnosis with respect to gestational age; 36
(2) If the physician determines that the 37
gestational age of the unborn child is twenty 38
weeks or more, prior to performing or inducing 39
an abortion upon the woman, the physician shall 40
determine if the unborn child is viable by using 41
and exercising that degree of care, skill, and 42
proficiency commonly exercised by a skillful, 43
careful, and prudent physician. In making this 44
determination of viability, the physician shall 45
perform or cause to be performed such medical 46
examinations and tests as are necessary to make 47
a finding of the gestational age, weight, and 48
lung maturity of the unborn child and shall 49
enter such findings and determination of 50
viability in the medical record of the woman; 51
(3) If the physician determines that the 52
gestational age of the unborn child is twenty 53
weeks or more, and further determines that the 54
unborn child is not viable and performs or 55
induces an abortion upon the woman, the 56
SB 1692 66
physician shall report such findings and 57
determinations and the reasons for such 58
determinations to the health care facility in 59
which the abortion is performed and to the state 60
board of registration for the healing arts, and 61
shall enter such findings and determinations in 62
the medical records of the woman and in the 63
individual abortion report submitted to the 64
department under section 188.052; 65
(4) (a) If the physician determines that 66
the unborn child is viable, the physician shall 67
not perform or induce an abortion upon the woman 68
unless the abortion is necessary to preserve the 69
life of the pregnant woman or that a 70
continuation of the pregnancy will create a 71
serious risk of substantial and irreversible 72
physical impairment of a major bodily function 73
of the woman. 74
(b) Before a physician may proceed with 75
performing or inducing an abortion upon a woman 76
when it has been determined that the unborn 77
child is viable, the physician shall first 78
certify in writing the medical threat posed to 79
the life of the pregnant woman, or the medical 80
reasons that continuation of the pregnancy would 81
cause a serious risk of substantial and 82
irreversible physical impairment of a major 83
bodily function of the pregnant woman. Upon 84
completion of the abortion, the physician shall 85
report the reasons and determinations for the 86
abortion of a viable unborn child to the health 87
care facility in which the abortion is performed 88
and to the state board of registration for the 89
healing arts, and shall enter such findings and 90
determinations in the medical record of the 91
woman and in the individual abortion report 92
submitted to the department under section 93
188.052. 94
(c) Before a physician may proceed with 95
performing or inducing an abortion upon a woman 96
when it has been determined that the unborn 97
child is viable, the physician who is to perform 98
the abortion shall obtain the agreement of a 99
second physician with knowledge of accepted 100
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obstetrical and neonatal practices and standards 101
who shall concur that the abortion is necessary 102
to preserve the life of the pregnant woman, or 103
that continuation of the pregnancy would cause a 104
serious risk of substantial and irreversible 105
physical impairment of a major bodily function 106
of the pregnant woman. This second physician 107
shall also report such reasons and 108
determinations to the health care facility in 109
which the abortion is to be performed and to the 110
state board of registration for the healing 111
arts, and shall enter such findings and 112
determinations in the medical record of the 113
woman and the individual abortion report 114
submitted to the department under section 115
188.052. The second physician shall not have 116
any legal or financial affiliation or 117
relationship with the physician performing or 118
inducing the abortion, except that such 119
prohibition shall not apply to physicians whose 120
legal or financial affiliation or relationship 121
is a result of being employed by or having staff 122
privileges at the same hospital as the term 123
"hospital" is defined in section 197.020. 124
(d) Any physician who performs or induces 125
an abortion upon a woman when it has been 126
determined that the unborn child is viable shall 127
utilize the available method or technique of 128
abortion most likely to preserve the life or 129
health of the unborn child. In cases where the 130
method or technique of abortion most likely to 131
preserve the life or health of the unborn child 132
would present a greater risk to the life or 133
health of the woman than another legally 134
permitted and available method or technique, the 135
physician may utilize such other method or 136
technique. In all cases where the physician 137
performs an abortion upon a viable unborn child, 138
the physician shall certify in writing the 139
available method or techniques considered and 140
the reasons for choosing the method or technique 141
employed. 142
(e) No physician shall perform or induce 143
an abortion upon a woman when it has been 144
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determined that the unborn child is viable 145
unless there is in attendance a physician other 146
than the physician performing or inducing the 147
abortion who shall take control of and provide 148
immediate medical care for a child born as a 149
result of the abortion. During the performance 150
of the abortion, the physician performing it, 151
and subsequent to the abortion, the physician 152
required to be in attendance, shall take all 153
reasonable steps in keeping with good medical 154
practice, consistent with the procedure used, to 155
preserve the life or health of the viable unborn 156
child; provided that it does not pose an 157
increased risk to the life of the woman or does 158
not pose an increased risk of substantial and 159
irreversible physical impairment of a major 160
bodily function of the woman. 161
3. Any person who knowingly performs or 162
induces an abortion of an unborn child in 163
violation of the provisions of this section is 164
guilty of a class D felony, and, upon a finding 165
of guilt or plea of guilty, shall be imprisoned 166
for a term of not less than one year, and, 167
notwithstanding the provisions of section 168
558.002, shall be fined not less than ten 169
thousand nor more than fifty thousand dollars. 170
4. Any physician who pleads guilty to or 171
is found guilty of performing or inducing an 172
abortion of an unborn child in violation of this 173
section shall be subject to suspension or 174
revocation of his or her license to practice 175
medicine in the state of Missouri by the state 176
board of registration for the healing arts under 177
the provisions of sections 334.100 and 334.103. 178
5. Any hospital licensed in the state of 179
Missouri that knowingly allows an abortion of an 180
unborn child to be performed or induced in 181
violation of this section may be subject to 182
suspension or revocation of its license under 183
the provisions of section 197.070. 184
6. Any abortion facility licensed in the 185
state of Missouri that knowingly allows an 186
abortion of an unborn child to be performed or 187
induced in violation of this section may be 188
SB 1692 69
subject to suspension or revocation of its 189
license under the provisions of section 197.220. 190
7. A woman upon whom an abortion is 191
performed or induced in violation of this 192
section shall not be prosecuted for a conspiracy 193
to violate the provisions of this section. 194
8. Nothing in this section shall be 195
construed as creating or recognizing a right to 196
abortion, nor is it the intention of this 197
section to make lawful any abortion that is 198
currently unlawful. 199
9. It is the intent of the legislature 200
that this section be severable as noted in 201
section 1.140. In the event that any section, 202
subsection, subdivision, paragraph, sentence, or 203
clause of this section be declared invalid under 204
the Constitution of the United States or the 205
Constitution of the State of Missouri, it is the 206
intent of the legislature that the remaining 207
provisions of this section remain in force and 208
effect as far as capable of being carried into 209
execution as intended by the legislature. 210
10. The general assembly may, by 211
concurrent resolution, appoint one or more of 212
its members who sponsored or co-sponsored this 213
act in his or her official capacity to intervene 214
as a matter of right in any case in which the 215
constitutionality of this law is challenged.] 216
[188.033. Whenever an abortion facility or 1
a family planning agency located in this state, 2
or any of its agents or employees acting within 3
the scope of his or her authority or employment, 4
provides to a woman considering an abortion the 5
name, address, telephone number, or website of 6
an abortion provider that is located outside of 7
the state, such abortion facility or family 8
planning agency or its agents or employees shall 9
also provide to such woman the printed materials 10
produced by the department under section 11
188.027. If the name, address, telephone 12
number, or website of such abortion provider is 13
not provided to such woman in person, such 14
printed materials shall be offered to her, and 15
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if she chooses, sent to such woman at no cost to 16
her the same day or as soon as possible either 17
electronically or by U.S. mail overnight 18
delivery service or by other overnight or same- 19
day delivery service to an address of such 20
woman's choosing. The department shall furnish 21
such printed materials at no cost and in 22
sufficient quantities to abortion facilities and 23
family planning agencies located within the 24
state.] 25
[188.038. 1. The general assembly of this 1
state finds that: 2
(1) Removing vestiges of any past bias or 3
discrimination against pregnant women, their 4
partners, and their family members, including 5
their unborn children, is an important task for 6
those in the legal, medical, social services, 7
and human services professions; 8
(2) Ending any current bias or 9
discrimination against pregnant women, their 10
partners, and their family members, including 11
their unborn children, is a legitimate purpose 12
of government in order to guarantee that those 13
who "are endowed by their Creator with certain 14
unalienable Rights" can enjoy "Life, Liberty and 15
the pursuit of Happiness"; 16
(3) The historical relationship of bias or 17
discrimination by some family planning programs 18
and policies towards poor and minority 19
populations, including, but not limited to, the 20
nonconsensual sterilization of mentally ill, 21
poor, minority, and immigrant women and other 22
coercive family planning programs and policies, 23
must be rejected; 24
(4) Among Missouri residents, the rate of 25
black or African-American women who undergo 26
abortions is significantly higher, about three 27
and one-half times higher, than the rate of 28
white women who undergo abortions. Among 29
Missouri residents, the rate of black or African- 30
American women who undergo repeat abortions is 31
significantly higher, about one and one-half 32
SB 1692 71
times higher, than the rate of white women who 33
undergo repeat abortions; 34
(5) Performing or inducing an abortion 35
because of the sex of the unborn child is 36
repugnant to the values of equality of females 37
and males and the same opportunities for girls 38
and boys, and furthers a false mindset of female 39
inferiority; 40
(6) Government has a legitimate interest 41
in preventing the abortion of unborn children 42
with Down Syndrome because it is a form of bias 43
or disability discrimination and victimizes the 44
disabled unborn child at his or her most 45
vulnerable stage. Eliminating unborn children 46
with Down Syndrome raises grave concerns for the 47
lives of those who do live with disabilities. 48
It sends a message of dwindling support for 49
their unique challenges, fosters a false sense 50
that disability is something that could have 51
been avoidable, and is likely to increase the 52
stigma associated with disability. 53
2. No person shall perform or induce an 54
abortion on a woman if the person knows that the 55
woman is seeking the abortion solely because of 56
a prenatal diagnosis, test, or screening 57
indicating Down Syndrome or the potential of 58
Down Syndrome in an unborn child. 59
3. No person shall perform or induce an 60
abortion on a woman if the person knows that the 61
woman is seeking the abortion solely because of 62
the sex or race of the unborn child. 63
4. Any physician or other person who 64
performs or induces or attempts to perform or 65
induce an abortion prohibited by this section 66
shall be subject to all applicable civil 67
penalties under this chapter including, but not 68
limited to, sections 188.065 and 188.085.] 69
[188.039. 1. For purposes of this 1
section, "medical emergency" means a condition 2
which, on the basis of the physician's good 3
faith clinical judgment, so complicates the 4
medical condition of a pregnant woman as to 5
necessitate the immediate abortion of her 6
SB 1692 72
pregnancy to avert her death or for which a 7
delay will create a serious risk of substantial 8
and irreversible impairment of a major bodily 9
function. 10
2. Except in the case of medical 11
emergency, no person shall perform or induce an 12
abortion unless at least seventy-two hours prior 13
thereto the physician who is to perform or 14
induce the abortion, a qualified professional, 15
or the referring physician has conferred with 16
the patient and discussed with her the 17
indicators and contraindicators, and risk 18
factors including any physical, psychological, 19
or situational factors for the proposed 20
procedure and the use of medications, including 21
but not limited to mifepristone, in light of her 22
medical history and medical condition. For an 23
abortion performed or an abortion induced by a 24
drug or drugs, such conference shall take place 25
at least seventy-two hours prior to the writing 26
or communication of the first prescription for 27
such drug or drugs in connection with inducing 28
an abortion. Only one such conference shall be 29
required for each abortion. 30
3. The patient shall be evaluated by the 31
physician who is to perform or induce the 32
abortion, a qualified professional, or the 33
referring physician during the conference for 34
indicators and contraindicators, risk factors 35
including any physical, psychological, or 36
situational factors which would predispose the 37
patient to or increase the risk of experiencing 38
one or more adverse physical, emotional, or 39
other health reactions to the proposed procedure 40
or drug or drugs in either the short or long 41
term as compared with women who do not possess 42
such risk factors. 43
4. At the end of the conference, and if 44
the woman chooses to proceed with the abortion, 45
the physician who is to perform or induce the 46
abortion, a qualified professional, or the 47
referring physician shall sign and shall cause 48
the patient to sign a written statement that the 49
woman gave her informed consent freely and 50
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without coercion after the physician or 51
qualified professional had discussed with her 52
the indicators and contraindicators, and risk 53
factors, including any physical, psychological, 54
or situational factors. All such executed 55
statements shall be maintained as part of the 56
patient's medical file, subject to the 57
confidentiality laws and rules of this state. 58
5. The director of the department of 59
health and senior services shall disseminate a 60
model form that physicians or qualified 61
professionals may use as the written statement 62
required by this section, but any lack or 63
unavailability of such a model form shall not 64
affect the duties of the physician or qualified 65
professional set forth in subsections 2 to 4 of 66
this section. 67
6. As used in this section, the term 68
"qualified professional" shall refer to a 69
physician, physician assistant, registered 70
nurse, licensed practical nurse, psychologist, 71
licensed professional counselor, or licensed 72
social worker, licensed or registered under 73
chapter 334, 335, or 337, acting under the 74
supervision of the physician performing or 75
inducing the abortion, and acting within the 76
course and scope of his or her authority 77
provided by law. The provisions of this section 78
shall not be construed to in any way expand the 79
authority otherwise provided by law relating to 80
the licensure, registration, or scope of 81
practice of any such qualified professional. 82
7. If the provisions in subsection 2 of 83
this section requiring a seventy-two-hour 84
waiting period for an abortion are ever 85
temporarily or permanently restrained or 86
enjoined by judicial order, then the waiting 87
period for an abortion shall be twenty-four 88
hours; provided, however, that if such temporary 89
or permanent restraining order or injunction is 90
stayed or dissolved, or otherwise ceases to have 91
effect, the waiting period for an abortion shall 92
be seventy-two hours.] 93
SB 1692 74
[188.047. 1. All tissue, except that 1
tissue needed for purposes described in 2
subsection 5 of this section, removed at the 3
time of abortion shall be submitted within five 4
days to a board-eligible or certified 5
pathologist for gross and histopathological 6
examination. The pathologist shall file a copy 7
of the tissue report with the state department 8
of health and senior services, and shall provide 9
within seventy-two hours a copy of the report to 10
the abortion facility or hospital in which the 11
abortion was performed or induced. The 12
pathologist's report shall be made a part of the 13
patient's permanent record. If the pathological 14
examination fails to identify evidence of a 15
completed abortion, the pathologist shall notify 16
the abortion facility or hospital within twenty- 17
four hours. 18
2. The department shall reconcile each 19
notice of abortion with its corresponding tissue 20
report. If the department does not receive the 21
notice of abortion or the tissue report, the 22
department shall make an inquiry of the abortion 23
facility or hospital. After such inquiry, if 24
the hospital or abortion facility has not 25
satisfactorily responded to said inquiry and the 26
department finds that the abortion facility or 27
hospital where the abortion was performed or 28
induced was not in compliance with the 29
provisions of this section, the department shall 30
consider such noncompliance a deficiency 31
requiring an unscheduled inspection of the 32
facility to ensure the deficiency is remedied, 33
subject to the provisions of chapter 197 34
regarding license suspensions, reviews, and 35
appeals. 36
3. Beginning January 1, 2018, the 37
department shall make an annual report to the 38
general assembly. The report shall include the 39
number of any deficiencies and inquiries by the 40
department of each abortion facility in the 41
calendar year and whether any deficiencies were 42
remedied and, for each abortion facility, 43
aggregated de-identified data about the total 44
SB 1692 75
number of abortions performed at the facility, 45
the termination procedures used, the number and 46
type of complications reported for each type of 47
termination procedure, whether the department 48
received the tissue report for each abortion, 49
and the existence and nature, if any, of any 50
inconsistencies or concerns between the abortion 51
reports submitted under section 188.052 and the 52
tissue report submitted under this section. The 53
report shall not contain any personal patient 54
information the disclosure of which is 55
prohibited by state or federal law. 56
4. All reports provided by the department 57
to the general assembly under this section shall 58
maintain confidentiality of all personal 59
information of patients, facility personnel, and 60
facility physicians. 61
5. Nothing in this section shall prohibit 62
the utilization of fetal organs or tissue 63
resulting from an abortion for medical or 64
scientific purposes to determine the cause or 65
causes of any anomaly, illness, death, or 66
genetic condition of the fetus, the paternity of 67
the fetus, or for law enforcement purposes. 68
6. The department may adopt rules, 69
regulations, and standards governing the reports 70
required under this section. In doing so, the 71
department shall ensure that these reports 72
contain all information necessary to ensure 73
compliance with all applicable laws and 74
regulations. Any rule or portion of a rule, as 75
that term is defined in section 536.010, that is 76
created under the authority delegated in this 77
section shall become effective only if it 78
complies with and is subject to all of the 79
provisions of chapter 536 and, if applicable, 80
section 536.028. This section and chapter 536 81
are nonseverable and if any of the powers vested 82
with the general assembly pursuant to chapter 83
536 to review, to delay the effective date, or 84
to disapprove and annul a rule are subsequently 85
held unconstitutional, then the grant of 86
rulemaking authority and any rule proposed or 87
SB 1692 76
adopted after October 24, 2017, shall be invalid 88
and void.] 89
[188.052. 1. An individual abortion 1
report for each abortion performed or induced 2
upon a woman shall be completed by the physician 3
who performed or induced the abortion. Abortion 4
reports shall include, but not be limited to, a 5
certification that the physician does not have 6
any knowledge that the woman sought the abortion 7
solely because of a prenatal diagnosis, test, or 8
screening indicating Down Syndrome or the 9
potential of Down Syndrome in the unborn child 10
and a certification that the physician does not 11
have any knowledge that the woman sought the 12
abortion solely because of the sex or race of 13
the unborn child. 14
2. An individual complication report for 15
any post-abortion care performed upon a woman 16
shall be completed by the physician providing 17
such post-abortion care. This report shall 18
include: 19
(1) The date of the abortion; 20
(2) The name and address of the abortion 21
facility or hospital where the abortion was 22
performed or induced; 23
(3) The nature of the abortion 24
complication diagnosed or treated. 25
3. All abortion reports shall be signed by 26
the attending physician who performed or induced 27
the abortion and submitted to the department 28
within forty-five days from the date of the 29
abortion. All complication reports shall be 30
signed by the physician providing the post- 31
abortion care and submitted to the department 32
within forty-five days from the date of the post- 33
abortion care. 34
4. A copy of the abortion report shall be 35
made a part of the medical record of the patient 36
of the abortion facility or hospital in which 37
the abortion was performed or induced. 38
5. The department shall be responsible for 39
collecting all abortion reports and complication 40
reports and collating and evaluating all data 41
SB 1692 77
gathered therefrom and shall annually publish a 42
statistical report based on such data from 43
abortions performed or induced in the previous 44
calendar year.] 45
[188.056. 1. Notwithstanding any other 1
provision of law to the contrary, no abortion 2
shall be performed or induced upon a woman at 3
eight weeks gestational age or later, except in 4
cases of medical emergency. Any person who 5
knowingly performs or induces an abortion of an 6
unborn child in violation of this subsection 7
shall be guilty of a class B felony, as well as 8
subject to suspension or revocation of his or 9
her professional license by his or her 10
professional licensing board. A woman upon whom 11
an abortion is performed or induced in violation 12
of this subsection shall not be prosecuted for a 13
conspiracy to violate the provisions of this 14
section. 15
2. It shall be an affirmative defense for 16
any person alleged to have violated the 17
provisions of subsection 1 of this section that 18
the person performed or induced an abortion 19
because of a medical emergency. The defendant 20
shall have the burden of persuasion that the 21
defense is more probably true than not. 22
3. Prosecution under this section shall 23
bar prosecution under section 188.057, 188.058, 24
or 188.375 if prosecution under such sections 25
would violate the provisions of Amendment V to 26
the Constitution of the United States or Article 27
I, Section 19 of the Constitution of Missouri. 28
4. If any one or more provisions, 29
subsections, sentences, clauses, phrases, or 30
words of this section or the application thereof 31
to any person, circumstance, or period of 32
gestational age is found to be unenforceable, 33
unconstitutional, or invalid by a court of 34
competent jurisdiction, the same is hereby 35
declared to be severable and the balance of the 36
section shall remain effective notwithstanding 37
such unenforceability, unconstitutionality, or 38
invalidity. The general assembly hereby 39
SB 1692 78
declares that it would have passed this section, 40
and each provision, subsection, sentence, 41
clause, phrase, or word thereof, irrespective of 42
the fact that any one or more provisions, 43
subsections, sentences, clauses, phrases, or 44
words of the section, or the application of the 45
section to any person, circumstance, or period 46
of gestational age, would be declared 47
unenforceable, unconstitutional, or invalid.] 48
[188.057. 1. Notwithstanding any other 1
provision of law to the contrary, no abortion 2
shall be performed or induced upon a woman at 3
fourteen weeks gestational age or later, except 4
in cases of medical emergency. Any person who 5
knowingly performs or induces an abortion of an 6
unborn child in violation of this subsection 7
shall be guilty of a class B felony, as well as 8
subject to suspension or revocation of his or 9
her professional license by his or her 10
professional licensing board. A woman upon whom 11
an abortion is performed or induced in violation 12
of this subsection shall not be prosecuted for a 13
conspiracy to violate the provisions of this 14
section. 15
2. It shall be an affirmative defense for 16
any person alleged to have violated the 17
provisions of subsection 1 of this section that 18
the person performed or induced an abortion 19
because of a medical emergency. The defendant 20
shall have the burden of persuasion that the 21
defense is more probably true than not. 22
3. Prosecution under this section shall 23
bar prosecution under section188.056, 188.058, 24
or 188.375 if prosecution under such sections 25
would violate the provisions of Amendment V to 26
the Constitution of the United States or Article 27
I, Section 19 of the Constitution of Missouri. 28
4. If any one or more provisions, 29
subsections, sentences, clauses, phrases, or 30
words of this section or the application thereof 31
to any person, circumstance, or period of 32
gestational age is found to be unenforceable, 33
unconstitutional, or invalid by a court of 34
SB 1692 79
competent jurisdiction, the same is hereby 35
declared to be severable and the balance of the 36
section shall remain effective notwithstanding 37
such unenforceability, unconstitutionality, or 38
invalidity. The general assembly hereby 39
declares that it would have passed this section, 40
and each provision, subsection, sentence, 41
clause, phrase, or word thereof, irrespective of 42
the fact that any one or more provisions, 43
subsections, sentences, clauses, phrases, or 44
words of the section, or the application of the 45
section to any person, circumstance, or period 46
of gestational age, would be declared 47
unenforceable, unconstitutional, or invalid.] 48
[188.058. 1. Notwithstanding any other 1
provision of law to the contrary, no abortion 2
shall be performed or induced upon a woman at 3
eighteen weeks gestational age or later, except 4
in cases of medical emergency. Any person who 5
knowingly performs or induces an abortion of an 6
unborn child in violation of this subsection 7
shall be guilty of a class B felony, as well as 8
subject to suspension or revocation of his or 9
her professional license by his or her 10
professional licensing board. A woman upon whom 11
an abortion is performed or induced in violation 12
of this section shall not be prosecuted for a 13
conspiracy to violate the provisions of this 14
section. 15
2. It shall be an affirmative defense for 16
any person alleged to have violated the 17
provisions of subsection 1 of this section that 18
the person performed or induced an abortion 19
because of a medical emergency. The defendant 20
shall have the burden of persuasion that the 21
defense is more probably true than not. 22
3. Prosecution under this section shall 23
bar prosecution under section 188.056, 188.057, 24
or 188.375 if prosecution under such sections 25
would violate the provisions of Amendment V to 26
the Constitution of the United States or Article 27
I, Section 19 of the Constitution of Missouri. 28
SB 1692 80
4. If any one or more provisions, 29
subsections, sentences, clauses, phrases, or 30
words of this section or the application thereof 31
to any person, circumstance, or period of 32
gestational age is found to be unenforceable, 33
unconstitutional, or invalid by a court of 34
competent jurisdiction, the same is hereby 35
declared to be severable and the balance of the 36
section shall remain effective notwithstanding 37
such unenforceability, unconstitutionality, or 38
invalidity. The general assembly hereby 39
declares that it would have passed this section, 40
and each provision, subsection, sentence, 41
clause, phrase, or word thereof, irrespective of 42
the fact that any one or more provisions, 43
subsections, sentences, clauses, phrases, or 44
words of the section, or the application of the 45
section to any person, circumstance, or period 46
of gestational age, would be declared 47
unenforceable, unconstitutional, or invalid.] 48
[188.075. 1. Any person who contrary to 1
the provisions of sections 188.010 to 188.085 2
knowingly performs, induces, or aids in the 3
performance or inducing of any abortion or 4
knowingly fails to perform any action required 5
by sections 188.010 to 188.085 shall be guilty 6
of a class A misdemeanor, unless a different 7
penalty is provided for in state law, and, upon 8
conviction, shall be punished as provided by law. 9
2. It shall be an affirmative defense for 10
any person alleged to have violated any 11
provision of this chapter that the person 12
performed an action or did not perform an action 13
because of a medical emergency. This 14
affirmative defense shall be available in 15
criminal, civil, and administrative actions or 16
proceedings. The defendant shall have the 17
burden of persuasion that the defense is more 18
probably true than not. 19
3. The attorney general shall have 20
concurrent original jurisdiction throughout the 21
state, along with each prosecuting attorney and 22
circuit attorney within their respective 23
SB 1692 81
jurisdictions, to commence actions for a 24
violation of any provision of this chapter, for 25
a violation of any state law on the use of 26
public funds for an abortion, or for a violation 27
of any state law which regulates an abortion 28
facility or a person who performs or induces an 29
abortion. The attorney general, or prosecuting 30
attorney or circuit attorney within their 31
respective jurisdictions, may seek injunctive or 32
other relief against any person who, or entity 33
which, is in violation of any provision of this 34
chapter, misuses public funds for an abortion, 35
or violates any state law which regulates an 36
abortion facility or a person who performs or 37
induces an abortion.] 38
[188.080. Any person who is not a 1
physician who performs or induces or attempts to 2
perform or induce an abortion on another is 3
guilty of a class B felony, and, upon 4
conviction, shall be punished as provided by 5
law. Any physician performing or inducing an 6
abortion who does not have clinical privileges 7
at a hospital which offers obstetrical or 8
gynecological care located within thirty miles 9
of the location at which the abortion is 10
performed or induced shall be guilty of a class 11
A misdemeanor, and, upon conviction shall be 12
punished as provided by law.] 13
[188.230. Nothing in this act is intended 1
to authorize anyone other than a physician to 2
perform an abortion.] 3
[188.375. 1. This section shall be known 1
and may be cited as the "Late-Term Pain-Capable 2
Unborn Child Protection Act". 3
2. As used in this section, the phrase 4
"late-term pain-capable unborn child" shall mean 5
an unborn child at twenty weeks gestational age 6
or later. 7
3. Notwithstanding any other provision of 8
law to the contrary, no abortion shall be 9
performed or induced upon a woman carrying a 10
late-term pain-capable unborn child, except in 11
SB 1692 82
cases of medical emergency. Any person who 12
knowingly performs or induces an abortion of a 13
late-term pain-capable unborn child in violation 14
of this subsection shall be guilty of a class B 15
felony, as well as subject to suspension or 16
revocation of his or her professional license by 17
his or her professional licensing board. A 18
woman upon whom an abortion is performed or 19
induced in violation of this subsection shall 20
not be prosecuted for a conspiracy to violate 21
the provisions of this subsection. 22
4. It shall be an affirmative defense for 23
any person alleged to have violated the 24
provisions of subsection 3 of this section that 25
the person performed or induced an abortion 26
because of a medical emergency. The defendant 27
shall have the burden of persuasion that the 28
defense is more probably true than not. 29
5. Prosecution under subsection 3 of this 30
section shall bar prosecution under section 31
188.056, 188.057, or 188.058 if prosecution 32
under such sections would violate the provisions 33
of Amendment V to the Constitution of the United 34
States or Article I, Section 19 of the 35
Constitution of Missouri. 36
6. When in cases of medical emergency a 37
physician performs or induces an abortion upon a 38
woman in her third trimester carrying a late- 39
term pain-capable unborn child, the physician 40
shall utilize the available method or technique 41
of abortion most likely to preserve the life or 42
health of the unborn child. In cases where the 43
method or technique of abortion most likely to 44
preserve the life or health of the unborn child 45
would present a greater risk to the life or 46
health of the woman than another legally 47
permitted and available method or technique, the 48
physician may utilize such other method or 49
technique. In all cases where the physician 50
performs or induces an abortion upon a woman 51
during her third trimester carrying a late-term 52
pain-capable unborn child, the physician shall 53
certify in writing the available method or 54
SB 1692 83
techniques considered and the reasons for 55
choosing the method or technique employed. 56
7. When in cases of medical emergency a 57
physician performs or induces an abortion upon a 58
woman during her third trimester carrying a late- 59
term pain-capable unborn child, there shall be 60
in attendance a physician other than the 61
physician performing or inducing the abortion 62
who shall take control of and provide immediate 63
medical care for a child born as a result of the 64
abortion. 65
8. Any physician who knowingly violates 66
any of the provisions of subsection 6 or 7 of 67
this section shall be guilty of a class D 68
felony, as well as subject to suspension or 69
revocation of his or her professional license by 70
his or her professional licensing board. A 71
woman upon whom an abortion is performed or 72
induced in violation of subsection 6 or 7 of 73
this section shall not be prosecuted for a 74
conspiracy to violate the provisions of those 75
subsections. 76
9. If any one or more provisions, 77
subsections, sentences, clauses, phrases, or 78
words of this section or the application thereof 79
to any person, circumstance, or period of 80
gestational age is found to be unenforceable, 81
unconstitutional, or invalid by a court of 82
competent jurisdiction, the same is hereby 83
declared to be severable and the balance of the 84
section shall remain effective notwithstanding 85
such unenforceability, unconstitutionality, or 86
invalidity. The general assembly hereby 87
declares that it would have passed this section, 88
and each provision, subsection, sentence, 89
clause, phrase, or word thereof, irrespective of 90
the fact that any one or more provisions, 91
subsections, sentences, clauses, phrases, or 92
words of the section, or the application of the 93
section to any person, circumstance, or period 94
of gestational age, would be declared 95
unenforceable, unconstitutional, or invalid.] 96
SB 1692 84
[334.245. 1. Notwithstanding any other 1
provision of law to the contrary that may allow 2
a person to provide services relating to 3
pregnancy, including prenatal, delivery, and 4
postpartum services, no person other than a 5
licensed physician is authorized to perform or 6
induce an abortion. 7
2. Any person who violates the provisions 8
of this section is guilty of a class B felony.] 9
[574.200. 1. A person commits the offense 1
of interference with medical assistance if he or 2
she, while serving in his or her capacity as an 3
employee of an abortion facility: 4
(1) Knowingly orders or requests medical 5
personnel to deviate from any applicable 6
standard of care or ordinary practice while 7
providing medical assistance to a patient for 8
reasons unrelated to the patient's health or 9
welfare; or 10
(2) Knowingly attempts to prevent medical 11
personnel from providing medical assistance to a 12
patient in accordance with all applicable 13
standards of care or ordinary practice for 14
reasons unrelated to the patient's health or 15
welfare. 16
2. The offense of interference with 17
medical assistance is a class A misdemeanor. 18
3. For purposes of this section, the term 19
"medical personnel" shall include, but not be 20
limited to, the following: 21
(1) Physicians and surgeons licensed under 22
chapter 334; 23
(2) Nurses licensed under chapter 335; 24
(3) Emergency medical services personnel 25
as defined in section 190.600; or 26
(4) Any person operating under the 27
supervision of such medical personnel.] 28
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