2023 -- S 0958

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LC001556

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     STATE OF RHODE ISLAND

IN GENERAL ASSEMBLY

JANUARY SESSION, A.D. 2023

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A N   A C T

RELATING TO HEALTH AND SAFETY -- RHODE ISLAND'S CHILDREN DESERVE

HELP NOT HARM ACT -- MINOR'S GENDER TRANSITION

     Introduced By: Senator E Morgan

     Date Introduced: May 01, 2023

     Referred To: Senate Judiciary

     It is enacted by the General Assembly as follows:

     SECTION 1. Legislative findings and purpose.

     The general assembly finds that:

     (1) Rhode Island has a compelling government interest protecting the health and safety of

its citizens, especially vulnerable children;

     (2) Only a small percentage of the American population experiences distress identifying

with their biological sex;

     (3) For the small percentage of children who are gender nonconforming or experience

distress identifying with their biological sex, studies consistently demonstrate that the majority

come to embrace their biological sex in adolescence or adulthood, thereby rendering most medical

physiological interventions unnecessary;

     (4) Scientific studies show that individuals experiencing distress identifying with their

biological sex have often experienced severe psychopathology preceding their gender dysphoria,

which indicates these individuals could benefit greatly from access to mental healthcare services;

     (5) Even among individuals who have undergone inpatient gender reassignment

procedures, suicide rates, psychiatric morbidities, and mortality rates remain markedly elevated

above the background population;

     (6) Some healthcare professionals are prescribing puberty-blocking drugs such as

gonadotropin-releasing hormone analogues, in order to delay the natural onset or progression of

puberty in children, who experience distress identifying with their biological sex:

     (i) Puberty-blocking drugs are being prescribed, despite the lack of any long-term

longitudinal studies evaluating the risks and benefits of using these drugs for the treatment of such

distress or gender dysphoria; and

     (ii) Puberty-blocking drugs are being prescribed in an off-label and experimental manner

on children;

     (7) Some healthcare professionals are also prescribing cross-sex hormones for children

who are experiencing distress identifying with their biological sex, despite the fact no randomized

clinical trials have been conducted on the efficacy or safety of the use of cross-sex hormones in

adults or children for the purpose of gender transition;

     (8) The use of cross-sex hormones comes with serious known risks:

     (i) For biological females, some risks may include;

     (A) Irreversible infertility;

     (B) Severe liver dysfunction;

     (C) Coronary artery disease, including heart attacks;

     (D) Increased risk of breast, cervical, and uterine cancers;

     (E) Cerebrovascular disease, including strokes;

     (F) Hypertension;

     (G) Erythrocytosis, which is an increase in red blood cells;

     (H) Sleep apnea;

     (I) Type 2 diabetes;

     (J) Loss of bone density;

     (K) Destabilization of psychiatric disorders; and

     (ii) For biological males, some risks may include:

     (A) Irreversible infertility;

     (B) Thromboembolic disease, including blood clots;

     (C) Cholelithiasis, including gallstones;

     (D) Coronary artery disease, including heart attacks;

     (E) Type 2 diabetes;

     (F) Breast cancer;

     (G) Macroprolactinoma, which is a tumor of the pituitary gland;

     (H) Cerebrovascular disease, including strokes; and

     (I) Hypertriglyceridemia, which is an elevated level of triglycerides in the blood;

     (9) Genital and non-genital gender reassignment surgeries are generally not recommended

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for children, although evidence indicates referrals for children to have such surgeries are becoming

more frequent;

     (10) Genital gender reassignment surgery includes several irreversible invasive procedures

for males and females and involves the alteration of biologically healthy and functional body parts.

These procedures are generally irreversible;

     (i) For biological males, surgery may involve:

     (A) Genital reconstruction, including a penectomy, which is the removal of the penis;

     (B) Orchiectomy, which is the removal of the testicles;

     (C) Vaginoplasty, which is the construction of a vagina-like structure, typically through a

penile inversion procedure;

     (D) Clitoroplasty which is the construction of a clitoris-like structure; and

     (E) Vulvoplasty, which is the construction of a vulva-like structure;

     (ii) For biological females, surgery may involve:

     (A) Hysterectomy or oophorectomy;

     (B) Reconstruction of the urethra;

     (C) Genital reconstruction including metoidioplasty or phalloplasty, which is the

construction of a penis-like structure;

     (D) Vaginectomy, which is the removal of the vagina;

     (E) Scrotoplasty, which is the construction of a scrotum-like structure; and

     (F) Implantation of erection and/or testicular prosthesis;

     (iii) The complications, risks, and long-term care concerns associated with genital sex

reassignment surgery, for both males and females, are numerous and complex;

     (iv) Non-genital sex reassignment surgery includes various invasive procedures for males

and females and also involves the alteration or removal of biologically health, and functional body

parts:

     (A) For biological males, this surgery may involve:

     (I) Augmentation mammoplasty;

     (II) Facial feminization surgery;

     (III) Liposuction;

     (IV) Lipofilling;

     (V) Voice feminization surgery;

     (VI) Thyroid cartilage reduction;

     (VII) Gluteal augmentation;

     (VIII) Hair reconstruction; and

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     (IX) Other aesthetic procedures;

     (B) For biological females, this surgery may involve:

     (I) Subcutaneous mastectomy;

     (II) Voice masculinization surgery;

     (III) Liposuction;

     (IV) Lipofilling;

     (V) Pectoral implants; and

     (VI) Other aesthetic procedures;

     (11) It is an accepted principle of economics and public policy that when a service or

product is subsidized or reimbursed, demand for that service or product increases; and

     (12) It is of grave concern to this general assembly that the medical community is allowing

individuals, who experience distress identifying with their biological sex, to be subjects of

irreversible and drastic non-genital gender reassignment surgery and irreversible, permanently

sterilizing genital gender reassignment surgeries, despite the lack of studies showing that such

extreme interventions have benefits that outweigh their risks or chances of cure. In fact, they may

increase the risk of suicide.

     SECTION 2. Title 23 of the General Laws entitled "HEALTH AND SAFETY" is hereby

amended by adding thereto the following chapter:

CHAPTER 99

RHODE ISLAND'S CHILDREN DESERVE HELP NOT HARM ACT

     23-99-1. Title.

     This act shall be known and may be cited as the "Rhode Island's Children Deserve Help

Not Harm Act".

     23-99-2. Definitions.

     The following definitions apply in the interpretation of the provisions of this chapter:

     (1) "Biological sex" means the biological indication of male and female in the context of

reproductive potential or capacity, such as sex chromosomes, naturally occurring sex hormones,

gonads, and nonambiguous internal and external genitalia, present at birth, including secondary sex

characteristics.

     (2) "Cross-sex hormones" means:

     (i) Testosterone or other androgens given to biological females in amounts that create

serum levels greater than would normally occur naturally in healthy biological females, which may

include without limitation, the following risks:

     (A) Irreversible infertility;

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     (B) Severe liver dysfunction;

     (C) Coronary artery disease, including heart attacks;

     (D) Increased risk of breast, cervical, and uterine cancers;

     (E) Cerebrovascular disease, including strokes;

     (F) Hypertension;

     (G) Erythrocytosis, which is an increase in red blood cells;

     (H) Sleep apnea;

     (I) Type 2 diabetes;

     (J) Loss of bone density; and

     (K) Destabilization of psychiatric disorders; and

     (ii) Estrogen given to biological males, in amounts that create serum levels greater than

would normally occur naturally in healthy biological males, which may include without limitation

the following risks:

     (A) Irreversible infertility;

     (B) Thromboembolic disease, including blood clots;

     (C) Cholelithiasis, including gallstones;

     (D) Coronary artery disease, including heart attacks;

     (E) Type 2 diabetes;

     (F) Breast cancer;

     (G) Macroprolactinoma, which is a tumor of the pituitary gland;

     (H) Cerebrovascular disease, including strokes; and

     (I) Hypertriglyceridemia, which is an elevated level of triglycerides in the blood.

     (3) "Gender" means the psychological, behavioral, social and cultural aspects of being male

and female.

     (4) "Gender reassignment surgery" means any surgical service that seeks to surgically alter

or remove healthy physical or anatomical characteristics or features, that are typical for the

individual's biological sex, in order to instill or create physiological or anatomical characteristics,

that resemble a sex different from the individual's biological sex, including without limitation,

genital or non-genital gender reassignment surgery performed for the purpose of assisting an

individual with a gender transition.

     (5) "Gender transition" means the process in which a person goes from identifying with

and living as a gender that corresponds to their biological sex, and may involve social, legal, or

physical changes.

     (6) "Gender transition procedures" means any medical or surgical service provided or

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performed for the purpose of assisting an individual with a physical gender transition:

     (i) Gender transition procedures include, without limitation, physician's services, inpatient

and outpatient hospital services, puberty-blocking drugs, cross-sex hormones, or genital or non-

genital gender reassignment surgery;

     (ii) Gender transition procedures do not include:

     (A) Services to persons born with a medically verifiable disorder of sex development,

including a person with external biological sex characteristics that are irresolvably ambiguous, such

as those born with 46 XX chromosomes with virilization, 46 XY chromosomes with

undervirilization, or having both ovarian and testicular tissue;

     (B) Services provided when a physician has otherwise diagnosed a disorder of sexual

development, that the physician has determined through genetic or biochemical testing that the

person does not have normal sex chromosome structure, sex steroid production, or sex steroid

hormone action;

     (C) The acute and chronic treatment of any infection, injury, disease, or disorder that has

been caused by or exacerbated by the performance of gender transition procedures, whether or not

the gender transition procedure, was performed in accordance with state and federal law or whether

or not funding for the gender transition procedure is permissible under this chapter; or

     (D) Any procedure undertaken because the individual suffers from a physical disorder,

physical injury, or physical illness that would, as certified by a physician, place the individual in

imminent danger of death or impairment of major bodily function, unless surgery is performed.

     (7) "Genital gender reassignment surgery" means a surgical procedure performed for the

purpose of assisting an individual with a physical gender transition, including, without limitation:

     (i) Surgical procedures such as a penectomy, orchiectomy, vaginoplasty, clitoroplasty, or

vulvoplasty for biologically male patients; or

     (ii) Surgical procedures such as hysterectomy, oophorectomy, reconstruction of the

urethra, metoidioplasty or phalloplasty, vaginectomy, scrotoplasty, or implantation of erection

and/or testicular protheses for biologically female patients.

     (8) "Non-genital gender reassignment surgery" means surgical procedures performed for

the purpose of assisting an individual with a physical gender transition, including, without

limitation:

     (i) Surgical procedures for biologically male patients, such as augmentation mammoplasty,

facial feminization surgery, liposuction, lipofilling, voice feminization surgery, thyroid cartilage

reduction, gluteal augmentation, hair reconstruction, or various aesthetic procedures; or

     (ii) Surgical procedures for biologically female patients, such as subcutaneous mastectomy,

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voice masculinization surgery, liposuction, lipofilling, pectoral implants, or various aesthetic

procedures.

     (9) "Physician" means a person who is licensed to practice medicine in this state.

     (10) "Puberty-blocking drugs" means gonadotropin-releasing hormone analogues or other

synthetic drugs used in biological males to stop luteinizing hormone secretion and therefore

testosterone production, or synthetic drugs used in biological females, which stop the production

of estrogen and progesterone, when used to delay or suppress pubertal development in children, for

the purpose of assisting an individual with a gender transition.

     (11) "Public funds" means state or local government monies, in addition to any department,

agency, or instrumentality authorized or appropriated under state law or derived from any fund in

which monies are deposited.

     23-99-3. Gender transition procedures for minors prohibited.

     (a) A physician or other healthcare professional shall not provide gender transition

procedures to any individual under eighteen (18) years of age.

     (b) A healthcare institution or entity shall not facilitate the provision of gender transition

procedures to any individual under eighteen (18) years of age.

     23-99-4. Insurance coverage for gender transition procedures for minors prohibited.

     (a) A health benefit plan under an insurance policy or other plan providing healthcare

coverage in this state shall not include reimbursement for gender transition procedures for a person

under eighteen (18) years of age.

     (b) A health benefit plan under an insurance policy or other plan providing healthcare

coverage in this state is not required to provide coverage for gender transition procedures.

     (c) A federal health benefit plan under an insurance policy or other plan providing

healthcare coverage, such as TRICare or Veterans Administration Healthcare, shall not include

reimbursement for gender transition procedures for a person under eighteen (18) years of age in

this state.

     23-99-5. Prohibition on aiding or abetting.

     (a) A person or entity shall not knowingly engage in conduct that aids or abets the

performance or inducement of gender transition procedures, to any individual under eighteen (18)

years of age, including employees of other state governments, the federal government, or foreign

governments.

     (b) This provision shall not apply to any first amendment-protected speech.

     (c) No parent of a child victim shall be held liable under this section.

     23-99-6. Prohibition on use of public funds for gender transition.

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     (a) Public funds shall not be directly or indirectly used, granted, paid, or distributed to any

entity, organization, or individual that provides gender transition procedures to an individual under

eighteen (18) years of age.

     (b) Healthcare services furnished in the following situations shall not include gender

transition procedures to an individual under eighteen (18) years of age:

     (1) By or in a facility owned by the state or a local government; or

     (2) By a physician or other healthcare professional employed by the state or local

government.

     (c) An amount paid by an individual or an entity, during a taxable year, for provision of

gender transition procedures or as premiums for healthcare coverage, that includes coverage for

gender transition procedures, is not tax-deductible.

     (d) The state Medicaid program shall not reimburse or provide coverage for gender

transition procedures to an individual under eighteen (18) years of age.

     23-99-7. Gender transition procedures on minors constitute unprofessional and

reckless conduct.

     Any referral for or provision of gender transition procedures to an individual, under

eighteen (18) years of age, is unprofessional conduct and is subject to discipline by the appropriate

licensing entity or disciplinary review board, with competent jurisdiction in this state.

     23-99-8. Enforcement actions for recovery of damages suffered as a result of gender

transition procedures on minors.

     (a) Statute of limitations:

     (1) Notwithstanding any other provision of law, an individual under eighteen (18) years of

age may bring an action, throughout their minority, through a parent or next friend, and may bring

an action in their own name, upon reaching the age of majority at any time from that point until

thirty (30) years after reaching the age of majority.

     (2) Exceptions:

     (i) If at the time the person abused attains the age of eighteen (18) years or they are under

other legal disability, the limitation period under subsection (a)(1) of this section does not begin to

run until the removal of the disability; and

     (ii) The limitation period in subsection (a)(1) of this section does not run during a time

period when the individual is subject to threats, intimidation, manipulation, fraudulent

concealment, or fraud perpetrated by the physician or other healthcare professional, who prescribed

or otherwise provided gender transition procedures or by any person, acting in the interest of the

physician or other healthcare professional.

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     (b) A person may assert an actual or threatened violation of this chapter, as a claim or

defense in a judicial or administrative proceeding.

     (1) The following damages may be awarded to the claimant:

     (i) Compensatory damages, including, but not limited to:

     (A) Pain and suffering;

     (B) Loss of reputation;

     (C) Loss of income; and

     (D) Loss of consortium, including, but not limited to, the loss of expectation of sharing

parenthood;

     (ii) Injunctive relief;

     (iii) Declaratory relief;

     (iv) Punitive damages;

     (v) Any other appropriate relief; and

     (vi) A prevailing party, who establishes a violation of this chapter shall recover reasonable

attorneys' fees and cost.

     (c) Notwithstanding any other provision of law, an action under this chapter, may be

commenced, and relief may be granted, in a judicial proceeding, without regard to whether the

person commencing the action has sought or exhausted available administrative remedies.

     (d) The attorney general may bring an action to enforce compliance with this chapter.

     (e) This chapter does not deny, impair, or otherwise affect any right or authority of the

attorney general, the State of Rhode Island, or any agency, officer, or employee of the state, acting

under any law, other than this chapter, to institute or intervene in any proceeding.

     23-99-9. Right of intervention.

     The general assembly, by joint resolution, may appoint one or more of its members who

sponsored or cosponsored this chapter in their official capacity, to intervene or defend the chapter

as a matter of right, in any case in which the constitutionality or enforceability of this chapter, any

portion thereof, or any rule or regulation adopted pursuant hereto, is challenged.

     23-99-10. Severability.

     Any provision of this chapter held to be invalid or unenforceable by its terms, or as applied

to any person or circumstance, shall be construed so as to give it the maximum effect, permitted by

law, unless such holding, shall be one of utter invalidity or unenforceability, in which event such

provision shall be deemed severable herefrom and shall not affect the remainder hereof or the

application of such provision to other persons not similarly situated to or to other, dissimilar

circumstances.

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     23-99-11. Effective date.

     This act shall take effect on January 1, 2024, in order that minors in this state currently

using puberty-blocking drugs or cross-sex hormones, shall have the time for appropriate medication

tapering and discontinuation, under the care of their physician or other healthcare professional.

     SECTION 3. This act shall take effect on January 1, 2024.

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EXPLANATION

BY THE LEGISLATIVE COUNCIL

OF

A N   A C T

RELATING TO HEALTH AND SAFETY -- RHODE ISLAND'S CHILDREN DESERVE

HELP NOT HARM ACT -- MINOR'S GENDER TRANSITION

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     This act would prohibit gender transition procedures for all minors, use of public funds for

that purpose, discipline for health care providers for providing same, a thirty (30) year statute of

limitation, and right to a civil action for damages.

     This act would take effect on January 1, 2024.

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