2009 -- H 5076

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LC00036

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STATE OF RHODE ISLAND

IN GENERAL ASSEMBLY

JANUARY SESSION, A.D. 2009

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A N A C T

RELATING TO HEALTH AND SAFETY -- HEALTH CARE RIGHTS OF CONSCIENCE

ACT

     Introduced By: Representatives Brien, Mattiello, Savage, Corvese, and MacBeth

     Date Introduced: January 13, 2009

     Referred To: House Judiciary

It is enacted by the General Assembly as follows:

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     SECTION 1. Section 23-17-11 of the General Laws in Chapter 23-17 entitled "Licensing

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of Health Care Facilities" is hereby repealed.

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     23-17-11. Abortion and sterilization -- Protection for nonparticipation -- Procedure.

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-- A physician or any other person who is a member of or associated with the medical staff of a

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health care facility or any employee of a health care facility in which an abortion or any

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sterilization procedure is scheduled, and who shall state in writing an objection to the abortion or

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sterilization procedure on moral or religious grounds, shall not be required to participate in the

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medical procedures which result in the abortion or sterilization, and the refusal of the person to

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participate in the medical procedures shall not form the basis for any claim of damages on

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account of the refusal or for any disciplinary or recriminatory action against the person.

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

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amended by adding thereto the following chapter:

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     CHAPTER 17.23

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HEALTH CARE RIGHTS OF CONSCIENCE ACT

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     23-17.23-1. Title. – This act may be known and cited as the "Health Care Rights of

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Conscience Act."

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     23-17.23-2. Legislative findings and purposes. – (a) It is the public policy of the state of

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Rhode Island to respect and protect the fundamental right of conscience of all individuals who

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provide health care services.

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     (b) Without comprehensive protection, health care rights of conscience may be violated

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in various ways, such as harassment, demotion, salary reduction, transfer, termination, loss of

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staffing privileges, denial of aid or benefits, and refusal to license, or refusal to certify.

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     (c) It is the purpose of this chapter to protect as a basic civil right, the right of all health

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care providers, institutions and payers to decline to counsel, advise, pay for, provide, perform,

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assist, or participate in providing or performing health care services that violate their consciences.

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Such health care services may include, but are not limited to, abortion, artificial birth control,

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artificial insemination, assisted reproduction, human cloning, euthanasia, human embryonic stem

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cell research, fetal experimentation, physician-assisted suicide, and sterilization.

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     (d) Accordingly, it is the purpose of this chapter to prohibit all forms of discrimination,

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disqualification, coercion, disability, or liability upon such health care providers, institutions and

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payers that decline to perform any health care service that violates their conscience.

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     23-17.23-3. Definitions. -- As used in this chapter:

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     (1) "Health care service" means any phase of patient medical care, treatment or

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procedure, including, but not limited to, the following: patient referral, counseling, therapy,

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testing, diagnosis or prognosis, research, instruction, prescribing, dispensing or administering any

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device, drug, or medication, surgery, or any other care or treatment rendered by health care

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providers or health care institutions.

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     (2) "Health care provider" means any individual who may be asked to participate in any

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way in a health care service, including, but not limited to: a physician, physician's assistant,

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nurse, nurses' aide, medical assistant, hospital employee, clinic employee, nursing home

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employee, pharmacist, pharmacy employee, researcher, medical or nursing school faculty, student

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or employee, counselor, social worker, or any professional, paraprofessional, or any other person

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who furnishes, or assists in the furnishing of health care services.

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     (3) "Health care institution" means any public or private organization, corporation,

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partnership, sole proprietorship, association, agency, network, joint venture, or other entity that is

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involved in providing health care services, including, but not limited to: hospitals, clinics,

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medical centers, ambulatory surgical centers, private physician's offices, pharmacies, nursing

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homes, university medical schools and nursing schools, medical training facilities, or other

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institutions or locations wherein health care services are provided to any person.

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     (4) "Health care payer" means any entity or employer that contracts for, pays for, or

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arranges for the payment of, in whole or in part, any health care service or product, including, but

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not limited to, health maintenance organizations, health plans, insurance companies, or

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management services organizations.

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     (5) "Employer" means any individual or entity that pays for or provides health benefits or

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health insurance coverage as a benefit to its employees, whether through a third-party, a health

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maintenance organization, a program of self insurance, or some other means.

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     (6) "Participate" in a health care service means to counsel, advise, provide, perform,

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assist in refer for, admit for purposes of providing, or participate in providing, any health care

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service, or any form of such service.

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     (7) "Pay" or "payment" means to pay, contract for, or otherwise arrange for the payment

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of, in whole or in part.

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     (8) "Conscience" means the religious, moral or ethical principles held by a health care

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provider, the health care institution or health care payer. For purposes of this chapter, a health

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care institution or health care payer's conscience shall be determined by reference to its existing

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or proposed religious, moral or ethical guidelines, mission statement, constitution, bylaws,

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articles of incorporation, regulations, or other relevant documents.

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     23-17.23-4. Rights of conscience of health care providers. – (a) Rights of conscience.

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A health care provider has the right not to participate, and no health care provider shall be

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required to participate, in a health care service that violates his or her conscience.

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     (b) Immunity from liability. No health care provider shall be civilly, criminally, or

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administratively liable for declining to participate in a health care service that violates his or her

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conscience.

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     (c) Discrimination. It shall be unlawful for any person, health care provider, health care

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institution, public or private institution, public official, or any board which certifies competency

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in medical specialties to discriminate against any health care provider in any manner based on his

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or her declining to participate in a health care service that violates his or her conscience. For

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purposes of this chapter, discrimination includes, but is not limited to, termination, transfer,

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refusal of staff privileges, refusal of board certification, adverse administrative action, demotion,

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loss of career specialty, reassignment to a different shift, reduction of wages or benefits, refusal to

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award any grant, contract, or other program, refusal to provide residency training opportunities,

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or any other penalty, disciplinary or retaliatory action.

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     23-17.23-5. Rights of conscience of health care institutions. – (a) Rights of conscience.

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A health care institution has the right not to participate, and no health care institution shall be

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required to participate, in a health care service that violates its conscience.

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     (b) Immunity from liability. A health care institution that declines to provide or

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participate in a health care service that violates its conscience shall not be civilly, criminally, or

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administratively liable if the institution provides a consent form to be signed by a patient before

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admission to the institution stating that it reserves the right to decline to provide or participate in

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health care services that violate its conscience.

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     (c) Discrimination. It shall be unlawful for any person, public or private institution, or

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public official to discriminate against any health care institution, or any person, association,

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corporation, or other entity attempting to establish a new health care institution or operating in

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existing health care institution, in any manner, including, but not limited to: any denial

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deprivation or disqualification with respect to licensure; any aid assistance, benefit or privilege,

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including staff privileges; or any authorization including authorization to create, expand, improve,

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acquire, or affiliate or merge with any health care institution, because such health care institution,

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or person, association, or corporation planning, proposing, or operating a health care institution,

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declines to participate in a health care service which violates the health care institution's

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conscience.

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     (d) Denial of aid or benefit. It shall be unlawful for any public official, agency,

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institution, or entity to deny any form of aid, assistance, grants, or benefits, or in any other

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manner to coerce, disqualify, or discriminate against any person, association, corporation, or

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other entity attempting to establish a new health care institution or operating an existing health

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care institution because the existing or proposed health care institution declines to participate in a

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health care service contrary to the health care institution's conscience.

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     23-17.23-6. Rights of conscience of health care payers. – (a) Rights of conscience. A

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health care payer has the right to decline to pay, and no health care payer shall be required to pay

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for or arrange for the payment of any health care service or product that violates its conscience.

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     (b) Immunity from liability. No health care payer and no person, association, corporation,

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or other entity that owns, operates, supervises, or manages a health care payer shall be civilly or

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criminally liable by reason of the health care payer's declining to pay for or arrange for the

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payment of any health care service that violates its conscience.

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     (c) Discrimination. It shall be unlawful for any person, public or private institution, or

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public official to discriminate against any health care payer; or any person, association,

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corporation, or other entity: (1) attempting to establish a new health care payer; or (2) operating

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an existing health care payer, in any manner, including, but not limited to, any denial,

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deprivation, or disqualification with respect to licensure, aid, assistance, benefit, privilege, or

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authorization, including, but not limited to, any authorization to create, expand, improve, acquire

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or affiliate or merge with any health care payer, because a health care payer, or person,

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association, corporation, or other entity planning, proposing, or operating a health care payer

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declines to pay for or arrange for the payment of any health care service that violates its

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conscience.

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     (d) Denial of aid or benefits. It shall be unlawful for any public official, agency,

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institution, or entity to deny any form of aid, assistance, grants, or benefits, or in any other

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manner to coerce disqualify, or discriminate against any health care payer, or any person,

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association, corporation, or other entity attempting to establish a new health care payer or

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operating an existing health care payer because the existing or proposed health care payer

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declines to pay for, or arrange for the payment of, any health care service that is contrary to its

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conscience.

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     23-17.23-7. Civil remedies. – (a) A civil action for damages or injunctive relief, or both,

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may be brought for the violation of any provision of this chapter. It shall not be a defense to any

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claim arising out of the violation of this act that such violation was necessary to prevent

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additional burden or expense on any other health care provider, health care institution, individual,

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or patient.

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     (b) Damage remedies. Any individual, association, corporation, entity, or health care

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institution injured by any public or private individual, association, agency, entity, or corporation

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by reason of any conduct prohibited by this act may commence a civil action. Upon finding a

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violation of this act, the aggrieved party shall be entitled to recover threefold the actual damages,

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including pain and suffering, sustained by such individual, association, corporation, entity or

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health care institution, the costs of the action, and reasonable attorneys' fees; but in no case shall

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recovery be less than five thousand dollars ($5,000) for each violation in addition to the cost of

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the action and reasonable attorneys' fees. These damage remedies shall be cumulative, and not

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exclusive of other remedies afforded under any other state or federal law.

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     (c) Injunctive remedies. The court in such civil action may award injunctive relief,

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including, but not limited to, ordering reinstatement of a health care provider to his or her prior

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job position.

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     23-17.23-8. Discrimination in provision of health services on basis of race or

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disability. – Nothing in this act shall be construed to authorize or shield from liability the denial

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of a health care service that a health care provider, a health care institution, or a health care payer

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provides to others on the basis of a patient's race or present or predicted disability. For purposes

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of this section, the term "disability" has the meaning given to it by section 12102(2)(a) of Title 42

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of the United States Code.

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     23-17.23-9. Severability. – The provisions of the chapter are declared to be severable,

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and if any provision, word, phrase, or clause of the chapter or the application thereof to any

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person shall be held invalid, such invalidity shall not affect the validity of the remaining portions

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of this chapter.

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     SECTION 3. This act shall take effect upon passage.

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LC00036

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EXPLANATION

BY THE LEGISLATIVE COUNCIL

OF

A N A C T

RELATING TO HEALTH AND SAFETY -- HEALTH CARE RIGHTS OF CONSCIENCE

ACT

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     This act would provide protection from discrimination to all health care providers who

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chose not to participate in a health care service that violates the conscience of the health care

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provider. The act would also provide a civil cause of action for damages in instances of

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violations of this act.

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     This act would take effect upon passage.

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LC00036

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