HB4356 103RD GENERAL ASSEMBLY

LRB103 36196 LNS 66288 b

103RD GENERAL ASSEMBLY
State of Illinois
2023 and 2024
HB4356

Introduced 1/16/2024, by Rep. William E Hauter

SYNOPSIS AS INTRODUCED:

New Act

Creates the Women's Health Protection Act. Requires all abortion clinics to be licensed by the Department of Public Health. Sets forth provisions relating to application procedures, license issuance, denial, suspension, revocation, or refusal, administrative decisions, and the adoption of rules. Requires the Department to establish policies and procedures for conducting prelicensure and relicensure inspections of abortion clinics. Provides that the Director of the Department shall adopt rules relating to an abortion clinic's physical facilities, supply and equipment standards, and personnel. Provides for civil penalties, including a $5,000 civil penalty for operating an abortion clinic without a license, a $5,000 civil penalty for intentionally violating the Act, and a $1,000 civil penalty for a first violation of the Act and $5,000 for a subsequent violation. Allows both the Office of the Attorney General and the Office of the State's Attorney for the county in which the violation occurred to initiate a legal action to enforce collection of civil penalties. Allows the Director to apply to any court of competent jurisdiction for an order enjoining any acts or practices which constitute or will constitute a violation of the Act. Provides that nothing in the Act makes lawful an abortion that is currently unlawful. Defines terms. States legislative findings and purposes. Effective one year after becoming law.

A BILL FOR

AN ACT concerning health.

Be it enacted by the People of the State of Illinois, represented in the General Assembly:

Section 1. Short title. This Act may be cited as the Women's Health Protection Act.

Section 5. Legislative findings and purposes.

(a) The General Assembly finds that:

(1) Most abortions in this State are performed in clinics devoted primarily to providing abortions and family planning services. Most women who seek abortions at these facilities lack any physician-patient relationship with the physician who performs the abortion either before or after the procedure. The women ordinarily do not return to the facility for post-surgical care. In most instances, the woman's only actual contact with the abortion provider occurs simultaneously with the abortion procedure, with little opportunity to ask questions about the procedure, potential complications, and proper follow-up care.

(2) The medical, emotional, and psychological consequences of an abortion are serious and can be lasting.

(3) Abortion can lead to both short-term and long-term medical complications. Potential complications from abortion include, among others, bleeding, hemorrhage, infection, uterine perforation, uterine scarring, blood clots, cervical tears, incomplete abortion (retained tissue), failure to actually terminate the pregnancy, free fluid in the abdomen, acute abdomen, organ damage, missed ectopic pregnancies, cardiac arrest, sepsis, respiratory arrest, reactions to anesthesia and other drugs, and even death.

(4) The risks for second-trimester abortions are greater than for first-trimester abortions. The risk of hemorrhage, in particular, is greater, and the resultant complications may require a hysterectomy, other reparative surgery, or a blood transfusion.

(5) The State has legitimate interests from the outset of pregnancy in protecting the health of women.

(6) More specifically, the State has a legitimate concern with the health of women who undergo abortions.

(b) Based on the findings in subsection (a), the purposes of this Act are to:

(1) regulate abortion clinics consistent with standard health and safety procedures of the Department of Public Health; and

(2) provide for the protection of public health through the development, establishment, and enforcement of medically appropriate standards of care and safety in abortion clinics.

Section 10. Definitions. As used in this Act:

"Abortion" has the meaning given to that term in Section 1-10 of the Reproductive Health Act.

"Abortion clinic" means a facility, other than an accredited hospital or health care professional's office, in which 5 or more first-trimester abortions, that are not chemical abortions, in any month or any second-trimester or third-trimester abortions are performed, and whose primary purpose is the performance of abortions.

"Advanced practice registered nurse" has the meaning given to that term in Section 50-10 of the Nurse Practice Act.

"Department" means the Department of Public Health.

"Director" means the Director of the Department of Public Health.

"Health care professional" means a person who is a licensed physician, advanced practice registered nurse, or physician assistant.

"Licensee" means an individual, a partnership, an association, a limited liability company, or a corporation authorized by the Department of Public Health to operate an abortion clinic.

"Physician" means a person licensed to practice medicine in all its branches under the Medical Practice Act of 1987.

"Physician assistant" has the meaning given to that term in Section 4 of the Physician Assistant Practice Act of 1987.

Section 15. Licensure requirements.

(a) Beginning one year after the effective date of this Act, all abortion clinics shall be licensed by the Department. Any existing abortion clinic shall apply for licensure within one year of the effective date of this Act.

(b) A licensure applicant shall apply to the Department with Department-provided forms. The Department shall include such information as the Department reasonably requires, including affirmative evidence of ability to comply with such reasonable standards and rules as are lawfully prescribed hereunder. The Department shall supply supplemental forms for additional information it requires as needed.

(c) The Department shall issue a license which is valid for a period of one year after the following procedures are fulfilled:

(1) the Department receives an application for license;

(2) the applicant and the facility meet the requirements established by this Act; and

(3) the minimum standards and administrative rules are adopted in accordance with this Act.

(d) The Department may issue a temporary or provisional license to an abortion clinic for a period of 6 months in cases where:

(1) no other State or local agency who is authorized to inspect abortion facilities has given a disapproval to such abortion clinic;

(2) sufficient compliance with the Department's minimum standards and rules require a time extension; and

(3) any failure to comply is not detrimental to the public's health and safety.

(e) A license:

(1) only applies to the location and licensee stated on the application;

(2) is nontransferable between other places or licensees once issued;

(3) if the location of the facility is changed, the license shall be automatically revoked;

(4) is valid for one year from the issuance date, unless sooner revoked;

(5) is only granted from a Department-prescribed form; and

(6) may be renewed yearly upon application and payment of the license fee if the applicant procures the original license.

(f) A licensee or licensee applicant shall:

(1) complete a renewal application form prior to all license renewals; and

(2) enclose a fee of $2,500, which is levied as the license fee for a one-year operation of an abortion clinic and paid into the Department's fund.

(g) The Department may deny, suspend, revoke, or refuse to renew a license in any case in which it finds that the applicant or licensee has substantially failed to comply with this Act's requirements or the Department's minimum standards and administrative rules adopted by the Department in accordance with this Act. In such case, the Department shall furnish the person, applicant, or licensee 30 days' notice specifying the reason or reasons for the action, however, if in the discretion of the Department, the failure to comply presents a substantial present threat to patient health and safety, the denial, suspension, revocation, or refusal to renew may be effective immediately.

(h) All final administrative decisions of the Department are subject to judicial review pursuant to the Administrative Review Law and its rules. As used in this subsection, "administrative decisions" has the meaning given to that term in Section 3-101 of the Code of Civil Procedure.

(i) The Department shall adopt any rules necessary to implement this Section.

Section 20. Inspections and investigations.

(a) The Department shall establish policies and procedures for conducting prelicensure and relicensure inspections of abortion clinics. Prior to issuing or reissuing a license, the Department shall conduct an on-site inspection to ensure compliance with this Act.

(b) The Department shall:

(1) establish policies and procedures for conducting inspections and investigations in accordance with complaints received by the Department and made against any abortion clinic; and

(2) receive, record, and dispose of complaints in accordance with established policies and procedures.

(c) If the Director determines that there is probable cause to believe a licensee, licensed abortion clinic, or abortion clinic is not adhering to this Act's requirements, the minimum standards or administrative rules adopted by the Department under the authority of this Act, or with any other standards and administrative rules related to the provision of abortion, the Director may issue an order authorizing an appropriately qualified employee or agent of the Department to enter upon the business premises with due consideration for patient care of the abortion clinic so as to inspect the physical premises and equipment and furnishing therein. No such order shall include the right of inspection of business, medical, or personnel records located on the premises. Any such order shall expire and become void 5 business days after its issuance by the Illinois State Medical Board. The execution of any such order shall be valid only during the normal business hours of the abortion clinic.

(d) An application for a license pursuant to this Act and the minimum standards or administrative rules adopted by the Department under the authority of this Act constitutes permission for an entry or inspection of the premises during the pendency of the application and, if licensed, during the term of the license, consistent with subsection (c).

(e) The Director may deny, suspend, revoke, or refuse to renew a license to operate an abortion clinic, if an inspection or investigation conducted pursuant to subsection (a), (b), or (c) reveals that a licensee or licensed abortion clinic is not adhering to:

(1) this Act's requirements; or

(2) the minimum standards or administrative rules adopted by the Department under this Act.

Section 25. Minimum standards and administrative rules for abortion clinics.

(a) The Director shall adopt rules for an abortion clinic's physical facilities. At a minimum, these rules shall prescribe standards for:

(1) adequate private space specifically designated for interviewing, counseling, and performing medical evaluations;

(2) dressing rooms for staff and patients;

(3) appropriate lavatory areas;

(4) areas for preprocedure hand washing;

(5) private procedure rooms;

(6) adequate lighting and ventilation for abortion procedures;

(7) surgical or gynecologic examination tables and other fixed equipment;

(8) post-procedure recovery rooms that are supervised, staffed, and equipped to meet the patients' needs;

(9) emergency exits to accommodate a stretcher or gurney;

(10) areas for cleaning and sterilizing instruments;

(11) adequate areas for the secure storage of medical records and necessary equipment and supplies; and

(12) a display in the abortion clinic, in a place that is conspicuous to patients, of the clinic's current license issued by the Department.

(b) The Director shall adopt rules to prescribe abortion clinic supply and equipment standards, including supplies and equipment that are required to be immediately available for use in an emergency. At a minimum, these rules shall:

(1) prescribe required equipment and supplies, including medications, required for:

(A) performing, in an appropriate fashion, any abortion procedure; and

(B) monitoring each patient's progress throughout the procedure and recovery period.

(2) require that the number or amount of equipment and supplies at the abortion clinic is adequate at all times to assure sufficient quantities of clean, sterilized, durable equipment, and supplies to meet each patient's needs;

(3) prescribe required equipment, supplies, and medications that shall be available and ready for immediate use in an emergency and requirements for written protocols and procedures to be followed by staff in an emergency, such as the loss of electrical power;

(4) prescribe required equipment and supplies for laboratory tests and the requirements for protocols to maintain laboratory equipment located in the abortion clinic or any equipment operated by clinic staff;

(5) require ultrasound equipment in all abortion clinics; and

(6) require that all equipment is safe for patients and the staff, meets applicable federal standards, and is checked annually.

(c) The Director shall adopt rules relating to abortion clinic personnel. At a minimum, the rules shall:

(1) require an abortion clinic designate a medical director who is licensed to practice medicine and surgery in this State as follows:

(A) health care professionals performing abortions are:

(i) licensed in this State; and

(ii) trained and educated in the procedures involved;

(B) registered nurses, licensed practical nurses, or other personnel supervised by a health care professional receive training in the specific responsibilities of their services provided at an abortion clinic; and

(C) volunteers, if any, receive training in the specific responsibilities of the services that volunteers provide at an abortion clinic, including counseling and patient advocacy;

(2) provide procedures for medical screening and evaluation of each abortion clinic patient;

(3) provide procedures for abortion;

(4) prescribe minimum recovery room standards for the abortion clinic;

(5) prescribe standards for follow-up care for abortion patients;

(6) prescribe minimum abortion clinic incident reporting. At a minimum, these reporting rules shall require that:

(A) the abortion clinic record each incident resulting in a patient's serious injury occurring at an abortion clinic, and report the incident in writing to the Department within 10 days after the incident. As used in this paragraph, "serious injury" means an injury that occurs at an abortion clinic and that creates a serious risk of substantial impairment of a major body organ or function;

(B) if a patient's death occurs, the abortion clinic report it to the Department no later than the next Department work day.

(C) an incident report be filed with the Department and other appropriate professional regulatory boards; and

(7) prohibit the Department from releasing personally identifiable patient or physician information.

(d) This Act's provisions and the rules adopted under the Act shall be in addition to any other laws and administrative or other rules which are applicable to abortion clinics.

Section 30. Civil penalties.

(a) Whoever operates an abortion clinic without a valid license issued by the Department is subject to a civil penalty of $5,000.

(b) Any person who intentionally violates this Act or any rules adopted under this Act is subject to a civil penalty of $5,000 for each violation.

(c) Any violation of this Act or any rules adopted under this Act may be subject to a civil penalty of $1,000 for a first violation and $5,000 for each subsequent violation imposed by the Department.

(d) Each day of violation constitutes a separate violation for purposes of assessing civil penalties.

(e) In deciding whether and to what extent to impose penalties, the Department shall consider the following factors:

(1) the gravity of the violation, including the probability that death or serious physical harm to a patient or individual will result or has resulted;

(2) the size of the population at risk due to the violation;

(3) the severity and scope of the actual or potential harm;

(4) the extent to which the provisions of the applicable statutes and rules were violated;

(5) any indications of good faith exercised by the licensee;

(6) the duration, frequency, and relevance of any previous violations committed by the licensee; and

(7) the financial benefit to the licensee of committing or continuing the violation.

(f) Both the Office of the Attorney General and the Office of the State's Attorney for the county in which the violation occurred may initiate a legal action to enforce collection of civil penalties.

Section 35. Injunctive remedies. In addition to any other penalty provided by law, whenever, in the Director's judgment, any person has engaged, or is about to engage, in any acts or practices which constitute, or will constitute, a violation of this Act, or any rule adopted under this Act, the Director shall apply to any court of competent jurisdiction for an order enjoining such acts and practices. Upon the Director's showing that such person has engaged, or is about to engage, in any such acts or practices, an injunction, restraining order, or such other order as may be appropriate shall be granted by such court without bond.

Section 40. Construction. Nothing in this Act makes lawful an abortion that is currently unlawful.

Section 97. Severability. Any provision of this Act 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 from this Act and shall not affect the remainder of this Act or the application of such provision to other persons not similarly situated or to other, dissimilar circumstances.

Section 99. Effective date. This Act takes effect one year after becoming law.