HOUSE BILL No. 5548


     April 11, 2000, Introduced by Rep. Kukuk and referred to the Committee on Family and Children Services.


        A bill to amend 1978 PA 368, entitled

   "Public health code,"

   by amending section 17015 (MCL 333.17015), as added by 1993 PA

   133.

               THE PEOPLE OF THE STATE OF MICHIGAN ENACT:

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           Sec. 17015.  (1) Subject to subsection  (7)  (9), a physi-

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      cian shall not perform an abortion otherwise permitted by law

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      without the patient's informed written consent, given freely and

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      without coercion.

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           (2) For purposes of this section:

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           (a) "Abortion" means the intentional use of an instrument,

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      drug, or other substance or device to terminate a woman's preg-

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      nancy for a purpose other than to increase the probability of a

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      live birth, to preserve the life or health of the child after

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      live birth, or to remove a dead fetus.  Abortion does not include


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      the use or prescription of a drug or device intended as a

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      contraceptive.

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           (b) "Fetus" means an individual organism of the species homo

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      sapiens in utero.

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           (c) "Local health department representative" means a person

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      employed by, or  contracted  UNDER CONTRACT to provide services

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      on behalf of, a local health department who meets  any  1 OR MORE

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      of the licensing requirements listed in  subsection (2)(e) 

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      SUBDIVISION (E).

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           (d) "Medical emergency" means that condition which, on the

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      basis of the physician's good faith clinical judgment, so compli-

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      cates the medical condition of a pregnant woman as to necessitate

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      the immediate abortion of her pregnancy to avert her death or for

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      which a delay will create serious risk of substantial and irre-

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      versible impairment of a major bodily function.

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           (e) "Qualified person assisting the physician" means another

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      physician or a physician's assistant licensed under this part or

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      part 175, a fully licensed or limited licensed psychologist

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      licensed under part 182, a professional counselor licensed under

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      part 181, a registered professional nurse or a licensed practical

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      nurse licensed under part 172, or a social worker registered  in

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      this state under article 16 of the occupational code, Act No. 299

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      of the Public Acts of 1980, being sections 339.1601 to 339.1610

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      of the Michigan Compiled Laws  UNDER PART 185.

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           (f) "Probable gestational age of the fetus" means the gesta-

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      tional age of the fetus at the time an abortion is planned to be

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      performed.  , as determined by the attending physician. 



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           (G) "PROVIDE THE PATIENT WITH A PHYSICAL COPY" MEANS GIVING

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      A PATIENT A COPY OF A REQUIRED DOCUMENT BY 1 OR MORE OF THE FOL-

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      LOWING MEANS:

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           (i) IN PERSON.

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           (ii) BY REGISTERED MAIL, RETURN RECEIPT REQUESTED.

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           (iii) BY PARCEL DELIVERY SERVICE THAT REQUIRES THE RECIPIENT

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      TO PROVIDE A SIGNATURE IN ORDER TO RECEIVE DELIVERY OF A PARCEL.

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           (3) Subject to subsection  (7)  (9), a physician or a quali-

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      fied person assisting the physician shall do all of the following

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      not less than 24 hours before that physician performs an abortion

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      upon a PATIENT WHO IS A pregnant woman:

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           (a) Confirm that, according to the best medical judgment of

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      a physician, the patient is pregnant, and determine the probable

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      gestational age of the fetus.

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           (b) Orally describe, in language designed to be understood

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      by the  pregnant woman  PATIENT, taking into account her age,

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      level of maturity, and intellectual capability, each of the

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      following:

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           (i) The probable gestational age of the fetus she is

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      carrying.

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           (ii) Information about what to do and whom to contact should

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      medical complications arise from the abortion.

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           (iii) Information about how to obtain pregnancy prevention

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      information through the department of  public  COMMUNITY health.

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           (c)  Preceded by an explanation that the patient has the

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      option to review or not review the written summary, present to

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      the patient  PROVIDE THE PATIENT WITH A PHYSICAL COPY OF the



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      written summary described in subsection  (8)(b)  (10)(B) that

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      corresponds to the procedure the patient will undergo and is pro-

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      vided by the department of  public  COMMUNITY health or approved

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      by the department of  public  COMMUNITY health under subsection

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       (8)(e)  (10)(E).

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           (d)  Preceded by an explanation that the patient has the

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      option to review or not review the depiction and description,

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      provide  PROVIDE the patient with a PHYSICAL copy of a medically

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      accurate depiction and description of a fetus supplied by the

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      department of  public  COMMUNITY health pursuant to subsection

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       (8)(a)  (10)(A) at the gestational age nearest the probable ges-

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      tational age of the patient's fetus.

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           (e) Provide the patient with a PHYSICAL copy of the prenatal

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      care and parenting information pamphlet distributed by the

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      department of  public  COMMUNITY health under section 9161.

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           (4) The requirements of subsection (3) may be fulfilled by

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      the physician or a qualified person assisting the physician at a

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      location other than the health facility where the abortion is to

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      be performed.  The physician or qualified person assisting the

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      physician may refer the patient to a local health department to

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      have a pregnancy confirmed as required under subsection (3)(a),

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      and to obtain the information required under subsection (3)(c)

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      and subsection (3)(d).  THE REQUIREMENTS OF SUBSECTION (3) CANNOT

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      BE FULFILLED BY THE PATIENT ACCESSING AN INTERNET WEBSITE OR BY

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      RECEIVING A FACSIMILE OR OTHER ELECTRONIC TRANSMISSION OF THE

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      INFORMATION REQUIRED UNDER SUBSECTION (3)(C) AND (D).





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           (5) Subject to subsection  (7)  (9), before  performing an

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      abortion  OBTAINING THE PATIENT'S SIGNATURE ON THE

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      ACKNOWLEDGEMENT AND CONSENT FORM, a physician PERSONALLY AND IN

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      THE PRESENCE OF THE PATIENT shall do all of the following:

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           (a) Provide the patient with the physician's name and inform

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      the patient of her right to withhold or withdraw her consent to

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      the abortion at any time before performance of the abortion.

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           (b) Orally describe, in language designed to be understood

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      by the  pregnant woman  PATIENT, taking into account her age,

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      level of maturity, and intellectual capability, each of the

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      following:

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           (i) The specific risk, if any, to the patient of the compli-

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      cations that have been associated with the procedure the patient

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      will undergo, based on the patient's particular medical condition

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      and history as determined by the physician.

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           (ii) The specific risk of complications, IF ANY, to the

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      patient if she chooses to continue the pregnancy based on the

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      patient's particular medical condition and history as determined

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      by a physician.

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            (c) Obtain the patient's signature, on a form prepared or

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      approved by the department, consenting to the abortion and

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      acknowledging that she has received the information required in

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      subsection (3), along with the explanations that she has the

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      option to review or not review the written summary described in

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      subsection (3)(c) and the depictions and descriptions described

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      in subsection (3)(d).  The physician shall retain a copy of the

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      acknowledgment and consent form, and where applicable, the



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      certification form completed under subsection (15), in the

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      patient's medical record. 

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           (C)  (d)  Provide the patient with a PHYSICAL copy of the

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      written acknowledgment and consent form described in subsection

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       (8)(c)  (10)(C), or approved by the department under subsection

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       (8)(e)  (10)(E).

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           (6) To protect a  woman's  PATIENT'S privacy, the informa-

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      tion set forth in subsection (3) and subsection (5) shall not be

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      disclosed to the  woman  PATIENT in the presence of another

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      patient.

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           (7) BEFORE PERFORMING AN ABORTION ON A PATIENT WHO IS A

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      PREGNANT WOMAN, A PHYSICIAN SHALL OBTAIN THE PATIENT'S SIGNATURE

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      ON A FORM PREPARED OR APPROVED BY THE DEPARTMENT CONSENTING TO

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      THE ABORTION AND ACKNOWLEDGING THAT SHE HAS RECEIVED THE INFORMA-

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      TION REQUIRED UNDER SUBSECTION (3).  THE PHYSICIAN SHALL RETAIN A

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      COPY OF THE ACKNOWLEDGEMENT AND CONSENT FORM AND, IF APPLICABLE,

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      THE CERTIFICATION FORM COMPLETED UNDER SUBSECTION (13), IN THE

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      PATIENT'S MEDICAL RECORD.

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           (8) A PHYSICIAN SHALL NOT REQUIRE OR OBTAIN PAYMENT FOR A

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      SERVICE PROVIDED TO A PATIENT WHO HAS INQUIRED ABOUT AN ABORTION

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      OR SCHEDULED AN ABORTION UNTIL THE EXPIRATION OF THE 24-HOUR

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      PERIOD REQUIRED IN SUBSECTION (3) AND THE PATIENT HAS SIGNED THE

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      ACKNOWLEDGEMENT AND CONSENT FORM REQUIRED UNDER SUBSECTION (7).

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           (9)  (7)  If the attending physician, utilizing his or her

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      experience, judgment, and professional competence, determines

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      that a medical emergency exists and necessitates performance of

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      an abortion before the requirements of subsections (1), (3), and



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      (5) can be met, the physician is exempt from the requirements of

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      subsections (1), (3), and (5), may perform the abortion, and

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      shall maintain a written record identifying with specificity the

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      medical factors upon which the determination of the medical emer-

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      gency is based.

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           (10)  (8)  The department of  public  COMMUNITY health
   shall

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      do each of the following:

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           (a) Produce medically accurate depictions, ILLUSTRATIONS, OR

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      PHOTOGRAPHS of the development of a human fetus  which reflect 

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      THAT INDICATE BY SCALE the actual size of the fetus at  4-week 

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      2-WEEK intervals from the fourth week through the twenty-eighth

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      week of gestation.  , using curriculum materials from the

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      Michigan model for comprehensive school health education for

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      grade 6, phase IV, lesson 22 in use on January 1, 1992.  Each

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      depiction, ILLUSTRATION, OR PHOTOGRAPH shall be accompanied by a

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      printed description, in nontechnical English,  Aramaic  ARABIC,

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      and Spanish, of the probable anatomical and physiological charac-

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      teristics of the fetus at that particular state of gestational

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      development.

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           (b) Develop, draft, and print, in nontechnical English,

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       Aramaic  ARABIC, and Spanish, written standardized summaries,

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      based upon the various medical procedures used to abort pregnan-

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      cies, that do each of the following:

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           (i) Describe, individually and on separate documents, those

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      medical procedures used to perform abortions in this state that

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      are recognized by the department.





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           (ii) Identify the physical complications that have been

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      associated with each procedure described in subparagraph (i),

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      INCLUDING, BUT NOT LIMITED TO, CURRENT, PUBLISHED DATA REGARDING

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      ANY SCIENTIFICALLY SIGNIFICANT RELATIONSHIP BETWEEN ABORTION AND

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      INCREASED RISK OF BREAST CANCER and with live birth, as deter-

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      mined by the department.  In identifying these complications, the

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      department shall consider the annual statistical report required

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      under section 2835(6), and shall consult with the  United States

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      center  FEDERAL CENTERS for disease control, the American college

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      of obstetricians and gynecologists, the Michigan state medical

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      society, or any other source that the department determines

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      appropriate FOR THE PURPOSE.

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           (iii) State that as the result of an abortion, some women

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      may experience depression, feelings of guilt, sleep disturbance,

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      loss of interest in work or sex, or anger, and that if these

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      symptoms occur and are intense or persistent, professional help

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      is recommended.

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           (iv) State that not all of the  risks  COMPLICATIONS listed

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      in subparagraph (ii) may pertain to that particular patient and

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      refer the patient to her physician for more personalized

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      information.

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           (v) Identify services available through public agencies to

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      assist the patient during her pregnancy and after the birth of

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      her child, should she choose to give birth and maintain custody

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      of her child.

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           (vi) Identify services available through public agencies to

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      assist the patient in placing her child in an adoptive or foster



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      home, should she choose to give birth but not maintain custody of

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      her child.

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           (vii) Identify services available through public agencies to

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      assist the patient and provide counseling should she experience

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      subsequent adverse psychological effects from the abortion.

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           (c) Develop, draft, and print, in nontechnical English,

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       Aramaic  ARABIC, and Spanish, an acknowledgment and consent form

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      that includes only the following language above a signature line

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      for the patient:

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          "I, ______________________________, hereby authorize

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          Dr. __________________ ("the physician") and any assistant

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          designated by the physician to perform upon me the follow-

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          ing operation(s) or procedure(s):

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          _______________________________________________________
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          (Name of operation(s) or procedure(s))

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          _______________________________________________________


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          I understand that I am approximately _____ weeks

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          pregnant.  I consent to an abortion procedure to termi-

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          nate my pregnancy.  I understand that I have the right

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          to withdraw my consent to the abortion procedure at any

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          time prior to performance of that procedure.  I acknowl-

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          edge I have received A COPY OF EACH OF the following:

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           (a) A  copy of a  medically accurate depiction, ILLUSTRA-

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      TION, OR PHOTOGRAPH of a fetus at the probable gestational age of

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      the fetus I am carrying.  , preceded by an explanation that I

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      have the option to review or not review the depiction. 





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           (b) A description of the medical procedure that will be used

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      to perform the abortion.  , preceded by an explanation that I

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      have the option to review or not review the description. 

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           (c) Information pertaining to potential risks and complica-

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      tions that have been associated with abortion and with live

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      birth.

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           (d) Information about what to do and whom to contact in the

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      event that complications arise from the abortion.

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           (e) Information pertaining to available pregnancy related

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      services.

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           (f) A prenatal care and parenting information pamphlet.

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           I have been given an opportunity to ask questions about the

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      operation(s) or procedure(s).  , and freely and voluntarily sign 

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      I CERTIFY THAT I HAVE NOT BEEN REQUIRED TO MAKE ANY PAYMENTS

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      BEFORE FREELY AND VOLUNTARILY SIGNING this form."

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           (d) Make available to physicians through the Michigan board

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      of medicine and the Michigan board of osteopathic medicine and

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      surgery, all local health departments, and any person upon

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      request the copies of medically accurate depictions, ILLUSTRA-

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      TIONS, OR PHOTOGRAPHS described in subdivision (a), the standard-

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      ized written summaries described in subdivision (b), the acknowl-

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      edgment and consent form described in subdivision (c), the prena-

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      tal care and parenting information pamphlet described in section

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      9161, and the certification form described in subdivision (f).

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           (e) Approve an alternative written summary or acknowledgment

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      and consent form submitted by a physician for department of

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       public  COMMUNITY health approval pursuant to this subsection,



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      if the proposed summary or acknowledgment and consent form

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      contains information substantially similar to the information

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      described in subdivisions (b) and (c).

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           (f) Develop, draft, and print a certification form to be

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      signed by a local health department representative at the time

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      and place a patient is provided the information described in sub-

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      section (3), as requested by the patient, verifying the date and

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      time the information is provided to that patient.

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           (11)  (9)  A physician's duty to inform the patient under

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      this section does not require disclosure of information beyond

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      what a reasonably well-qualified physician licensed under this

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      article would possess.

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           (12)  (10)  A written consent form meeting the requirements

14
      set forth in this section and signed by the  pregnant woman 

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      PATIENT is presumed valid.  The presumption created by this sub-

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      section may be rebutted by evidence that establishes, by a pre-

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      ponderance of the evidence, that consent was obtained through

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      fraud, negligence, deception, misrepresentation, coercion, or

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      duress.

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           (13)  (11)  A completed certification form described in sub-

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      section  (8)(f)  (10)(F) that is signed by a local health depart-

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      ment representative is presumed valid.  The presumption created

23
      by this subsection may be rebutted by evidence that establishes,

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      by a preponderance of the evidence, that the physician who relied

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      upon the certification had actual knowledge that the certificate

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      contained a false or misleading statement or signature.





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           (14)  (12)  This section does not create a right to

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      abortion.

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           (15)  (13)  Notwithstanding any other provision of this sec-

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      tion, a person shall not perform an abortion that is prohibited

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      by law.

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           (16)  (14)  If any portion of this act or the application of

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      this act to any person or circumstances is found invalid by a

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      court, that invalidity  shall  DOES not affect the remaining por-

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      tions or applications of the act  which  THAT can be given effect

10
      without the invalid portion or application,  provided  IF those

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      remaining portions are not determined by the court to be

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      inoperable.

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           (17)  (15)  Upon  an individual's  A PATIENT'S
   request, each

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      local health department shall:

15
           (a) Provide a pregnancy test for that  individual  PATIENT

16
      and determine the probable gestational stage of THE FETUS OF a

17
      confirmed pregnancy.

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           (b)  Preceded by an explanation that the individual has the

19
      option to review or not review the written summaries, provide 

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      PROVIDE THE PATIENT WITH A PHYSICAL COPY OF the summaries

21
      described in subsection  (8)(b)  (10)(B) that are recognized by

22
      the department as applicable to the  individual's  PATIENT'S ges-

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      tational stage of pregnancy.

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           (c)  Preceded by an explanation that the individual has the

25
      option to review or not review the depiction and description,

26
      provide the individual  PROVIDE THE PATIENT with a PHYSICAL copy

27
      of a medically accurate depiction and description of a fetus



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      described in subsection  (8)(a)  (10)(A) at the gestational age

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      nearest the probable gestational age of the  patient's  fetus OF

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      THE PATIENT.

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           (d) Ensure that the  individual  PATIENT is provided with a

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      completed certification form described in subsection  (8)(f) 

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      (10)(F) at the time the information is provided.

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           (18)  (16)  The identity and address of a patient who is

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      provided information or who consents to an abortion pursuant to

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      this section is confidential and is subject to disclosure only

10
      with the consent of the patient OR BY JUDICIAL PROCESS.

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           (19)  (17) The identity and address of a patient who is pro-

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      vided information or who consents to an abortion pursuant to this

13
      section is confidential and is subject to disclosure only with

14
      the consent of the patient or by judicial process.  A local

15
      health department with a file containing the identity and address

16
      of a patient described in  this  subsection (18) who has been

17
      assisted by the local health department under this section shall

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      do both of the following:

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           (a) Only release the identity and address of the patient to

20
      a physician or qualified person assisting the physician in order

21
      to verify the receipt of the information required under this

22
      section.

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           (b) Destroy the information containing the identity and

24
      address of the patient within 30 days after assisting the patient

25
      under this section.







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