SB653: Bill Text

SB653,15,9 2. Access, particularly, to continually improving, medically accurate, high quality, safe patient care from obstetricians, gynecologists, pediatricians, emergency room physicians, and family medicine physicians who attended medical residency programs that provided training in evidence-based, clinically sound and current, comprehensive reproductive health care with reliance on up-to-date, medically accurate didactic materials.

SB653,15,16 (b) The office of advancement in medical knowledge and care shall investigate developments affecting the policy of the state and patient rights under this section, submit an annual report of its findings to the appropriate standing committees of the legislature handling issues relating to health, as determined by the speaker of the assembly and the president of the senate under s. 13.172 (3), and distribute the report to the governor, the deans of all schools of medicine in the state, and the directors of all medical residency programs in the state.

SB653,15,18 (8) Whoever violates this section shall be subject to the civil remedies under s. 258.55.

SB653,15,21 258.10 Employment retribution and discrimination prohibition. (1) In this section, "adverse employment action" means any of the following actions engaged in or taken by an employer:

SB653,15,24 (a) Employment retribution, or unfair discrimination in employment under s. 111.31, in the hiring, licensing, terms or conditions of employment, compensation, promotion, privileges, or termination of any health care provider.

SB653,16,2 (b) Employment retribution, or unfair discrimination in employment under s. 111.31, in the extension of staff or other privileges to any health care provider.

SB653,16,6 (c) Any adverse action against a health care provider with respect to hiring, licensing, terms or conditions of employment, compensation, promotion, privileges, termination, or quantity, schedule, or nature of the health care provider's assignments or duties.

SB653,16,8 (2) No person may take any adverse employment action against a health care provider because the health care provider does any of the following:

SB653,16,11 (a) Performs or assists or has performed or assisted in a sterilization procedure, an abortion procedure, or other reproductive health service for an employer or as a volunteer.

SB653,16,12 (b) Participates in or has participated in biomedical and behavioral research.

SB653,16,14 (c) Engages or has engaged in activities that support or promote any of the procedures, services, or research described under par. (a) or (b).

SB653,16,17 (d) Has asserted or exercised, under s. 258.25, a conscientious belief to not provide or to provide any standard reproductive health care services, as defined in s. 258.25 (1) (k).

SB653,16,21 (3) A hospital or health care facility shall provide a written notice to each health care provider applicant, and annually to each health care provider, describing the employment retribution and discrimination prohibitions under sub. (2). Notices may be provided to applicants and employees electronically.

SB653,17,2 (4) A hospital or health care facility may not, without the express consent of a health care provider, disclose information about a health care provider's procedures, services, or research to that health care provider's potential or prospective employers if the disclosure divulges activities that the hospital or health care facility could not use itself for disciplinary or other prohibited purposes under sub. (2).

SB653,17,5 (5) Whoever engages in employment retribution or discrimination against a health care provider in violation of sub. (2), (3), or (4) shall be subject to the civil remedies under s. 258.55.

SB653,17,7 258.15 Implementation health care task force. (1) In this section, "task force" means the implementation health care task force established under sub. (2).

SB653,17,12 (2) The secretary of the department shall establish a special committee under s. 15.04 (1) (c) called the implementation health care task force to examine and report annually upon the challenges and successes in achieving the state policies and rights created or described in this chapter. The task force described in this section shall be comprised of the following members:

SB653,17,15 (a) A law enforcement officer designated by the Wisconsin Professional Police Association who specializes in investigating crimes involving harassment under s. 947.013 or stalking under s. 940.32.

SB653,17,16 (b) The state public defender, or his or her designee.

SB653,17,18 (c) A representative designated by a statewide professional medical organization that represents registered nurses.

SB653,17,21 (d) An assistant district attorney designated by the association of state prosecutors who has significant professional experience prosecuting crimes involving harassment under s. 947.013 or stalking under s. 940.32.

SB653,17,24 (e) A representative designated by a statewide nonprofit organization dedicated to advancing access to standard reproductive health care services, as defined in s. 258.25 (1) (k).

SB653,18,2 (f) A representative designated by a statewide professional medical organization that specializes in the fields of obstetrics and gynecology.

SB653,18,4 (g) A representative designated by a statewide professional medical organization that specializes in the field of family medicine.

SB653,18,5 (h) A representative designated by a scientific advisory group.

SB653,18,8 (i) A representative designated by a nonprofit organization with a multi-year record of advocating for assuring access to comprehensive, community-oriented primary health care services.

SB653,18,10 (3) If a vacancy occurs in the task force membership, the vacancy shall be filled in the same manner as the initial appointment.

SB653,18,16 (4) The task force shall submit an annual report in December of each year that is made publicly available either in paper or electronic form, published on the department's website, and delivered to the governor and the legislature documenting the progress of the task force and including its findings for the year and containing recommendations for future actions. The report must address all of the following issues:

SB653,18,17 (a) All studies performed and the results of those studies.

SB653,18,19 (b) Evaluations of the effectiveness of existing law in resolving issues within the scope of mandate of the task force.

SB653,18,22 (c) Recommendations for new services, resources, and legislative or administrative policies to secure more effective implementation of state policies, rights, and remedies.

SB653,18,24 (d) Recommendations to enhance public consideration of those issues not susceptible to immediate legal or administrative resolution.

SB653,19,3 (e) A full presentation of the findings, evaluations, and recommendations of each member who, in whole or in part, does not agree with the findings, evaluations, or recommendations of the majority of the members of the task force.

SB653,19,13 (5) The task force shall meet in person at least twice annually on such dates and times as the members determine. A majority of all the task force members shall constitute a quorum for the transaction of any business, for the performance of any duty, or for the exercise of any action by the task force. The task force may meet in person or by telephone or by using other communication technologies, and may hold meetings to discuss issues even in the absence of quorum. The task force shall attempt to engage, and solicit the input of, a broad and diverse range of groups, organizations, and individuals. In doing so, the task force may use whatever networking and communication technologies will most effectively further its mission and facilitate this outreach.

SB653,19,15 (6) The chair of the task force will be selected by a majority of the members that constitute the task force.

SB653,19,18 (7) No member shall serve beyond the time when he or she holds the office, employment, or status by reason of which he or she was initially eligible for appointment.

SB653,19,22 (8) The task force shall serve without compensation but shall be eligible for reimbursement for necessary and reasonable expenses incurred in the performance of their official duties within the limits of funds appropriated or otherwise made available to the department for its purposes.

SB653,20,4 (9) The task force may draw upon the human resources and expertise of private institutions, including those institutions associated with individuals appointed to the task force to the extent considered appropriate by those institutions. The task force may not permit financial remuneration for assistance provided under this subsection, and private institutions may not be provide assistance with any intent to influence the deliberations of the task force to the advantage of the participating private entity.

SB653,20,7 (10) The department shall, as part of its routine functions, designate and provide staffing and support services sufficient to ensure that the task force can complete its work and submit its report each year.

SB653,20,9 258.20 Comprehensive women's health research council. (1) In this section:

SB653,20,10 (a) "Council" means the comprehensive women's health research council.

SB653,20,15 (b) "Research" means basic and clinical research in evidence-based care on voluntary termination of pregnancy in the areas of safety and quality, including improvements of medical and surgical techniques, medication and pain management, psychosocial aspects of care, impacts of medical or surgical care restrictions, patient outcomes, and contraception immediately following pregnancy.

SB653,20,23 (2) The council shall identify and assess the needs for research on voluntary termination of pregnancy, prioritize research projects most likely to improve health outcomes for women in this state, and propose ways and means to fund those projects. To accomplish the duty under this subsection, the council shall review medical and scientific literature and solicit opinions from reproductive health care providers and from medical and scientific researchers on the current status of research on voluntary termination of pregnancy and on improving women's health outcomes.

SB653,21,3 (3) The council shall meet at least twice annually on dates and at times as the members determine. The council may meet in person, by telephone, or by using other means of communication.

SB653,21,8 (4) The council may request human resources and expertise of private institutions, including those institutions associated with individuals appointed to the council. The private institutions may provide those human resources and that expertise as they consider appropriate without compensation and without intent to influence the deliberations of the council to the advantage of the private institution.

SB653,21,11 (5) The department shall designate and provide staffing and support services sufficient, including a needs assessment, to ensure that the council is able to conduct its work.

SB653,21,15 (6) Annually, in December, the council shall submit to the governor, to the department for publication on the department's Internet site, and to the legislature in the manner described under s. 13.172 (2) a report that addresses all of the following:

SB653,21,17 (a) An assessment of the current status and any gaps in research on voluntary termination of pregnancy and on improving health outcomes for women.

SB653,21,19 (b) An inventory of significant research needed to advance and improve health care outcomes for women.

SB653,21,21 (c) A prioritization of the research considered by the council to most likely result in improving the health outcome of women in this state.

SB653,21,23 (d) The findings of the council regarding the availability of public and private funding to meet the research needs identified by the council under par. (b).

SB653,21,25 (e) An estimate of the funding needed to meet the research needs prioritized by the council under par. (c).

SB653,22,3 (f) A statement of criteria and standards recommended by the council for awarding grants for the research identified under par. (b) or prioritized under par. (c) when funding is available.

SB653,22,11 (7) It is the policy of the state to support and attain improved health care outcomes for all women who voluntarily terminate a pregnancy in this state. In recognition of this policy, with awareness that national level research directed towards achieving improved outcomes on voluntary termination of pregnancy remains limited and that continuing advances in safe and effective health care in all medical fields requires ongoing evidence-based research, the department shall engage in activities and pursue strategies to continually advance the science and medicine of voluntary termination of pregnancy.

SB653,22,13 258.25 Enabling patient care while honoring conscience of reproductive health care providers. (1) Definitions. In this section:

SB653,22,18 (a) "Appropriate medical screening examination" means an examination reasonably tailored to identify reproductive health care issues and conditions specific to the patient and is comparable to a hospital's standard screening examination for other patients presenting symptoms, health care issues, conditions, illnesses, injuries, or diseases.

SB653,22,23 (b) "Capabilities" means, in the context of a hospital's provision of services pursuant to sub. (2), the availability of physical space, equipment, supplies, and services that the hospital provides, such as surgery, psychiatry, obstetrics, intensive care, pediatrics, trauma care, and that the level of care that the personnel of the hospital provides is within the training and scope of their professional licenses.

SB653,23,2 (c) "Capacity" means the physical ability of a hospital to accommodate the individual requesting examination or treatment. Capacity encompasses such things as numbers and availability of qualified staff, beds, and equipment and the hospital's past practices of accommodating additional patients in excess of its occupancy limits.

SB653,23,7 (d) "Conscientious belief" means sincerely held religious, moral, or ethical beliefs held by an individual that stands for the central moral core of the individual's character, and for purposes of this section does not include beliefs that are motivated by or based upon race, color, national origin, ethnicity, sex, creed, or sexual orientation.

SB653,23,11 (e) "Hospital" has the meaning given in s. 50.33 (2), except that "hospital" as used in this section does not include a critical access hospital or a hospital that does not meet the conditions of participation in any federal health care program as specified in 42 USC 1395x (e) and 1395cc.

SB653,23,15 (f) "Maternity care services" means maternity support services, prenatal care, ambulatory care maternity services, complications of pregnancy, neonatal care, inpatient institution maternity care, including labor and delivery, and postpartum care.

SB653,23,18 (g) "Medically necessary care" means health care services or products that a prudent physician would provide to a patient to prevent, diagnose, or treat an illness, injury, disease, condition, or its symptoms in a manner that is all of the following:

SB653,23,19 1. In accordance with generally accepted standards of medical practice.

SB653,23,20 2. Clinically appropriate in terms of type, frequency, extent, site, and duration.

SB653,23,22 3. Not primarily for the economic benefit of the health plans and purchasers or for the convenience of the treating physician or other health care provider.

SB653,24,2 (h) "Reasonably accommodate" means making existing facilities used by reproductive health care providers readily accessible, job restructuring, part-time or modified work schedules, acquisition or modification of equipment or devices, adjustment or modifications of policies, and the provision of other similar accommodations.

SB653,24,9 (i) "Reproductive health care provider" means a natural person who is an employee, independent contractor, or consultant of a hospital, or is otherwise affiliated with a hospital, and who provides services as a physician of medicine or osteopathy, a physician's assistant, a specialist assistant, a nurse, or a nurse practitioner, and is directly involved in providing medical treatment to a patient during a procedure in which the patient receives medical treatment in the hospital for a standard reproductive health care service.

SB653,24,14 (j) "Stabilizing treatment" means, with respect to an emergent or urgent medical condition covered in sub. (2) (d) of this section, medically appropriate medical measures to ensure that no material deterioration of the condition is likely, within reasonable medical probability, to result from or occur during the transfer of the individual from a hospital if such a transfer were to occur.

SB653,24,22 (k) "Standard reproductive health care services" means family planning; contraception and birth-spacing services; full-spectrum contraceptive education; counseling for and access to emergency contraception; screening, assessment, and treatment of reproductive tract infections and sexually transmitted infections including HIV/AIDS; screening, assessment, and treatment for gynecologic and breast cancers; routine well-woman and preventive exams; pregnancy testing; infertility services; miscarriage and abortion services; sterilization; obstetric care and services; and menopause and perimenopause services.

SB653,25,3 (L) "Transfer" means the movement, including the discharge, of an individual outside a hospital at the direction of any person employed by, or affiliated or associated with, directly or indirectly, the hospital, but does not include such a movement of an individual who has been declared dead, or leaves the facility without the permission of any person employed by, or affiliated or associated with, directly or indirectly, the hospital.

SB653,25,7 (m) "Undue hardship" means, as determined by the examination of the facts, an actual, as opposed to a speculative, hardship that necessarily and significantly either interferes with a hospital's delivery of safe health care or degrades its provision of medically necessary care to patients.

SB653,25,11 (2) Reproductive health care services. (a) A hospital that has a department or service offering maternity care services shall permit all standard reproductive health care services and all maternity care services, provided that such services are within the capacity and capabilities of the hospital.

SB653,25,16 (b) In the case of a hospital that has a department or service that offers maternity care services, if any individual comes to the hospital and a request is made on the individual's behalf for examination, treatment, or care for any standard reproductive health care service, the hospital shall provide an appropriate medical screening examination within the capabilities of the hospital.

SB653,25,19 (c) Whenever a health care provider, within the training and scope of his or her professional license, is available to provide or perform care appropriate for a patient's reproductive health care condition, the hospital must do all of the following:

SB653,25,21 1. Permit that reproductive health care provider to provide standard reproductive health care services.

SB653,25,24 2. Reasonably accommodate that provider in providing any standard reproductive health care service, provided that the provider has given notice to the hospital of his or her readiness to provide such care under sub. (3).

SB653,26,3 3. Provide sufficient support, including ancillary services routinely available for patients with comparable medical needs or circumstances, to ensure the provision of medically necessary care of the patient.

SB653,26,10 (d) Whenever a health care provider, within the training and scope of his or her professional license, is not available to provide or perform care appropriate for a patient's reproductive health care condition, and the hospital reasonably determines that the individual who came to the hospital seeking examination, treatment, or care for any standard reproductive health care service has an emergent or urgent medical condition, the hospital shall, within the staff and facilities available at the hospital, do all of the following:

SB653,26,12 1. Provide for further medical examination and treatment as may be required to stabilize the medical condition.

SB653,26,14 2. Provide necessary stabilizing treatment for the patient's presented reproductive health care condition.

SB653,26,16 3. Counsel the patient on all medically appropriate treatments specific to the patient's reproductive health care condition and circumstances.

SB653,26,18 4. Offer and provide referral to health care providers who provide those treatments.

SB653,26,20 (e) A hospital that has fulfilled the requirements of par. (d) may transfer the individual to another medical facility when the patient is medically stable.

SB653,26,24 (3) Conscientious beliefs. Because the provision of medically necessary care for one or more specific standard reproductive health care services may implicate religious, moral, or ethical conscientious beliefs, a reproductive health care provider may do any of the following:

SB653,27,6 (a) Give written notice to a hospital that has a department or service offering maternity care services, describing in detail the provider's conscientious belief, the core values associated with that belief, how he or she came to hold that belief, and how it affects the provider's readiness to provide specific standard reproductive health care services. If a provider submits a written notice under this paragraph, all of the following apply:

SB653,27,8 1. A provider's assertion in a written notice of his or her conscientious belief under this paragraph is prima facie evidence of its validity.

SB653,27,15 2. A hospital challenging the validity of a conscientious belief has the burden of showing by clear and convincing evidence that the provider's notice does not describe a conscientious belief. If a hospital determines as a matter of fact that a notice does not describe a conscientious belief, the hospital shall issue findings of fact and explain in writing how the hospital has met the clear and convincing evidentiary standard in making its determination that the provider's notice did not describe a conscientious belief.

SB653,27,20 (b) Give written notice to a hospital that has a department or service offering maternity care services that the provider, within his or her training and within the scope of his or her professional license, accepts and is ready to provide specific standard reproductive health care services identified in the notice. If a provider submits a written notice under this paragraph, all of the following apply:

SB653,28,3 1. The hospital shall honor the provider's conscientious belief, unless it is determined that the notice submitted by the provider did not describe a conscientious belief, and shall reasonably accommodate the provider's decisions, including, if specified, a decision to provide certain specific standard reproductive health care services, or for example, a decision to provide abortion services until the limit on the period of gestation under state law or until viability when no gestation limit is set by state law, provided that the hospital may deny an accommodation if it would create an undue hardship.