April 04, 2020
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_h0517__
HB 517

1
A bill to be entitled
2An act relating to reproductive health services and family
3planning; creating the "Prevention First Act"; providing
4definitions; providing duties of licensed health care
5practitioners and facilities relating to the treatment of
6rape survivors; requiring the Department of Health to
7provide certain information; requiring the Agency for
8Health Care Administration to provide for enforcement and
9impose penalties; requiring the agency to adopt rules;
10amending s. 390.011, F.S.; defining the term
11"contraception"; creating s. 390.027, F.S.; specifying
12that the provision of contraception is not subject to ch.
13390, F.S., relating to the termination of pregnancies;
14creating s. 465.191, F.S.; providing definitions;
15requiring licensed pharmacies to dispense certain forms of
16contraception without delay; specifying conditions under
17which a pharmacy may refuse to provide a contraceptive;
18providing for a person to file a complaint with the
19Department of Health if he or she believes that a
20violation of such provisions has occurred; providing for
21the Attorney General to bring a civil action; amending ss.
22465.016 and 465.023, F.S.; providing that a violation of
23requirements for dispensing contraception constitutes
24grounds for the Department of Health or the Board of
25Pharmacy to impose disciplinary action or suspend or
26revoke a pharmacist's license or permit; providing for
27severability; providing an effective date.
28
29     WHEREAS, although the Centers for Disease Control and
30Prevention included family planning in its published list of Ten
31Great Public Health Achievements in the 20th Century, the United
32States still has one of the highest rates of unintended
33pregnancies among industrialized nations, and
34     WHEREAS, the Legislature finds that family planning is
35basic health care for women and that access to contraception
36helps women prevent unintended pregnancy and control the timing
37and spacing of planned births, and
38     WHEREAS, 46.3 percent of pregnancies among women in this
39state are unintended according to the Florida Pregnancy Risk
40Assessment Monitoring System initiated by the United States
41Centers for Disease Control and Prevention and the Florida
42Department of Health, and
43     WHEREAS, 98 percent of all women will use contraception at
44some point in their lifetime according to the Guttmacher
45Institute, and
46     WHEREAS, currently more than 1.9 million women in Florida
47are in need of contraceptive services and supplies, and
48     WHEREAS, the Legislature finds that the victimization of
49women through rape is compounded by the possibility that the
50rape survivors may suffer unintended pregnancies, and half of
51such pregnancies end in abortion, and
52     WHEREAS, women rely on prescription contraceptives for a
53range of medical purposes in addition to birth control, such as
54regulation of menstrual cycles and the treatment of
55endometriosis, and
56     WHEREAS, the Legislature further finds that providing
57access to family planning information, family planning services,
58and birth control will prevent abortions and unintended
59pregnancies, thereby significantly reducing the number of women
60and teens who need medical assistance, Medicaid, Kidcare, and
61other social services, and
62     WHEREAS, the Legislature recognizes that the most recent
63study of women in need of family planning services by the
64Florida State University Center for Prevention and Early
65Intervention Policy found that only 26 percent of women in this
66state who are in need of such services are currently receiving
67them, and
68     WHEREAS, according to the Department of Health's Family
69Planning Program, for every dollar spent on family planning
70services, up to $24 is saved as a result of averting
71expenditures for public programs that support women who have
72unintended pregnancies and their infants, NOW, THEREFORE,
73
74Be It Enacted by the Legislature of the State of Florida:
75
76     Section 1.  This act may be cited as the "Prevention First
77Act."
78     Section 2.  Treatment for survivors of rape.-
79     (1)  DEFINITIONS.-As used in this section, the term:
80     (a)  "Agency" means the Agency for Health Care
81Administration.
82     (b)  "Care to a rape survivor" means medical examinations,
83procedures, and services provided to a rape survivor.
84     (c)  "Department" means the Department of Health.
85     (d)  "Emergency contraception" means one or more
86prescription or over-the-counter drugs used separately or in
87combination to be administered to or self-administered by a
88patient to prevent pregnancy within a medically recommended
89amount of time after sexual intercourse and dispensed for that
90purpose, in accordance with professional standards of practice,
91and determined to be safe by the United States Food and Drug
92Administration.
93     (e)  "Health care facility" means a facility licensed under
94chapter 395, Florida Statutes.
95     (f)  "Incest" means a sexual offense described in s.
96826.04, Florida Statutes.
97     (g)  "Medically and factually accurate" means information
98that is supported by the weight of research conducted in
99compliance with accepted scientific methods and that is
100recognized as accurate and objective by leading professional
101organizations and agencies having relevant expertise in the
102field.
103     (h)  "Rape" means sexual battery as described in ss.
104794.011 and 827.071, Florida Statutes.
105     (i)  "Rape survivor" means a person who alleges or is
106alleged to have been raped or who is the victim of alleged
107incest and because of the alleged offense seeks treatment as a
108patient.
109     (2)  DUTIES OF LICENSED PRACTITIONERS AND FACILITIES.-
110     (a)  A health care practitioner licensed under chapter 458,
111chapter 459, or chapter 464, Florida Statutes, or a health care
112facility licensed under chapter 395, Florida Statutes, providing
113care to a rape survivor shall:
114     1.  Provide each female rape survivor with medically and
115factually accurate, clear, and concise information concerning
116emergency contraception, including its indications and
117contraindications and the risks associated with its use.
118     2.  Inform each female rape survivor of her medical option
119to receive emergency contraception.
120     (b)  If emergency contraception is requested, the health
121care practitioner or health care facility shall immediately
122provide the female rape survivor with the complete regimen of
123emergency contraception, unless contraindicated as determined by
124a pregnancy test approved by the United States Food and Drug
125Administration.
126     (c)  The Agency for Health Care Administration, with input
127from the Florida Hospital Association and the Florida Council
128Against Sexual Violence, shall adopt a protocol to implement the
129requirements of this subsection.
130     (3)  PATIENT INFORMATION.-
131     (a)  The department shall:
132     1.  Develop, prepare, and produce informational materials
133relating to emergency contraception for the prevention of
134pregnancy for distribution to and use in all health care
135facilities in the state which provide care to rape survivors, in
136quantities sufficient to comply with the requirements of this
137section, to the extent that funds are available.
138     2.  Develop, prepare, and post information on the
139department's Internet website relating to the duty of licensed
140health care practitioners and health care facilities to provide
141emergency contraception to female rape survivors.
142     (b)  Information provided to female rape survivors or
143female victims of sexual assault must:
144     1.  Be medically and factually accurate;
145     2.  Be clearly written, readily comprehensible, and
146culturally appropriate as determined by the department, in
147collaboration with community sexual assault programs and other
148relevant stakeholders; and
149     3.  Explain the nature of emergency contraception,
150including its use, safety, efficacy, and availability.
151     (4)  ENFORCEMENT AND PENALTIES.-
152     (a)  In addition to any other remedies provided by law, the
153agency shall respond to complaints using all available
154investigative tools and shall, in the course of other compliance
155reviews, determine whether a health care facility is in
156compliance with this section. If the agency finds that a health
157care facility is not in compliance with this section, the agency
158shall:
159     1.  Impose a fine of $5,000 per woman who is:
160     a.  Denied medically and factually accurate information
161about emergency contraception and not informed of her medical
162option to receive emergency contraception; or
163     b.  Not provided the complete regimen of emergency
164contraception, if emergency contraception is requested.
165     2.  Impose a fine of $5,000 for failure to comply with this
166section and an additional fine of $5,000 for every 30 days of
167noncompliance.
168     (b)  The agency shall adopt rules as necessary to
169administer the provisions of this section.
170     Section 3.  Present subsections (4) through (8) of section
171390.011, Florida Statutes, are redesignated as subsections (5)
172through (9), respectively, and a new subsection (4) is added to
173that section, to read:
174     390.011  Definitions.-As used in this chapter, the term:
175     (4)  "Contraception" means any drug or device approved by
176the United States Food and Drug Administration to prevent
177pregnancy.
178     Section 4.  Section 390.027, Florida Statutes, is created
179to read:
180     390.027  Access to contraception.-The provision of
181contraception is not subject to or governed by this chapter.
182     Section 5.  Section 465.191, Florida Statutes, is created
183to read:
184     465.191  Patient contraceptive protection.-
185     (1)  DEFINITIONS.-As used in this section, the term:
186     (a)  "Contraception" or "contraceptive" means any
187prescription drug or over-the-counter oral contraceptive
188approved by the United States Food and Drug Administration to
189prevent pregnancy.
190     (b)  "Employee" means a person hired, by contract or any
191other form of agreement, by a pharmacy.
192     (c)  "Product" means a drug or device approved by the
193United States Food and Drug Administration.
194     (d)  "Professional clinical judgment" means the use of
195professional knowledge and skills to form a clinical judgment in
196accordance with prevailing medical standards.
197     (e)  "Without delay," with respect to a pharmacy dispensing
198a prescription for contraception, means within the pharmacy's
199customary timeframe for dispensing the prescription for other
200products.
201     (2)  DUTIES OF LICENSED PHARMACIES.-
202     (a)  If a patient requests a contraceptive that is in
203stock, the pharmacy shall ensure that the contraceptive is
204provided to the patient or patient representative without delay.
205     (b)  A pharmacy shall ensure that its employees do not:
206     1.  Intimidate, threaten, or harass a patient in the
207delivery of services relating to a request for contraception;
208     2.  Interfere with or obstruct the delivery of services
209relating to a request for contraception;
210     3.  Intentionally misrepresent or deceive a patient about
211the availability of contraception or its mechanism of action;
212     4.  Breach medical confidentiality with respect to a
213request for contraception or threaten to breach such
214confidentiality; or
215     5.  Refuse to return a valid, lawful prescription for
216contraception upon a patient's or patient representative's
217request.
218     (c)  This section does not prohibit a pharmacy from
219refusing to provide a contraceptive to a patient if:
220     1.  It is unlawful to dispense the contraceptive to the
221patient without a valid, lawful prescription and such
222prescription is not presented;
223     2.  The patient or patient representative is unable to pay
224for the contraceptive; or
225     3.  The employee of the pharmacy refuses to provide the
226contraceptive on the basis of a professional clinical judgment.
227     (d)  This section does not prevent a pharmacist or other
228person from refusing to furnish any in-stock contraceptive for
229religious reasons so long as the pharmacy reasonably
230accommodates the patient or patient representative without delay
231and in compliance with this section.
232     (e)  This section does not alter any standard established
233under the Florida Civil Rights Act of 1992.
234     (f)  Any person who believes that a violation of this
235section has occurred may file a complaint with the Department of
236Health.
237     (g)  If the Attorney General has reasonable cause to
238believe that any person or group of persons is being, has been,
239or may be injured by conduct constituting a violation of this
240section, the Attorney General may bring a civil action in the
241name of the state, as parens patriae on behalf of natural
242persons residing in the state.
243     Section 6.  Paragraph (t) is added to subsection (1) of
244section 465.016, Florida Statutes, to read:
245     465.016  Disciplinary actions.-
246     (1)  The following acts constitute grounds for denial of a
247license or disciplinary action, as specified in s. 456.072(2):
248     (t)  Violating the provisions of s. 465.191.
249     Section 7.  Subsection (1) of section 465.023, Florida
250Statutes, is amended to read:
251     465.023  Pharmacy permittee; disciplinary action.-
252     (1)  The department or the board may revoke or suspend the
253permit of any pharmacy permittee, and may fine, place on
254probation, or otherwise discipline any pharmacy permittee if the
255permittee, or any affiliated person, partner, officer, director,
256or agent of the permittee, including a person fingerprinted
257under s. 465.022(3), has:
258     (a)  Obtained a permit by misrepresentation or fraud or
259through an error of the department or the board;
260     (b)  Attempted to procure, or has procured, a permit for
261any other person by making, or causing to be made, any false
262representation;
263     (c)  Violated any of the requirements of this chapter or
264any of the rules of the Board of Pharmacy; of chapter 499, known
265as the "Florida Drug and Cosmetic Act"; of 21 U.S.C. ss. 301-
266392, known as the "Federal Food, Drug, and Cosmetic Act"; of 21
267U.S.C. ss. 821 et seq., known as the Comprehensive Drug Abuse
268Prevention and Control Act; or of chapter 893;
269     (d)  Been convicted or found guilty, regardless of
270adjudication, of a felony or any other crime involving moral
271turpitude in any of the courts of this state, of any other
272state, or of the United States;
273     (e)  Been convicted or disciplined by a regulatory agency
274of the Federal Government or a regulatory agency of another
275state for any offense that would constitute a violation of this
276chapter;
277     (f)  Been convicted of, or entered a plea of guilty or nolo
278contendere to, regardless of adjudication, a crime in any
279jurisdiction which relates to the practice of, or the ability to
280practice, the profession of pharmacy;
281     (g)  Been convicted of, or entered a plea of guilty or nolo
282contendere to, regardless of adjudication, a crime in any
283jurisdiction which relates to health care fraud; or
284     (h)  Dispensed any medicinal drug based upon a
285communication that purports to be a prescription as defined by
286s. 465.003(14) or s. 893.02 when the pharmacist knows or has
287reason to believe that the purported prescription is not based
288upon a valid practitioner-patient relationship that includes a
289documented patient evaluation, including history and a physical
290examination adequate to establish the diagnosis for which any
291drug is prescribed and any other requirement established by
292board rule under chapter 458, chapter 459, chapter 461, chapter
293463, chapter 464, or chapter 466; or.
294     (i)  Violated the provisions of s. 465.191.
295     Section 8.  If any provision of this act or the application
296thereof to any person or circumstance is held invalid, the
297invalidity does not affect other provisions or applications of
298the act which can be given effect without the invalid provision
299or application, and to this end the provisions of this act are
300severable.
301     Section 9.  This act shall take effect July 1, 2010.


CODING: Words stricken are deletions; words underlined are additions.
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