HB-5711, As Passed House, June 13, 2012

SUBSTITUTE FOR

HOUSE BILL NO. 5711

A bill to amend 1978 PA 368, entitled

"Public health code,"

by amending sections 2803, 2804, 2834, 2848, 13807, 16221, 16226,

16299, 17015, 17515, 20115, and 22224 (MCL 333.2803, 333.2804,

333.2834, 333.2848, 333.13807, 333.16221, 333.16226, 333.16299,

333.17015, 333.17515, 333.20115, and 333.22224), sections 2803,

2834, and 2848 as amended by 2002 PA 562, section 2804 as amended

by 1990 PA 149, section 13807 as added by 1990 PA 21, section

16221 as amended by 2011 PA 222, section 16226 as amended by 2011

PA 224, section 16299 as amended by 2002 PA 685, section 17015 as

amended by 2006 PA 77, section 17515 as added by 1993 PA 133, and

section 20115 as amended and section 22224 as added by 1999 PA

206, and by adding sections 2836, 2854, 17015a, 17017, 17019,

17517, and 17519.

THE PEOPLE OF THE STATE OF MICHIGAN ENACT:

1 Sec. 2803. (1) "Abortion" means that term as defined in

2 section 17015.

3 (2) ~~(1)~~ "Dead body" means a human body or fetus, or a part

4 of a dead human body or fetus, in a condition from which it may

5 reasonably be concluded that death has occurred.

6 (3) ~~(2)~~ "Fetal death" means the death of a fetus ~~which~~ that

7 has completed at least 20 weeks of gestation or weighs at least

8 400 grams. Fetal death includes a stillbirth. The definition

9 shall conform in all other respects as closely as possible to the

10 definition recommended by the federal agency responsible for

11 vital statistics.

12 (4) "Fetal remains" means a dead fetus or part of a dead

13 fetus that has completed at least 10 weeks of gestation or has

14 reached the stage of development that, upon visual inspection of

15 the fetus or part of the fetus, the head, torso, or extremities

16 appear to be supported by skeletal or cartilaginous structures.

17 Fetal remains do not include the umbilical cord or placenta.

18 (5) ~~(3)~~ "File" means to present a certificate, report, or

19 other record to the local registrar ~~provided for in this part~~ for

20 registration by the state registrar.

21 (6) ~~(4)~~ "Final disposition" means the burial, cremation,

22 interment, or other legal disposition of a dead ~~human~~ body or

23 ~~fetus~~ fetal remains.

24 Sec. 2804. (1) "Institution" means a public or private

25 establishment ~~which~~ that provides inpatient medical, surgical, or

26 diagnostic care or treatment or nursing, custodial, or

1 domiciliary care to 2 or more unrelated individuals, including an

2 establishment to which individuals are committed by law.

3 (2) "Law enforcement agency" means a police agency of a

4 city, village, or township; a sheriff's department; the

5 department of state police; and any other governmental law

6 enforcement agency.

7 (3) "Live birth" means a term defined by departmental rule

8 ~~which~~ that shall conform as closely as possible to the definition

9 of live birth recommended by the federal agency responsible for

10 vital statistics.

11 (4) "Local registrar" means the county clerk or the clerk's

12 deputy, or in the case of a city having a population of 40,000 or

13 more, the city clerk or city department designated by the

14 governing body of the city; or a registrar appointed pursuant to

15 section 2814. Population shall be determined according to the

16 latest federal decennial census.

17 (5) "Medical waste" means that term as defined in section

18 13805.

19 (6) "Miscarriage" means the spontaneous expulsion of a

20 nonviable fetus that has completed less than 20 weeks of

21 gestation.

22 (7) "Products of conception" means that term as defined in

23 section 13807.

24 (8) ~~(5)~~ "Registration" means the acceptance by the state

25 registrar and the incorporation of certificates provided for in

26 this part into the official vital records.

27 Sec. 2834. (1) A fetal death occurring in this state ~~, as~~

1 ~~defined by section 2803,~~ shall be reported to the state registrar

2 within 5 days after delivery. The state registrar shall prescribe

3 the form and manner for reporting fetal deaths.

4 (2) The fetal death reporting form shall not contain the

5 name of the biological parents, common identifiers such as social

6 security or drivers license numbers, or other information

7 identifiers that would make it possible to identify in any manner

8 or in any circumstances the biological parents of the fetus. A

9 state agency shall not compare data in an information system file

10 with data in another computer system ~~which~~ that would result in

11 identifying in any way a woman or father involved in a fetal

12 death. Statistical information ~~which~~ that may reveal the identity

13 of the biological parents involved in a fetal death shall not be

14 maintained. This subsection does not apply after June 1, 2003.

15 (3) If a dead fetus that has completed at least 20 weeks of

16 gestation is delivered in an institution, the individual in

17 charge of the institution or his or her authorized representative

18 shall prepare and file the fetal death report and make

19 arrangements for the final disposition of the dead fetus pursuant

20 to section 2848, unless the parents, or parent if the mother is

21 unmarried, expressly requests the responsibility of final

22 disposition and that disposition does not conflict with any state

23 or federal law, rule, or regulation.

24 (4) If a dead fetus that has completed at least 20 weeks of

25 gestation is delivered outside an institution, the physician in

26 attendance shall prepare and file the fetal death report. If a

27 physician becomes aware of a fetal death or miscarriage that has

1 occurred outside an institution, the physician shall inform the

2 parents, or parent if the mother is unmarried, that the parents

3 or parent has a right under state law to determine the final

4 disposition of the dead fetus.

5 (5) If a fetal death occurs without medical attendance at or

6 after the delivery or if inquiry is required by the medical

7 examiner, the attendant, mother, or other person having knowledge

8 of the fetal death shall notify the medical examiner who shall

9 investigate the cause and prepare and file the fetal death

10 report. Except as otherwise specifically provided, this section

11 and section 2848 do not apply to a miscarriage that occurs

12 outside an institution.

13 (6) The fetal death reports required under this section and

14 filed before June 1, 2003 are confidential statistical reports to

15 be used only for medical and health purposes and shall not be

16 incorporated into the permanent official records of the system of

17 vital statistics. A schedule for the disposition of these reports

18 shall be provided for by the department. The department or any

19 employee of the department shall not disclose to any person

20 outside the department the reports or the contents of the reports

21 required by this section and filed before June 1, 2003 in ~~any~~

22 ~~manner or fashion so as to permit~~ a way that permits the person

23 ~~or entity~~ to whom the report is disclosed to identify ~~in any way~~

24 the biological parents.

25 (7) The fetal death reports required under this section and

26 filed on or after June 1, 2003 are permanent vital records

27 documents and shall be incorporated into the system of vital

1 statistics. ~~as described in section 2805.~~ Access to a fetal death

2 report or information contained on a fetal death report ~~shall be~~

3 is the same as to a live birth record ~~in accordance with~~ under

4 sections 2882, 2883, and 2888.

5 (8) With information provided to the department under

6 subsection (7), the department shall create a certificate of

7 stillbirth ~~which shall conform~~ that conforms as nearly as

8 possible to recognized national standardized forms and ~~shall~~

9 ~~include,~~ includes, but is not be limited to, the following

10 information:

11 (a) The name of the fetus, if it was given a name by the

12 parent or parents.

13 (b) The number of weeks of gestation completed.

14 (c) The date of delivery and weight at the time of delivery.

15 (d) The name of the parent or parents.

16 (e) The name of the health facility in which the fetus was

17 delivered or the name of the health professional in attendance if

18 the delivery was outside a health facility.

19 (9) If a miscarriage occurs outside an institution and a

20 health professional is present or is immediately aware of the

21 miscarriage, the health professional shall inform the parents, or

22 parent if the mother is unmarried, that the parents or parent has

23 a right under state law to determine the final disposition of the

24 fetal remains.

25 Sec. 2836. (1) All fetal remains resulting from abortions

26 shall be disposed of by means lawful for other dead bodies,

27 including burial, cremation, or interment. Unless the mother has

1 provided written consent for research on the fetal remains under

2 section 2688, a physician who performs an abortion shall arrange

3 for the final disposition of the fetal remains resulting from the

4 abortion. If the fetal remains resulting from an abortion are

5 disposed of by cremation, the fetal remains shall be incinerated

6 separately from any other medical waste. However, this subsection

7 does not prohibit the simultaneous cremation of fetal remains

8 with products of conception or other fetal remains resulting from

9 abortions.

10 (2) This section does not require a physician to discuss the

11 final disposition of the fetal remains with the mother before

12 performing the abortion, nor does it require a physician to

13 obtain authorization from the mother for the final disposition of

14 the fetal remains upon completion of the abortion.

15 Sec. 2848. (1) Except as provided in sections 2844 and 2845,

16 a funeral director or person acting as a funeral director, who

17 first assumes custody of a dead body, not later than 72 hours

18 after death or the finding of a dead body and before final

19 disposition of the body, shall obtain authorization for the final

20 disposition. The authorization for final disposition of a dead

21 body shall be issued on a form prescribed by the state registrar

22 and signed by the local registrar or the state registrar.

23 (2) ~~Before~~ Unless the mother has provided written consent

24 for research on the dead fetus under section 2688, before final

25 disposition of a dead fetus, irrespective of the duration of

26 pregnancy, or before final disposition of fetal remains resulting

27 from a miscarriage, the funeral director or person assuming

1 responsibility for the final disposition of the fetus or fetal

2 remains shall obtain from the parents, or parent ~~in case of an~~ if

3 the mother is unmarried, ~~mother,~~ an authorization for final

4 disposition on a form prescribed and furnished or approved by the

5 state registrar. The authorization may allow final disposition to

6 be by a funeral director, the individual in charge of the

7 institution where the fetus was delivered or miscarried, or an

8 institution or agency authorized to accept donated bodies, or

9 fetuses, or fetal remains under this ~~code~~ act. The funeral

10 director, individual in charge of the institution, or other

11 person making the final disposition shall take into account the

12 expressed wishes of the parents, or parent if the mother is

13 unmarried, if the wishes do not conflict with any state or

14 federal law, rule, or regulation. After final disposition, the

15 funeral director, the individual in charge of the institution, or

16 other person making the final disposition shall retain the permit

17 for not less than 7 years. This section as amended by the

18 amendatory act that added this sentence does not require a

19 religious service or ceremony as part of the final disposition of

20 fetal remains.

21 (3) If final disposition is by cremation, the medical

22 examiner of the county in which death occurred shall sign the

23 authorization for final disposition.

24 (4) A body may be moved from the place of death to be

25 prepared for final disposition with the consent of the physician

26 or county medical examiner who certifies the cause of death.

27 (5) A permit for disposition issued under the law of another

1 state that accompanies a dead body or dead fetus brought into

2 this state is authorization for final disposition of the dead

3 body or dead fetus in this state.

4 Sec. 2854. A person who violates this part by failing to

5 dispose of fetal remains resulting from an abortion as prescribed

6 in section 2836 or by failing to obtain the proper authorization

7 for final disposition of a dead body as provided under section

8 2848 is responsible for a state civil infraction as provided

9 under chapter 88 of the revised judicature act of 1961, 1961 PA

10 236, MCL 600.8801 to 600.8835, and may be ordered to pay a civil

11 fine of not more than $1,000.00 per violation.

12 Sec. 13807. (1) "Pathogen" means a microorganism that

13 produces disease.

14 (2) "Pathological waste" means human organs, tissues, body

15 parts other than teeth, products of conception, and fluids

16 removed by trauma or during surgery, or autopsy, or other medical

17 procedure, and not fixed in formaldehyde.

18 (3) "Point of generation" means the point at which medical

19 waste leaves the producing facility site.

20 (4) "Producing facility" means a facility that generates,

21 stores, decontaminates, or incinerates medical waste.

22 (5) "Products of conception" means any tissues or fluids,

23 placenta, umbilical cord, or other uterine contents resulting

24 from a pregnancy. Products of conception do not include a fetus

25 or fetal body parts.

26 (6) ~~(5)~~ "Release" means any spilling, leaking, pumping,

27 pouring, emitting, emptying, discharging, injecting, escaping,

1 leaching, dumping, or disposing of medical waste into the

2 environment in violation of this part.

3 (7) ~~(6)~~ "Response activity" means an activity necessary to

4 protect the public health, safety, welfare, and the environment,

5 and includes, but is not limited to, evaluation, cleanup,

6 removal, containment, isolation, treatment, monitoring,

7 maintenance, replacement of water supplies, and temporary

8 relocation of people.

9 (8) ~~(7)~~ "Sharps" means needles, syringes, scalpels, and

10 intravenous tubing with needles attached.

11 (9) ~~(8)~~ "Storage" means the containment of medical waste in

12 a manner that does not constitute disposal of the medical waste.

13 (10) ~~(9)~~ "Transport" means the movement of medical waste

14 from the point of generation to any intermediate point and

15 finally to the point of treatment or disposal. Transport does not

16 include the movement of medical waste from a health facility or

17 agency to another health facility or agency for the purposes of

18 testing and research.

19 Sec. 16221. The department may investigate activities

20 related to the practice of a health profession by a licensee, a

21 registrant, or an applicant for licensure or registration. The

22 department may hold hearings, administer oaths, and order the

23 taking of relevant testimony ~~to be taken~~ and shall report its

24 findings to the appropriate disciplinary subcommittee. The

25 disciplinary subcommittee shall proceed under section 16226 if it

26 finds that 1 or more of the following grounds exist:

27 (a) A violation of general duty, consisting of negligence or

1 failure to exercise due care, including negligent delegation to

2 or supervision of employees or other individuals, whether or not

3 injury results, or any conduct, practice, or condition that

4 impairs, or may impair, the ability to safely and skillfully

5 practice the health profession.

6 (b) Personal disqualifications, consisting of 1 or more of

7 the following:

8 (i) Incompetence.

9 (ii) Subject to sections 16165 to 16170a, substance abuse as

10 defined in section 6107.

11 (iii) Mental or physical inability reasonably related to and

12 adversely affecting the licensee's ability to practice in a safe

13 and competent manner.

14 (iv) Declaration of mental incompetence by a court of

15 competent jurisdiction.

16 (v) Conviction of a misdemeanor punishable by imprisonment

17 for a maximum term of 2 years; a misdemeanor involving the

18 illegal delivery, possession, or use of a controlled substance;

19 or a felony. A certified copy of the court record is conclusive

20 evidence of the conviction.

21 (vi) Lack of good moral character.

22 (vii) Conviction of a criminal offense under section 520e or

23 520g of the Michigan penal code, 1931 PA 328, MCL 750.520e and

24 750.520g. A certified copy of the court record is conclusive

25 evidence of the conviction.

26 (viii) Conviction of a violation of section 492a of the

27 Michigan penal code, 1931 PA 328, MCL 750.492a. A certified copy

1 of the court record is conclusive evidence of the conviction.

2 (ix) Conviction of a misdemeanor or felony involving fraud in

3 obtaining or attempting to obtain fees related to the practice of

4 a health profession. A certified copy of the court record is

5 conclusive evidence of the conviction.

6 (x) Final adverse administrative action by a licensure,

7 registration, disciplinary, or certification board involving the

8 holder of, or an applicant for, a license or registration

9 regulated by another state or a territory of the United States,

10 by the United States military, by the federal government, or by

11 another country. A certified copy of the record of the board is

12 conclusive evidence of the final action.

13 (xi) Conviction of a misdemeanor that is reasonably related

14 to or that adversely affects the licensee's ability to practice

15 in a safe and competent manner. A certified copy of the court

16 record is conclusive evidence of the conviction.

17 (xii) Conviction of a violation of section 430 of the

18 Michigan penal code, 1931 PA 328, MCL 750.430. A certified copy

19 of the court record is conclusive evidence of the conviction.

20 (xiii) Conviction of a criminal offense under section 520b,

21 520c, 520d, or 520f of the Michigan penal code, 1931 PA 328, MCL

22 750.520b, 750.520c, 750.520d, and 750.520f. A certified copy of

23 the court record is conclusive evidence of the conviction.

24 (c) Prohibited acts, consisting of 1 or more of the

25 following:

26 (i) Fraud or deceit in obtaining or renewing a license or

27 registration.

1 (ii) Permitting ~~the~~ a license or registration to be used by

2 an unauthorized person.

3 (iii) Practice outside the scope of a license.

4 (iv) Obtaining, possessing, or attempting to obtain or

5 possess a controlled substance as defined in section 7104 or a

6 drug as defined in section 7105 without lawful authority; or

7 selling, prescribing, giving away, or administering drugs for

8 other than lawful diagnostic or therapeutic purposes.

9 (d) Unethical business practices, consisting of 1 or more of

10 the following:

11 (i) False or misleading advertising.

12 (ii) Dividing fees for referral of patients or accepting

13 kickbacks on medical or surgical services, appliances, or

14 medications purchased by or in behalf of patients.

15 (iii) Fraud or deceit in obtaining or attempting to obtain

16 third party reimbursement.

17 (e) Unprofessional conduct, consisting of 1 or more of the

18 following:

19 (i) Misrepresentation to a consumer or patient or in

20 obtaining or attempting to obtain third party reimbursement in

21 the course of professional practice.

22 (ii) Betrayal of a professional confidence.

23 (iii) Promotion for personal gain of an unnecessary drug,

24 device, treatment, procedure, or service.

25 (iv) Either of the following:

26 (A) A requirement by a licensee other than a physician that

27 an individual purchase or secure a drug, device, treatment,

1 procedure, or service from another person, place, facility, or

2 business in which the licensee has a financial interest.

3 (B) A referral by a physician for a designated health

4 service that violates 42 USC 1395nn or a regulation promulgated

5 under that section. For purposes of this ~~subparagraph,~~

6 subdivision, 42 USC 1395nn and the regulations promulgated under

7 that section as they exist on June 3, 2002 are incorporated by

8 reference. A disciplinary subcommittee shall apply 42 USC 1395nn

9 and the regulations promulgated under that section regardless of

10 the source of payment for the designated health service referred

11 and rendered. If 42 USC 1395nn or a regulation promulgated under

12 that section is revised after June 3, 2002, the department shall

13 officially take notice of the revision. Within 30 days after

14 taking notice of the revision, the department shall decide

15 whether or not the revision pertains to referral by physicians

16 for designated health services and continues to protect the

17 public from inappropriate referrals by physicians. If the

18 department decides that the revision does both of those things,

19 the department may promulgate rules to incorporate the revision

20 by reference. If the department does promulgate rules to

21 incorporate the revision by reference, the department shall not

22 make any changes to the revision. As used in this ~~subparagraph,~~

23 sub-subparagraph, "designated health service" means that term as

24 defined in 42 USC 1395nn and the regulations promulgated under

25 that section and "physician" means that term as defined in

26 sections 17001 and 17501.

27 (v) For a physician who makes referrals pursuant to 42 USC

1 1395nn or a regulation promulgated under that section, refusing

2 to accept a reasonable proportion of patients eligible for

3 medicaid and refusing to accept payment from medicaid or medicare

4 as payment in full for a treatment, procedure, or service for

5 which the physician refers the individual and in which the

6 physician has a financial interest. A physician who owns all or

7 part of a facility in which he or she provides surgical services

8 is not subject to this subparagraph if a referred surgical

9 procedure he or she performs in the facility is not reimbursed at

10 a minimum of the appropriate medicaid or medicare outpatient fee

11 schedule, including the combined technical and professional

12 components.

13 (f) Beginning June 3, 2003, the department of consumer and

14 industry services shall prepare the first of 3 annual reports on

15 the effect of 2002 PA 402 on access to care for the uninsured and

16 medicaid patients. The department shall report on the number of

17 referrals by licensees of uninsured and medicaid patients to

18 purchase or secure a drug, device, treatment, procedure, or

19 service from another person, place, facility, or business in

20 which the licensee has a financial interest.

21 (g) Failure to report a change of name or mailing address

22 within 30 days after the change occurs.

23 (h) A violation, or aiding or abetting in a violation, of

24 this article or of a rule promulgated under this article.

25 (i) Failure to comply with a subpoena issued pursuant to

26 this part, failure to respond to a complaint issued under this

27 article or article 7, failure to appear at a compliance

1 conference or an administrative hearing, or failure to report

2 under section 16222 or 16223.

3 (j) Failure to pay an installment of an assessment levied

4 ~~pursuant to~~ under the insurance code of 1956, 1956 PA 218, MCL

5 500.100 to 500.8302, within 60 days after notice by the

6 appropriate board.

7 (k) A violation of section 17013 or 17513.

8 (l) Failure to meet 1 or more of the requirements for

9 licensure or registration under section 16174.

10 (m) A violation of section 17015, or 17015a, 17017, 17515,

11 or 17517.

12 (n) A violation of section 17016 or 17516.

13 (o) Failure to comply with section 9206(3).

14 (p) A violation of section 5654 or 5655.

15 (q) A violation of section 16274.

16 (r) A violation of section 17020 or 17520.

17 (s) A violation of the medical records access act, 2004 PA

18 47, MCL 333.26261 to 333.26271.

19 (t) A violation of section 17764(2).

20 (u) A violation of section 17019 or 17519.

21 Sec. 16226. (1) After finding the existence of 1 or more of

22 the grounds for disciplinary subcommittee action listed in

23 section 16221, a disciplinary subcommittee shall impose 1 or more

24 of the following sanctions for each violation:

25 Violations of Section 16221 Sanctions

26 Subdivision (a), (b)(ii), Probation, limitation, denial,

27 (b)(iv), (b)(vi), or suspension, revocation,

1 (b)(vii) restitution, community service,

2 or fine.

4 Subdivision (b)(viii) Revocation or denial.

6 Subdivision (b)(i), Limitation, suspension,

7 (b)(iii), (b)(v), revocation, denial,

8 (b)(ix), (b)(x), probation, restitution,

9 (b)(xi), or (b)(xii) community service, or fine.

11 Subdivision (b)(xiii) Probation, limitation, denial,

12 suspension, revocation,

13 restitution, community service,

14 fine, or, subject to subsection

15 (5), permanent revocation.

18 Subdivision (c)(i) Denial, revocation, suspension,

19 probation, limitation, community

20 service, or fine.

22 Subdivision (c)(ii) Denial, suspension, revocation,

23 restitution, community service,

24 or fine.

26 Subdivision (c)(iii) Probation, denial, suspension,

27 revocation, restitution,

28 community service, or fine.

30 Subdivision (c)(iv) Fine, probation, denial,

31 or (d)(iii) suspension, revocation, community

1 service, or restitution.

3 Subdivision (d)(i) Reprimand, fine, probation,

4 or (d)(ii) community service, denial,

5 or restitution.

7 Subdivision (e)(i) Reprimand, fine, probation,

8 limitation, suspension, community

9 service, denial, or restitution.

11 Subdivision (e)(ii) Reprimand, probation,

12 or (i)(i) suspension, restitution,

13 community service, denial, or

14 fine.

16 Subdivision (e)(iii), Reprimand, fine, probation,

17 (e)(iv), or (e)(v) suspension, revocation,

18 limitation, community service,

19 denial, or restitution.

21 Subdivision (g) Reprimand or fine.

23 Subdivision (h) or (s) Reprimand, probation, denial,

24 suspension, revocation,

25 limitation, restitution,

26 community service, or fine.

28 Subdivision (j) Suspension or fine.

30 Subdivision (k), (p), Reprimand or fine.

31 or (r)

2 Subdivision (l) Reprimand, denial, or

3 limitation.

5 Subdivision (m) or (o) Denial, revocation, restitution,

6 probation, suspension,

7 limitation, reprimand, or fine.

9 Subdivision (n) Revocation or denial.

11 Subdivision (q) Revocation.

13 Subdivision (t) Revocation, fine, and

14 restitution.

15 Subdivision (u) Limitation described in section

16 17019 or 17519, as applicable

17 (2) Determination of sanctions for violations under this

18 section shall be made by a disciplinary subcommittee. If, during

19 judicial review, the court of appeals determines that a final

20 decision or order of a disciplinary subcommittee prejudices

21 substantial rights of the petitioner for 1 or more of the grounds

22 listed in section 106 of the administrative procedures act of

23 1969, 1969 PA 306, MCL 24.306, and holds that the final decision

24 or order is unlawful and is to be set aside, the court shall

25 state on the record the reasons for the holding and may remand

26 the case to the disciplinary subcommittee for further

27 consideration.

28 (3) A disciplinary subcommittee may impose a fine of up to,

1 but not exceeding, $250,000.00 for a violation of section

2 16221(a) or (b).

3 (4) A disciplinary subcommittee may require a licensee or

4 registrant or an applicant for licensure or registration who has

5 violated this article or article 7 or a rule promulgated under

6 this article or article 7 to satisfactorily complete an

7 educational program, a training program, or a treatment program,

8 a mental, physical, or professional competence examination, or a

9 combination of those programs and examinations.

10 (5) A disciplinary subcommittee shall not impose the

11 sanction of permanent revocation for a violation of section

12 16221(b)(xiii) unless the violation occurred while the licensee or

13 registrant was acting within the health profession for which he

14 or she was licensed or registered.

15 Sec. 16299. (1) Except as otherwise provided in subsection

16 (2), a person who violates or aids or abets another in a

17 violation of this article, other than those matters described in

18 sections 16294 and 16296, is guilty of a misdemeanor punishable

19 as follows:

20 (a) For the first offense, by imprisonment for not more than

21 90 days, or a fine of not more than $100.00, or both.

22 (b) For the second or subsequent offense, by imprisonment

23 for not less than 90 days nor more than 6 months, or a fine of

24 not less than $200.00 nor more than $500.00, or both.

25 (2) Subsection (1) does not apply to a violation of section

26 17015, or 17017, 17019, 17515, 17517, or 17519.

27 Sec. 17015. (1) Subject to subsection (10), a physician

1 shall not perform an abortion otherwise permitted by law without

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

3 coercion to abort.

4 (2) For purposes of this section and section 17015a:

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

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

7 pregnancy for a purpose other than to increase the probability of

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

9 live birth, or to remove a ~~dead~~ fetus that has died as a result

10 of natural causes, accidental trauma, or a criminal assault on

11 the pregnant woman. Abortion does not include the use or

12 prescription of a drug or device intended as a contraceptive.

13 (b) "Coercion to abort" means an act committed with the

14 intent to coerce an individual to have an abortion, which act is

15 prohibited by section 213a of the Michigan penal code, 1931 PA

16 328, MCL 750.213a.

17 (c) "Domestic violence" means that term as defined in

18 section 1 of 1978 PA 389, MCL 400.1501.

19 (d) ~~(b)~~ "Fetus" means an individual organism of the species

20 homo sapiens in utero.

21 (e) ~~(c)~~ "Local health department representative" means a

22 person , who meets 1 or more of the licensing requirements listed

23 in subdivision ~~(f)~~ (h) and who is employed by, or under contract

24 to provide services on behalf of, a local health department.

25 (f) ~~(d)~~ "Medical emergency" means that condition which, on

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

27 complicates the medical condition of a pregnant woman as to

1 necessitate the immediate abortion of her pregnancy to avert her

2 death or for which a delay will create serious risk of

3 substantial and irreversible impairment of a major bodily

4 function.

5 (g) ~~(e)~~ "Medical service" means the provision of a

6 treatment, procedure, medication, examination, diagnostic test,

7 assessment, or counseling, including, but not limited to, a

8 pregnancy test, ultrasound, pelvic examination, or an abortion.

9 (h) ~~(f)~~ "Qualified person assisting the physician" means

10 another physician or a physician's assistant licensed under this

11 part or part 175, a fully licensed or limited licensed

12 psychologist licensed under part 182, a professional counselor

13 licensed under part 181, a registered professional nurse or a

14 licensed practical nurse licensed under part 172, or a social

15 worker licensed under part 185.

16 (i) ~~(g)~~ "Probable gestational age of the fetus" means the

17 gestational age of the fetus at the time an abortion is planned

18 to be performed.

19 (j) ~~(h)~~ "Provide the patient with a physical copy" means

20 confirming that the patient accessed the internet website

21 described in subsection (5) and received a printed valid

22 confirmation form from the website and including that form in the

23 patient's medical record or giving a patient a copy of a required

24 document by 1 or more of the following means:

25 (i) In person.

26 (ii) By registered mail, return receipt requested.

27 (iii) By parcel delivery service that requires the recipient

1 to provide a signature in order to receive delivery of a parcel.

2 (iv) By facsimile transmission.

3 (3) Subject to subsection (10), a physician or a qualified

4 person assisting the physician shall do all of the following not

5 less than 24 hours before that physician performs an abortion

6 upon a patient who is a pregnant woman:

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

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

9 gestational age of the fetus.

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

11 by the patient, taking into account her age, level of maturity,

12 and intellectual capability, each of the following:

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

14 carrying.

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

16 medical complications arise from the abortion.

17 (iii) Information about how to obtain pregnancy prevention

18 information through the department of community health.

19 (c) Provide the patient with a physical copy of the written

20 standardized summary described in subsection (11)(b) that

21 corresponds to the procedure the patient will undergo and is

22 provided by the department of community health. If the procedure

23 has not been recognized by the department, but is otherwise

24 allowed under Michigan law, and the department has not provided a

25 written standardized summary for that procedure, the physician

26 shall develop and provide a written summary that describes the

27 procedure, any known risks or complications of the procedure, and

1 risks associated with live birth and meets the requirements of

2 subsection (11)(b)(iii) through (vii).

3 (d) Provide the patient with a physical copy of a medically

4 accurate depiction, illustration, or photograph and description

5 of a fetus supplied by the department of community health

6 pursuant to subsection (11)(a) at the gestational age nearest the

7 probable gestational age of the patient's fetus.

8 (e) Provide the patient with a physical copy of the prenatal

9 care and parenting information pamphlet distributed by the

10 department of community health under section 9161.

11 (f) Provide the patient with a physical copy of the

12 prescreening summary on prevention of coercion to abort described

13 in subsection (11)(i).

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

15 the physician or a qualified person assisting the physician at a

16 location other than the health facility where the abortion is to

17 be performed. The requirement of subsection (3)(a) that a

18 patient's pregnancy be confirmed may be fulfilled by a local

19 health department under subsection (18). The requirements of

20 subsection (3) cannot be fulfilled by the patient accessing an

21 internet website other than the internet website ~~described in~~

22 ~~subsection (5)~~ that is maintained ~~through~~ and operated by the

23 department under subsection (11)(g).

24 (5) The requirements of subsection (3)(c) through ~~(e)~~ (f)

25 may be fulfilled by a patient accessing the internet website that

26 is maintained and operated ~~through~~ by the department under

27 subsection (11)(g) and receiving a printed, valid confirmation

1 form from the website that the patient has reviewed the

2 information required in subsection (3)(c) through ~~(e)~~ (f) at

3 least 24 hours before an abortion being performed on the patient.

4 The website shall not require any information be supplied by the

5 patient. The department shall not track, compile, or otherwise

6 keep a record of information that would identify a patient who

7 accesses this website. The patient shall supply the valid

8 confirmation form to the physician or qualified person assisting

9 the physician to be included in the patient's medical record to

10 comply with this subsection.

11 (6) Subject to subsection (10), before obtaining the

12 patient's signature on the acknowledgment and consent form, a

13 physician personally and in the presence of the patient shall do

14 all of the following:

15 (a) Provide the patient with the physician's name, confirm

16 with the patient that the coercion to abort screening required

17 under section 17015a was performed, and inform the patient of her

18 right to withhold or withdraw her consent to the abortion at any

19 time before performance of the abortion.

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

21 by the patient, taking into account her age, level of maturity,

22 and intellectual capability, each of the following:

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

24 complications that have been associated with the procedure the

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

26 condition and history as determined by the physician.

27 (ii) The specific risk of complications, if any, to the

1 patient if she chooses to continue the pregnancy based on the

2 patient's particular medical condition and history as determined

3 by a physician.

4 (7) To protect a patient's privacy, the information set

5 forth in subsection (3) and subsection (6) shall not be disclosed

6 to the patient in the presence of another patient.

7 (8) If at any time ~~prior to~~ before the performance of an

8 abortion, a patient undergoes an ultrasound examination, or a

9 physician determines that ultrasound imaging will be used during

10 the course of a patient's abortion, the physician or qualified

11 person assisting the physician shall provide the patient with the

12 opportunity to view or decline to view an active ultrasound image

13 of the fetus, and offer to provide the patient with a physical

14 picture of the ultrasound image of the fetus ~~prior to~~ before the

15 performance of the abortion. ~~Before~~ After the expiration of the

16 24-hour period prescribed under subsection (3) but before

17 performing an abortion on a patient who is a pregnant woman, a

18 physician or a qualified person assisting the physician shall do

19 all of the following:

20 (a) Obtain the patient's signature on the acknowledgment and

21 consent form described in subsection (11)(c) confirming that she

22 has received the information required under subsection (3).

23 (b) Provide the patient with a physical copy of the signed

24 acknowledgment and consent form described in subsection (11)(c).

25 (c) Retain a copy of the signed acknowledgment and consent

26 form described in subsection (11)(c) and, if applicable, a copy

27 of the pregnancy certification form completed under subsection

1 (18)(b), in the patient's medical record.

2 (9) This subsection does not prohibit notifying the patient

3 that payment for medical services will be required or that

4 collection of payment in full for all medical services provided

5 or planned may be demanded after the 24-hour period described in

6 this subsection has expired. A physician or an agent of the

7 physician shall not collect payment, in whole or in part, for a

8 medical service provided to or planned for a patient before the

9 expiration of 24 hours from the time the patient has done either

10 or both of the following, except in the case of a physician or an

11 agent of a physician receiving capitated payments or under a

12 salary arrangement for providing those medical services:

13 (a) Inquired about obtaining an abortion after her pregnancy

14 is confirmed and she has received from that physician or a

15 qualified person assisting the physician the information required

16 under subsection (3)(c) and (d).

17 (b) Scheduled an abortion to be performed by that physician.

18 (10) If the attending physician, utilizing his or her

19 experience, judgment, and professional competence, determines

20 that a medical emergency exists and necessitates performance of

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

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

23 subsections (1), (3), and (6), may perform the abortion, and

24 shall maintain a written record identifying with specificity the

25 medical factors upon which the determination of the medical

26 emergency is based.

27 (11) The department of community health shall do each of the

1 following:

2 (a) Produce medically accurate depictions, illustrations, or

3 photographs of the development of a human fetus that indicate by

4 scale the actual size of the fetus at 2-week intervals from the

5 fourth week through the twenty-eighth week of gestation. Each

6 depiction, illustration, or photograph shall be accompanied by a

7 printed description, in nontechnical English, Arabic, and

8 Spanish, of the probable anatomical and physiological

9 characteristics of the fetus at that particular state of

10 gestational development.

11 (b) Subject to subdivision ~~(g),~~ (e), develop, draft, and

12 print, in nontechnical English, Arabic, and Spanish, written

13 standardized summaries, based upon the various medical procedures

14 used to abort pregnancies, that do each of the following:

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

16 medical procedures used to perform abortions in this state that

17 are recognized by the department.

18 (ii) Identify the physical complications that have been

19 associated with each procedure described in subparagraph (i) and

20 with live birth, as determined by the department. In identifying

21 these complications, the department shall consider the annual

22 statistical report required under section ~~2835(6)~~ 2835, and shall

23 consider studies concerning complications that have been

24 published in a peer review medical journal, with particular

25 attention paid to the design of the study, and shall consult with

26 the federal centers for disease control and prevention, the

27 American ~~college~~ congress of obstetricians and gynecologists, the

1 Michigan state medical society, or any other source that the

2 department determines appropriate for the purpose.

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

4 experience depression, feelings of guilt, sleep disturbance, loss

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

6 occur and are intense or persistent, professional help is

7 recommended.

8 (iv) State that not all of the complications listed in

9 subparagraph (ii) may pertain to that particular patient and refer

10 the patient to her physician for more personalized information.

11 (v) Identify services available through public agencies to

12 assist the patient during her pregnancy and after the birth of

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

14 of her child.

15 (vi) Identify services available through public agencies to

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

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

18 her child.

19 (vii) Identify services available through public agencies to

20 assist the patient and provide counseling should she experience

21 subsequent adverse psychological effects from the abortion.

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

23 Arabic, and Spanish, an acknowledgment and consent form that

24 includes only the following language above a signature line for

25 the patient:

26 "I, _____________________________ , voluntarily and

27 willfully hereby authorize Dr. __________________ ("the

1 physician") and any assistant designated by the physician to

2 perform upon me the following operation(s) or procedure(s):

3 ____________________________________________________________

4 __

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

6 ____________________________________________________________

7 __

8 A. I understand that I am approximately _____ weeks

9 pregnant. I consent to an abortion procedure to terminate my

10 pregnancy. I understand that I have the right to withdraw my

11 consent to the abortion procedure at any time prior to

12 performance of that procedure.

13 B. I understand that it is illegal for anyone to coerce me

14 into seeking an abortion.

15 C. I acknowledge that at least 24 hours before the scheduled

16 abortion I have received a physical copy of each of the

17 following:

18 1. ~~(a)~~ A medically accurate depiction, illustration, or

19 photograph of a fetus at the probable gestational age of the

20 fetus I am carrying.

21 2. ~~(b)~~ A written description of the medical procedure that

22 will be used to perform the abortion.

23 3. ~~(c)~~ A prenatal care and parenting information pamphlet.

24 D. If any of the ~~above listed~~ documents listed in paragraph

25 C were transmitted by facsimile, I certify that the documents

26 were clear and legible.

27 E. I acknowledge that the physician who will perform the

1 abortion has orally described all of the following to me:

2 1. (i) The specific risk to me, if any, of the complications

3 that have been associated with the procedure I am scheduled to

4 undergo.

5 2. (ii) The specific risk to me, if any, of the complications

6 if I choose to continue the pregnancy.

7 F. I acknowledge that I have received all of the following

8 information:

9 1. ~~(d)~~ Information about what to do and whom to contact in

10 the event that complications arise from the abortion.

11 2. ~~(e)~~ Information pertaining to available pregnancy related

12 services.

13 G. I have been given an opportunity to ask questions about

14 the operation(s) or procedure(s).

15 H. I certify that I have not been required to make any

16 payments for an abortion or any medical service before the

17 expiration of 24 hours after I received the written materials

18 listed in ~~paragraphs (a), (b), and (c) above,~~ paragraph C, or 24

19 hours after the time and date listed on the confirmation form if

20 ~~paragraphs (a), (b), and (c) were~~ the information described in

21 paragraph C was viewed from the state of Michigan internet

22 website.".

23 (d) Make available to physicians through the Michigan board

24 of medicine and the Michigan board of osteopathic medicine and

25 surgery, and to any person upon request, the copies of medically

26 accurate depictions, illustrations, or photographs described in

27 subdivision (a), the written standardized ~~written~~ summaries

1 described in subdivision (b), the acknowledgment and consent form

2 described in subdivision (c), the prenatal care and parenting

3 information pamphlet described in section 9161, ~~and~~ the pregnancy

4 certification form described in subdivision (f), and the

5 materials regarding coercion to abort described in subdivision

6 (i).

7 (e) The department shall not develop written standardized

8 summaries for abortion procedures under subdivision (b) that

9 utilize medication that has not been approved by the United

10 States food and drug administration for use in performing an

11 abortion.

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

13 signed by a local health department representative at the time

14 and place a patient has a pregnancy confirmed, as requested by

15 the patient, verifying the date and time the pregnancy is

16 confirmed.

17 (g) Develop, operate, and maintain an internet website that

18 allows a patient considering an abortion to review the

19 information required in subsection (3)(c) through ~~(e).~~ (f). After

20 the patient reviews the required information, the department

21 shall assure that a confirmation form can be printed by the

22 patient from the internet website that will verify the time and

23 date the information was reviewed. A confirmation form printed

24 under this subdivision becomes invalid 14 days after the date and

25 time printed on the confirmation form.

26 (h) Include on the informed consent internet website

27 developed under subdivision (g) a list of health care providers,

1 facilities, and clinics that offer to perform ultrasounds free of

2 charge. The list shall be organized geographically and shall

3 include the name, address, and telephone number of each health

4 care provider, facility, and clinic.

5 (i) After considering the standards and recommendations of

6 the joint commission on accreditation of healthcare

7 organizations, the Michigan domestic violence prevention and

8 treatment board, the Michigan coalition against domestic and

9 sexual violence or successor organization, and the American

10 medical association, do all of the following:

11 (i) Develop, draft, and print or make available in printable

12 format, in nontechnical English, Arabic, and Spanish, a notice

13 that is required to be posted in facilities and clinics under

14 section 17015a. The notice shall be at least 8-1/2 inches by 14

15 inches, shall be printed in at least 44-point type, and shall

16 contain at a minimum all of the following:

17 (A) A statement that it is illegal under Michigan law to

18 coerce a woman to have an abortion.

19 (B) A statement that help is available if a woman is being

20 threatened or intimidated; is being physically, emotionally, or

21 sexually harmed; or feels afraid for any reason.

22 (C) The telephone number of at least 1 domestic violence

23 hotline and 1 sexual assault hotline.

24 (ii) Develop, draft, and print or make available in printable

25 format, in nontechnical English, Arabic, and Spanish, a

26 prescreening summary on prevention of coercion to abort that, at

27 a minimum, contains the information required under subparagraph

1 (i) and notifies the patient that an oral screening for coercion

2 to abort will be conducted before her giving written consent to

3 obtain an abortion.

4 (iii) Develop, draft, and print screening and training tools

5 and accompanying training materials to be utilized by a physician

6 or qualified person assisting the physician while performing the

7 coercion to abort screening required under section 17015a. The

8 screening tools shall instruct the physician or qualified person

9 assisting the physician to do, at a minimum, all of the

10 following:

11 (A) Orally inform the patient that coercion to abort is

12 illegal and is grounds for a civil action, but clarifying that

13 discussions about pregnancy options, including personal or

14 intensely emotional expressions about those options, are not

15 necessarily coercion to abort and illegal.

16 (B) Orally ask the patient if her husband, parents,

17 siblings, relatives, or employer, the father or putative father

18 of the fetus, the parents of the father or putative father of the

19 fetus, or any other individual has engaged in coercion to abort

20 and coerced her into seeking an abortion.

21 (C) Orally ask the patient if an individual is taking

22 harmful actions against her, including, but not limited to,

23 intimidating her, threatening her, physically hurting her, or

24 forcing her to engage in sexual activities against her wishes.

25 (D) Document the findings from the coercion to abort

26 screening in the patient's medical record.

27 (iv) Develop, draft, and print protocols and accompanying

1 training materials to be utilized by a physician or a qualified

2 person assisting the physician if a patient discloses coercion to

3 abort or that domestic violence is occurring, or both, during the

4 coercion to abort screening. The protocols shall instruct the

5 physician or qualified person assisting the physician to do, at a

6 minimum, all of the following:

7 (A) Follow the requirements of section 17015a as applicable.

8 (B) Assess the patient's current level of danger.

9 (C) Explore safety options with the patient.

10 (D) Provide referral information to the patient regarding

11 law enforcement and domestic violence and sexual assault support

12 organizations.

13 (E) Document any referrals in the patient's medical record.

14 (12) A physician's duty to inform the patient under this

15 section does not require disclosure of information beyond what a

16 reasonably well-qualified physician licensed under this article

17 would possess.

18 (13) A written consent form meeting the requirements set

19 forth in this section and signed by the patient is presumed

20 valid. The presumption created by this subsection may be rebutted

21 by evidence that establishes, by a preponderance of the evidence,

22 that consent was obtained through fraud, negligence, deception,

23 misrepresentation, coercion, or duress.

24 (14) A completed certification form described in subsection

25 (11)(f) that is signed by a local health department

26 representative is presumed valid. The presumption created by this

27 subsection may be rebutted by evidence that establishes, by a

1 preponderance of the evidence, that the physician who relied upon

2 the certification had actual knowledge that the certificate

3 contained a false or misleading statement or signature.

4 (15) This section does not create a right to abortion.

5 (16) Notwithstanding any other provision of this section, a

6 person shall not perform an abortion that is prohibited by law.

7 (17) If any portion of this act or the application of this

8 act to any person or circumstances is found invalid by a court,

9 that invalidity does not affect the remaining portions or

10 applications of the act that can be given effect without the

11 invalid portion or application, if those remaining portions are

12 not determined by the court to be inoperable.

13 (18) Upon a patient's request, each local health department

14 shall:

15 (a) Provide a pregnancy test for that patient to confirm the

16 pregnancy as required under subsection (3)(a) and determine the

17 probable gestational stage of the fetus. The local health

18 department need not comply with this subdivision if the

19 requirements of subsection (3)(a) have already been met.

20 (b) If a pregnancy is confirmed, ensure that the patient is

21 provided with a completed pregnancy certification form described

22 in subsection (11)(f) at the time the information is provided.

23 (19) The identity and address of a patient who is provided

24 information or who consents to an abortion pursuant to this

25 section is confidential and is subject to disclosure only with

26 the consent of the patient or by judicial process.

27 (20) A local health department with a file containing the

1 identity and address of a patient described in subsection (19)

2 who has been assisted by the local health department under this

3 section shall do both of the following:

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

5 a physician or qualified person assisting the physician in order

6 to verify the receipt of the information required under this

7 section.

8 (b) Destroy the information containing the identity and

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

10 under this section.

11 Sec. 17015a. (1) At the time a patient first presents at a

12 private office, freestanding surgical outpatient facility, or

13 other facility or clinic in which abortions are performed for the

14 purpose of obtaining an abortion, whether before or after the

15 expiration of the 24-hour period described in section 17015(3),

16 the physician or qualified person assisting the physician shall

17 orally screen the patient for coercion to abort using the

18 screening tools developed by the department under section

19 17015(11).

20 (2) If a patient discloses that she is the victim of

21 domestic violence that does not include coercion to abort, the

22 physician or qualified person assisting the physician shall

23 follow the protocols developed by the department under section

24 17015(11).

25 (3) If a patient discloses coercion to abort, the physician

26 or qualified person assisting the physician shall follow the

27 protocols developed by the department under section 17015(11).

1 (4) If a patient who is under the age of 18 discloses

2 domestic violence or coercion to abort by an individual

3 responsible for the health or welfare of the minor patient, the

4 physician or qualified person assisting the physician shall

5 report that fact to a local child protective services office.

6 (5) A private office, freestanding surgical outpatient

7 facility, or other facility or clinic in which abortions are

8 performed shall post in a conspicuous place in an area of its

9 facility that is accessible to patients, employees, and visitors

10 the notice described in section 17015(11)(i). A private office,

11 freestanding surgical outpatient facility, or other facility or

12 clinic in which abortions are performed shall make available in

13 an area of its facility that is accessible to patients,

14 employees, and visitors publications that contain information

15 about violence against women.

16 (6) This section does not create a right to abortion.

17 Notwithstanding any other provision of this section, a person

18 shall not perform an abortion that is prohibited by law.

19 Sec. 17017. (1) A physician shall not diagnose and prescribe

20 a medical abortion for a patient who is or is presumed to be

21 pregnant without first personally performing a physical

22 examination of the patient. A physician shall not utilize other

23 means including, but not limited to, an internet web camera, to

24 diagnose and prescribe a medical abortion.

25 (2) A physician shall obtain the informed consent of a

26 patient in the manner prescribed under section 17015 to perform a

27 medical abortion. The physician shall be physically present at

1 the location of the medical abortion and at the time any

2 prescription drug is dispensed or administered during a medical

3 abortion. The prescribing physician shall provide direct

4 supervision of the dispensing or administering of a prescription

5 drug during a medical abortion. An individual under the direct

6 supervision of the prescribing physician who is qualified by

7 education and training as provided in this act may dispense or

8 administer the prescription drug during a medical abortion.

9 (3) A physician shall not give, sell, dispense, administer,

10 otherwise provide, or prescribe a prescription drug to an

11 individual for the purpose of inducing an abortion in the

12 individual unless the physician satisfies all the criteria

13 established by federal law or guideline that a physician must

14 satisfy in order to give, sell, dispense, administer, otherwise

15 provide, or prescribe a prescription drug for inducing an

16 abortion.

17 (4) This section does not create a right to abortion.

18 Notwithstanding any other provision of this section, a person

19 shall not perform an abortion that is prohibited by law.

20 (5) As used in this section:

21 (a) "Abortion" means that term as defined in section 17015.

22 (b) "Federal law or guideline" means any law, rule, or

23 regulation of the United States or any drug approval letter,

24 including the use of medication guides and patient agreements as

25 described in a drug approval letter, of the United States food

26 and drug administration, which law, rule, regulation, or letter

27 governs or regulates the use of prescription drugs for the

1 purpose of inducing abortions.

2 (c) "Medical abortion" means an abortion procedure that

3 utilizes a prescription drug or drugs including, but not limited

4 to, mifepristone, misoprostol, or ulipristal acetate.

5 (d) "Prescription drug" means that term as defined in

6 section 17708.

7 Sec. 17019. (1) A physician who meets all of the following

8 shall maintain professional liability coverage of not less than

9 $1,000,000.00, or provide equivalent security as determined by

10 the department, for the purpose of compensating a woman suffering

11 from abortion complications caused by the gross negligence or

12 malpractice of the physician:

13 (a) He or she performs 6 or more abortions per month.

14 (b) Meets any of the following:

15 (i) He or she was found liable for damages in 2 or more civil

16 lawsuits in the preceding 7 years related to harm caused by

17 abortions performed by him or her.

18 (ii) The disciplinary subcommittee has imposed 1 or more

19 sanctions against his or her license under this article for

20 unprofessional, unethical, or negligent conduct in the preceding

21 7 years.

22 (iii) He or she operates, or has supervisory authority over,

23 an office or facility where abortions are performed and that

24 office or facility was found during a follow-up inspection to be

25 noncompliant with health and safety requirements after previous

26 inspections had formally identified the compliance failures and

27 needed corrective actions.

1 (2) Subject to sections 16221 and 16226, if the disciplinary

2 subcommittee finds that a physician is in violation of subsection

3 (1), the disciplinary subcommittee shall immediately limit the

4 physician's license to prohibit the physician from performing

5 abortions until he or she meets subsection (1).

6 (3) As used in this section, "abortion" means that term as

7 defined in section 17015.

8 Sec. 17515. A physician, before performing an abortion on a

9 patient, shall comply with ~~section~~ sections 17015 and 17015a.

10 Sec. 17517. A physician shall comply with section 17017.

11 Sec. 17519. (1) A physician who meets all of the following

12 shall maintain professional liability coverage of not less than

13 $1,000,000.00, or provide equivalent security as determined by

14 the department, for the purpose of compensating a woman suffering

15 from abortion complications caused by the gross negligence or

16 malpractice of the physician:

17 (a) He or she performs 6 or more abortions per month.

18 (b) Meets any of the following:

19 (i) He or she was found liable for damages in 2 or more civil

20 lawsuits in the preceding 7 years related to harm caused by

21 abortions performed by him or her.

22 (ii) The disciplinary subcommittee has imposed 1 or more

23 sanctions against his or her license under this article for

24 unprofessional, unethical, or negligent conduct in the preceding

25 7 years.

26 (iii) He or she operates, or has supervisory authority over,

27 an office or facility where abortions are performed and that

1 office or facility was found during a follow-up inspection to be

2 noncompliant with health and safety requirements after previous

3 inspections had formally identified the compliance failures and

4 needed corrective actions.

5 (2) Subject to sections 16221 and 16226, if the disciplinary

6 subcommittee finds that a physician is in violation of subsection

7 (1), the disciplinary subcommittee shall immediately limit the

8 physician's license to prohibit the physician from performing

9 abortions until he or she meets subsection (1).

10 (3) As used in this section, "abortion" means that term as

11 defined in section 17015.

12 Sec. 20115. (1) The department may promulgate rules to

13 further define the term "health facility or agency" and the

14 definition of a health facility or agency listed in section 20106

15 as required to implement this article. The department may define

16 a specific organization as a health facility or agency for the

17 sole purpose of certification authorized under this article. For

18 purpose of certification only, an organization defined in section

19 20106(5), 20108(1), or 20109(4) is considered a health facility

20 or agency. The term "health facility or agency" does not mean a

21 visiting nurse service or home aide service conducted by and for

22 the adherents of a church or religious denomination for the

23 purpose of providing service for those who depend upon spiritual

24 means through prayer alone for healing.

25 (2) The department shall promulgate rules to differentiate a

26 freestanding surgical outpatient facility from a private office

27 of a physician, dentist, podiatrist, or other health

1 professional. The department shall specify in the rules that a

2 facility including, but not limited to, a private practice office

3 described in this subsection ~~in which 50% or more of the patients~~

4 ~~annually served at the facility undergo an abortion~~ must be

5 licensed under this article as a freestanding surgical outpatient

6 facility if that facility publicly advertises outpatient abortion

7 services and performs 6 or more abortions per month.

8 (3) The department shall promulgate rules that in effect

9 republish R 325.3826, R 325.3832, R 325.3835, R 325.3857, R

10 325.3866, R 325.3867, and R 325.3868 of the Michigan

11 administrative code, but shall include in the rules standards for

12 a freestanding surgical outpatient facility ~~in which 50% or more~~

13 ~~of the patients annually served in the freestanding surgical~~

14 ~~outpatient facility undergo an abortion.~~ or private practice

15 office that publicly advertises outpatient abortion services and

16 performs 6 or more abortions per month. The department shall

17 assure that the standards are consistent with the most recent

18 United States supreme court decisions regarding state regulation

19 of abortions.

20 (4) Subject to section 20145 and part 222, the department

21 may modify or waive 1 or more of the rules contained in R

22 325.3801 to R 325.3877 of the Michigan administrative code

23 regarding construction or equipment standards, or both, for a

24 freestanding surgical outpatient facility ~~in which 50% or more of~~

25 ~~the patients annually served in the freestanding surgical~~

26 ~~outpatient facility undergo an abortion~~ that publicly advertises

27 outpatient abortion services and performs 6 or more abortions per

1 month, if both of the following conditions are met:

2 (a) The freestanding surgical outpatient facility was in

3 existence and operating on ~~the effective date of the amendatory~~

4 ~~act that added this subsection.~~March 10, 2000.

5 (b) The department makes a determination that the existing

6 construction or equipment conditions, or both, within the

7 freestanding surgical outpatient facility are adequate to

8 preserve the health and safety of the patients and employees of

9 the freestanding surgical outpatient facility or that the

10 construction or equipment conditions, or both, can be modified to

11 adequately preserve the health and safety of the patients and

12 employees of the freestanding surgical outpatient facility

13 without meeting the specific requirements of the rules.

14 (5) As used in this subsection, "abortion" means that term

15 as defined in section 17015.

16 Sec. 22224. (1) A health facility required to be licensed as

17 a freestanding surgical outpatient facility by rules promulgated

18 under section 20115(2) due to the performance of abortions at

19 that facility is not required to obtain a certificate of need in

20 order to be granted a license as a freestanding surgical

21 outpatient facility. However, a health facility described in this

22 subsection is subject to this part for the services performed at

23 that facility other than abortions.

24 (2) If a freestanding surgical outpatient facility is

25 applying for a certificate of need to initiate, replace, or

26 expand a covered clinical service consisting of surgical

27 services, the department shall not count abortion procedures in