Rep. Norm Thurston — Voting Record

Bill

Number

H.B. 224 (2024GS)

Sponsor

Rep. Judkins, M.

Final action

House/ filed 3/1/2024

Outcome

Failed / filed without passage

Summary

What it does

• This bill:
• modifies the definitions of "primary sex characteristic surgical procedure" and "secondary sex characteristic surgical procedure" to prohibit performing a "primary sex characteristic surgical procedure" or a "secondary sex characteristic surgical procedure" on an individual who is less than 18 years old.

Every vote on this bill

Bill text

MEDICAL SURGERY AMENDMENTS
GENERAL SESSION
STATE OF UTAH
Chief Sponsor: Marsha Judkins
Senate Sponsor: 
 Michael S. Kennedy
LONG TITLE
General Description:
This bill modifies provisions related to medical surgeries. 
Highlighted Provisions:
This bill:
▸ modifies the definitions of "primary sex characteristic surgical procedure" and
"secondary sex characteristic surgical procedure" to prohibit performing a "primary
sex characteristic surgical procedure" or a "secondary sex characteristic surgical
procedure" on an individual who is less than 18 years old.
Money Appropriated in this Bill:
None
Other Special Clauses:
None
Utah Code Sections Affected:
AMENDS:
58-67-102
, as last amended by Laws of Utah 2023, Chapter 2
58-68-102
, as last amended by Laws of Utah 2023, Chapter 2
Be it enacted by the Legislature of the state of Utah:
Section 1. Section 
58-67-102
 is amended to read:
58-67-102.
Definitions.
In addition to the definitions in Section 
58-1-102
, as used in this chapter:
(1) (a) "Ablative procedure" means a procedure that is expected to excise, vaporize,
disintegrate, or remove living tissue, including the use of carbon dioxide lasers and erbium:
YAG lasers.
(b) "Ablative procedure" does not include hair removal.
(2) "ACGME" means the Accreditation Council for Graduate Medical Education of the
American Medical Association.
(3) "Administrative penalty" means a monetary fine or citation imposed by the division
for acts or omissions determined to constitute unprofessional or unlawful conduct, in
accordance with a fine schedule established by the division in collaboration with the board, as a
result of an adjudicative proceeding conducted in accordance with Title 63G, Chapter 4,
Administrative Procedures Act.
(4) "Associate physician" means an individual licensed under Section 
58-67-302.8
.
(5) "Attempted sex change" means an attempt or effort to change an individual's body
to present that individual as being of a sex or gender that is different from the individual's
biological sex at birth.
(6) "Biological sex at birth" means an individual's sex, as being male or female,
according to distinct reproductive roles as manifested by:
(a) sex and reproductive organ anatomy;
(b) chromosomal makeup; and
(c) endogenous hormone profiles.
(7) "Board" means the Physicians Licensing Board created in Section 
58-67-201
.
(8) "Collaborating physician" means an individual licensed under Section 
58-67-302
who enters into a collaborative practice arrangement with an associate physician.
(9) "Collaborative practice arrangement" means the arrangement described in Section
58-67-807
.
(10) (a) "Cosmetic medical device" means tissue altering energy based devices that
have the potential for altering living tissue and that are used to perform ablative or nonablative
procedures, such as American National Standards Institute (ANSI) designated Class IIIb and
Class IV lasers, intense pulsed light, radio frequency devices, and lipolytic devices, and
excludes ANSI designated Class IIIa and lower powered devices.
(b) Notwithstanding Subsection (10)(a), if an ANSI designated Class IIIa and lower
powered device is being used to perform an ablative procedure, the device is included in the
definition of cosmetic medical device under Subsection (10)(a).
(11) "Cosmetic medical procedure":
(a) includes the use of cosmetic medical devices to perform ablative or nonablative
procedures; and
(b) does not include a treatment of the ocular globe such as refractive surgery.
(12) "Diagnose" means:
(a) to examine in any manner another person, parts of a person's body, substances,
fluids, or materials excreted, taken, or removed from a person's body, or produced by a person's
body, to determine the source, nature, kind, or extent of a disease or other physical or mental
condition;
(b) to attempt to conduct an examination or determination described under Subsection
(12)(a);
(c) to hold oneself out as making or to represent that one is making an examination or
determination as described in Subsection (12)(a); or
(d) to make an examination or determination as described in Subsection (12)(a) upon
or from information supplied directly or indirectly by another person, whether or not in the
presence of the person making or attempting the diagnosis or examination.
(13) "LCME" means the Liaison Committee on Medical Education of the American
Medical Association.
(14) "Medical assistant" means an unlicensed individual who may perform tasks as
described in Subsection 
58-67-305
(6).
(15) "Medically underserved area" means a geographic area in which there is a
shortage of primary care health services for residents, as determined by the Department of
Health and Human Services.
(16) "Medically underserved population" means a specified group of people living in a
defined geographic area with a shortage of primary care health services, as determined by the
Department of Health and Human Services.
(17) (a) (i) "Nonablative procedure" means a procedure that is expected or intended to
alter living tissue, but is not intended or expected to excise, vaporize, disintegrate, or remove
living tissue.
(ii) Notwithstanding Subsection (17)(a)(i) nonablative procedure includes hair
removal.
(b) "Nonablative procedure" does not include:
(i) a superficial procedure as defined in Section 
58-1-102
;
(ii) the application of permanent make-up; or
(iii) the use of photo therapy and lasers for neuromusculoskeletal treatments that are
performed by an individual licensed under this title who is acting within the individual's scope
of practice.
(18) "Physician" means both physicians and surgeons licensed under Section
58-67-301
, Utah Medical Practice Act, and osteopathic physicians and surgeons licensed under
Section 
58-68-301
, Utah Osteopathic Medical Practice Act.
(19) (a) "Practice of medicine" means:
(i) to diagnose, treat, correct, administer anesthesia, or prescribe for any human
disease, ailment, injury, infirmity, deformity, pain or other condition, physical or mental, real
or imaginary, including to perform cosmetic medical procedures, or to attempt to do so, by any
means or instrumentality, and by an individual in Utah or outside the state upon or for any
human within the state;
(ii) when a person not licensed as a physician directs a licensee under this chapter to
withhold or alter the health care services that the licensee has ordered;
(iii) to maintain an office or place of business for the purpose of doing any of the acts
described in Subsection (19)(a)(i) or (ii) whether or not for compensation; or
(iv) to use, in the conduct of any occupation or profession pertaining to the diagnosis or
treatment of human diseases or conditions in any printed material, stationery, letterhead,
envelopes, signs, or advertisements, the designation "doctor," "doctor of medicine,"
"physician," "surgeon," "physician and surgeon," "Dr.," "M.D.," or any combination of these
designations in any manner which might cause a reasonable person to believe the individual
using the designation is a licensed physician and surgeon, and if the party using the designation
is not a licensed physician and surgeon, the designation must additionally contain the
description of the branch of the healing arts for which the person has a license, provided that an
individual who has received an earned degree of doctor of medicine degree but is not a licensed
physician and surgeon in Utah may use the designation "M.D." if it is followed by "Not
Licensed" or "Not Licensed in Utah" in the same size and style of lettering.
(b) The practice of medicine does not include:
(i) except for an ablative medical procedure as provided in Subsection (19)(b)(ii) the
conduct described in Subsection (19)(a)(i) that is performed in accordance with a license issued
under another chapter of this title;
(ii) an ablative cosmetic medical procedure if the scope of practice for the person
performing the ablative cosmetic medical procedure includes the authority to operate or
perform a surgical procedure; or
(iii) conduct under Subsection 
58-67-501
(2).
(20) "Prescription device" means an instrument, apparatus, implement, machine,
contrivance, implant, in vitro reagent, or other similar or related article, and any component
part or accessory, which is required under federal or state law to be prescribed by a practitioner
and dispensed by or through a person or entity licensed under this chapter or exempt from
licensure under this chapter.
(21) "Prescription drug" means a drug that is required by federal or state law or rule to
be dispensed only by prescription or is restricted to administration only by practitioners.
(22) (a) "Primary sex characteristic surgical procedure" means any of the following [
if
done for the purpose of effectuating or facilitating an individual's attempted sex change
]:
(i) [
for an individual whose biological sex at birth is male,
] castration, orchiectomy,
penectomy, vaginoplasty, or vulvoplasty;
(ii) [
for an individual whose biological sex at birth is female,
] hysterectomy,
oophorectomy, metoidioplasty, or phalloplasty; or
(iii) any surgical procedure that is related to or necessary for a procedure described in
Subsection (22)(a)(i) or (ii), that would result in the sterilization of an individual who is not
sterile.
(b) "Primary sex characteristic surgical procedure" does not include:
(i) surgery or other procedures or treatments performed on an individual who:
(A) is born with external biological sex characteristics that are irresolvably ambiguous;
(B) is born with 46, XX chromosomes with virilization;
(C) is born with 46, XY chromosomes with undervirilization;
(D) has both ovarian and testicular tissue; or
(E) has been diagnosed by a physician, based on genetic or biochemical testing, with a
sex development disorder characterized by abnormal sex chromosome structure, sex steroid
hormone production, or sex steroid hormone action for a male or female; or
(ii) removing a body part:
(A) because the body part is cancerous or diseased; or
(B) for a reason that is medically necessary, other than to effectuate or facilitate an
individual's attempted sex change.
(23) (a) "Secondary sex characteristic surgical procedure" means any of the following
[
if done for the purpose of effectuating or facilitating an individual's attempted sex change
]:
(i) [
for an individual whose biological sex at birth is male,
] breast augmentation
surgery, chest feminization surgery, or facial feminization surgery; or
(ii) [
for an individual whose biological sex at birth is female,
] mastectomy, breast
reduction surgery, chest masculinization surgery, or facial masculinization surgery.
(b) "Secondary sex characteristic surgical procedure" does not include:
(i) surgery or other procedures or treatments performed on an individual who:
(A) is born with external biological sex characteristics that are irresolvably ambiguous;
(B) is born with 46, XX chromosomes with virilization;
(C) is born with 46, XY chromosomes with undervirilization;
(D) has both ovarian and testicular tissue; or
(E) has been diagnosed by a physician, based on genetic or biochemical testing, with a
sex development disorder characterized by abnormal sex chromosome structure, sex steroid
hormone production, or sex steroid hormone action for a male or female; or
(ii) removing a body part:
(A) because the body part is cancerous or diseased; or
(B) for a reason that is medically necessary, other than to effectuate or facilitate an
individual's attempted sex change.
(24) "SPEX" means the Special Purpose Examination of the Federation of State
Medical Boards.
(25) "Unlawful conduct" means the same as that term is defined in Sections 
58-1-501
and 
58-67-501
.
(26) "Unprofessional conduct" means the same as that term is defined in Sections
58-1-501
 and 
58-67-502
, and as may be further defined by division rule.
Section 2. Section 
58-68-102
 is amended to read:
58-68-102.
Definitions.
In addition to the definitions in Section 
58-1-102
, as used in this chapter:
(1) (a) "Ablative procedure" means a procedure that is expected to excise, vaporize,
disintegrate, or remove living tissue, including the use of carbon dioxide lasers and erbium:
YAG lasers.
(b) "Ablative procedure" does not include hair removal.
(2) "ACGME" means the Accreditation Council for Graduate Medical Education of the
American Medical Association.
(3) "Administrative penalty" means a monetary fine imposed by the division for acts or
omissions determined to constitute unprofessional or unlawful conduct, as a result of an
adjudicative proceeding conducted in accordance with Title 63G, Chapter 4, Administrative
Procedures Act.
(4) "AOA" means the American Osteopathic Association.
(5) "Associate physician" means an individual licensed under Section 
58-68-302.5
.
(6) "Attempted sex change" means an attempt or effort to change an individual's body
to present that individual as being of a sex or gender that is different from the individual's
biological sex at birth.
(7) "Biological sex at birth" means an individual's sex, as being male or female,
according to distinct reproductive roles as manifested by:
(a) sex and reproductive organ anatomy;
(b) chromosomal makeup; and
(c) endogenous hormone profiles.
(8) "Board" means the Osteopathic Physician and Surgeon's Licensing Board created in
Section 
58-68-201
.
(9) "Collaborating physician" means an individual licensed under Section 
58-68-302
who enters into a collaborative practice arrangement with an associate physician.
(10) "Collaborative practice arrangement" means the arrangement described in Section
58-68-807
.
(11) (a) "Cosmetic medical device" means tissue altering energy based devices that
have the potential for altering living tissue and that are used to perform ablative or nonablative
procedures, such as American National Standards Institute (ANSI) designated Class IIIb and
Class IV lasers, intense pulsed light, radio frequency devices, and lipolytic devices and
excludes ANSI designated Class IIIa and lower powered devices.
(b) Notwithstanding Subsection (11)(a), if an ANSI designated Class IIIa and lower
powered device is being used to perform an ablative procedure, the device is included in the
definition of cosmetic medical device under Subsection (11)(a).
(12) "Cosmetic medical procedure":
(a) includes the use of cosmetic medical devices to perform ablative or nonablative
procedures; and
(b) does not include a treatment of the ocular globe such as refractive surgery.
(13) "Diagnose" means:
(a) to examine in any manner another person, parts of a person's body, substances,
fluids, or materials excreted, taken, or removed from a person's body, or produced by a person's
body, to determine the source, nature, kind, or extent of a disease or other physical or mental
condition;
(b) to attempt to conduct an examination or determination described under Subsection
(13)(a);
(c) to hold oneself out as making or to represent that one is making an examination or
determination as described in Subsection (13)(a); or
(d) to make an examination or determination as described in Subsection (13)(a) upon
or from information supplied directly or indirectly by another person, whether or not in the
presence of the person making or attempting the diagnosis or examination.
(14) "Medical assistant" means an unlicensed individual who may perform tasks as
described in Subsection 
58-68-305
(6).
(15) "Medically underserved area" means a geographic area in which there is a
shortage of primary care health services for residents, as determined by the Department of
Health and Human Services.
(16) "Medically underserved population" means a specified group of people living in a
defined geographic area with a shortage of primary care health services, as determined by the
Department of Health and Human Services.
(17) (a) (i) "Nonablative procedure" means a procedure that is expected or intended to
alter living tissue, but is not expected or intended to excise, vaporize, disintegrate, or remove
living tissue.
(ii) Notwithstanding Subsection (17)(a)(i), nonablative procedure includes hair
removal.
(b) "Nonablative procedure" does not include:
(i) a superficial procedure as defined in Section 
58-1-102
;
(ii) the application of permanent make-up; or
(iii) the use of photo therapy lasers for neuromusculoskeletal treatments that are
performed by an individual licensed under this title who is acting within the individual's scope
of practice.
(18) "Physician" means both physicians and surgeons licensed under Section
58-67-301
, Utah Medical Practice Act, and osteopathic physicians and surgeons licensed under
Section 
58-68-301
, Utah Osteopathic Medical Practice Act.
(19) (a) "Practice of osteopathic medicine" means:
(i) to diagnose, treat, correct, administer anesthesia, or prescribe for any human
disease, ailment, injury, infirmity, deformity, pain, or other condition, physical or mental, real
or imaginary, or to attempt to do so, by any means or instrumentality, which in whole or in part
is based upon emphasis of the importance of the musculoskeletal system and manipulative
therapy in the maintenance and restoration of health, by an individual in Utah or outside of the
state upon or for any human within the state;
(ii) when a person not licensed as a physician directs a licensee under this chapter to
withhold or alter the health care services that the licensee has ordered;
(iii) to maintain an office or place of business for the purpose of doing any of the acts
described in Subsection (19)(a)(i) or (ii) whether or not for compensation; or
(iv) to use, in the conduct of any occupation or profession pertaining to the diagnosis or
treatment of human diseases or conditions, in any printed material, stationery, letterhead,
envelopes, signs, or advertisements, the designation "doctor," "doctor of osteopathic medicine,"
"osteopathic physician," "osteopathic surgeon," "osteopathic physician and surgeon," "Dr.,"
"D.O.," or any combination of these designations in any manner which might cause a
reasonable person to believe the individual using the designation is a licensed osteopathic
physician, and if the party using the designation is not a licensed osteopathic physician, the
designation must additionally contain the description of the branch of the healing arts for which
the person has a license, provided that an individual who has received an earned degree of
doctor of osteopathic medicine but is not a licensed osteopathic physician and surgeon in Utah
may use the designation "D.O." if it is followed by "Not Licensed" or "Not Licensed in Utah"
in the same size and style of lettering.
(b) The practice of osteopathic medicine does not include:
(i) except for an ablative medical procedure as provided in Subsection (19)(b)(ii), the
conduct described in Subsection (19)(a)(i) that is performed in accordance with a license issued
under another chapter of this title;
(ii) an ablative cosmetic medical procedure if the scope of practice for the person
performing the ablative cosmetic medical procedure includes the authority to operate or
perform a surgical procedure; or
(iii) conduct under Subsection 
58-68-501
(2).
(20) "Prescription device" means an instrument, apparatus, implement, machine,
contrivance, implant, in vitro reagent, or other similar or related article, and any component
part or accessory, which is required under federal or state law to be prescribed by a practitioner
and dispensed by or through a person or entity licensed under this chapter or exempt from
licensure under this chapter.
(21) "Prescription drug" means a drug that is required by federal or state law or rule to
be dispensed only by prescription or is restricted to administration only by practitioners.
(22) (a) "Primary sex characteristic surgical procedure" means any of the following [
if
done for the purpose of effectuating or facilitating an individual's attempted sex change
]:
(i) [
for an individual whose biological sex at birth is male,
] castration, orchiectomy,
penectomy, vaginoplasty, or vulvoplasty;
(ii) [
for an individual whose biological sex at birth is female,
] hysterectomy,
oophorectomy, metoidioplasty, or phalloplasty; or
(iii) any surgical procedure that is related to or necessary for a procedure described in
Subsection (22)(a)(i) or (ii), that would result in the sterilization of an individual who is not
sterile.
(b) "Primary sex characteristic surgical procedure" does not include:
(i) surgery or other procedures or treatments performed on an individual who:
(A) is born with external biological sex characteristics that are irresolvably ambiguous;
(B) is born with 46, XX chromosomes with virilization;
(C) is born with 46, XY chromosomes with undervirilization;
(D) has both ovarian and testicular tissue; or
(E) has been diagnosed by a physician, based on genetic or biochemical testing, with a
sex development disorder characterized by abnormal sex chromosome structure, sex steroid
hormone production, or sex steroid hormone action for a male or female; or
(ii) removing a body part:
(A) because the body part is cancerous or diseased; or
(B) for a reason that is medically necessary, other than to effectuate or facilitate an
individual's attempted sex change.
(23) (a) "Secondary sex characteristic surgical procedure" means any of the following
[
if done for the purpose of effectuating or facilitating an individual's attempted sex change
]:
(i) [
for an individual whose biological sex at birth is male,
] breast augmentation
surgery, chest feminization surgery, or facial feminization surgery; or
(ii) [
for an individual whose biological sex at birth is female,
] mastectomy, breast
reduction surgery, chest masculinization surgery, or facial masculinization surgery.
(b) "Secondary sex characteristic surgical procedure" does not include:
(i) surgery or other procedures or treatments performed on an individual who:
(A) is born with external biological sex characteristics that are irresolvably ambiguous;
(B) is born with 46, XX chromosomes with virilization;
(C) is born with 46, XY chromosomes with undervirilization;
(D) has both ovarian and testicular tissue; or
(E) has been diagnosed by a physician, based on genetic or biochemical testing, with a
sex development disorder characterized by abnormal sex chromosome structure, sex steroid
hormone production, or sex steroid hormone action for a male or female; or
(ii) removing a body part:
(A) because the body part is cancerous or diseased; or
(B) for a reason that is medically necessary, other than to effectuate or facilitate an
individual's attempted sex change.
(24) "SPEX" means the Special Purpose Examination of the Federation of State
Medical Boards.
(25) "Unlawful conduct" means the same as that term is defined in Sections 
58-1-501
and 
58-68-501
.
(26) "Unprofessional conduct" means the same as that term is defined in Sections
58-1-501
 and 
58-68-502
 and as may be further defined by division rule.
Section 3. 
Effective date.
This bill takes effect on May 1, 2024.