A BILL FOR AN ACT ENTITLED: "AN ACT providing for youth health protection; PROVIDING DEFINITIONS; prohibiting certain medications and medical procedures for the treatment of gender dysphoria in Minors; and establishing a civil penalty for health care providers providing prohibited treatment providing for enforcement."
NEW SECTION. Section 2. Purpose. The purpose of [sections 1 through 5] is to enhance the protection of minors, pursuant to Article II, section 15, of the Montana constitution, from any form of pressure to undergo irreversible medical procedures to change sex prior to attaining the age of majority who experience distress at identifying with their biological sex from being subjects of irreversible and drastic nongenital gender reassignment surgery and irreversible, permanently sterilizing genital gender reassignment surgery despite the lack of studies showing that the benefits of these extreme interventions outweigh the risks.
(1) "Cross-sex hormones" include antiandrogen, estrogen, and testosterone means testosterone or other androgens given to biological females at doses that are profoundly larger or more potent than would normally occur naturally in healthy biological females or estrogen given to biological males at doses that are profoundly larger or more potent than would normally occur naturally in healthy biological males.
(2)(3) "Gender dysphoria" means a medical diagnosis based on a persistent, marked difference between a patient's expressed or experienced gender and the gender others would assign the patient causing clinically significant distress or impairment, as defined in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders.
(3)(4) "Gender reassignment surgery" includes but is not limited to orchiectomy, vaginoplasty, mastectomy, hysterectomy, metoidioplasty, oophorectomy, penectomy, and phalloplasty means any medical or surgical service that seeks to surgically alter or remove healthy physical or anatomical characteristics or features that are typical for the individual's biological sex in order to instill or create physiological or anatomical characteristics that resemble a sex different from the individual's birth sex, including but not limited to genital or nongenital gender reassignment surgery performed for the purpose of assisting an individual with a gender transition.
(5) "Gender transition" means the process in which an individual goes from identifying with and living as a gender that corresponds with the individual's biological sex to identifying with and living as a gender different than the individual's biological sex and may involve social, legal, or physical changes.
(6) (a) "Gender transition procedures" means any medical or surgical service, including but not limited to physicians' services, inpatient and outpatient hospital services, or prescribed drugs related to gender transition, that seeks to alter or remove physical or anatomical characteristics or features that are typical for the individual's biological sex and to instill or create physiological or anatomical characteristics that resemble a sex different from the individual's birth sex.
(b) Gender transition procedures include but are not limited to services that provide puberty-blocking drugs, cross-sex hormones, or other mechanisms to promote the development of feminizing or masculinizing features in the opposite sex, or genital or nongenital gender reassignment surgery performed for the purpose of assisting an individual with a gender transition.
(i) services to those born with a medically verifiable disorder of sex development, including an individual with external biological sex characteristics that are irresolvably ambiguous such as those born with 46, XX chromosomes with virilization, 46, XY chromosomes with undervirilization, or having both ovarian and testicular tissues;
(ii) services provided when a physician has diagnosed a disorder of sexual development in which the physician has determined through genetic or biochemical testing that the individual does not have normal sex chromosome structure, sex steroid hormone production, or sex steroid hormone action for a biological male or a biological female;
(iii) the treatment of an infection, injury, disease, or disorder that has been caused by or exacerbated by the performance of gender transition procedures, whether or not the gender transition procedure was performed in accordance with state or federal law; or
(iv) a procedure undertaken because the individual suffers from a physical disorder, physical injury, or physical illness that would, as certified by a physician, place the individual in imminent danger of death or impairment of major bodily function unless surgery is performed.
(b) hysterectomy/oophorectomy, reconstruction of the fixed part of the urethra with or without a metoidioplasty or a phalloplasty, vaginectomy, scrotoplasty, or implantation of erection or testicular prostheses for biologically female patients.
(4)(8) "Health care provider" means a physician licensed under Title 37, chapter 3, an advanced practice registered nurse licensed under Title 37, chapter 8, or a physician assistant licensed under Title 37.
(a) augmentation mammoplasty, facial feminization surgery, liposuction, lipofilling, voice surgery, thyroid cartilage reduction, gluteal augmentation (implants), hair reconstruction, or aesthetic procedures for biologically male patients; or
(11) "Sex", "birth sex", or "biological sex" refer to the biological indication of male or female as understood in the context of reproductive potential or capacity, including sex chromosomes, naturally occurring sex hormones, gonads, and nonambiguous internal and external genitalia present at birth, without regard to an individual's psychological, chosen, or subjective experience of gender.
NEW SECTION.Section 5. Civil penalties. A health care provider convicted of violating [section 4] shall be fined an amount not less than $500 or more than $50,000.Fines collected under this section must be deposited in the state general fund.
NEW SECTION. Section 5. Enforcement -- cause of action. (1) A referral for or provision of gender transition procedures to a minor is considered unprofessional conduct and the heath care provider is subject to discipline by the appropriate licensing entity under Title 37.
(2) A person may assert an actual or threatened violation of [sections 1 through 5] as a claim or defense in a judicial or administrative proceeding and obtain compensatory damages, injunctive relief, declaratory relief, or any other appropriate relief.
(b) A minor may bring a cause of action through a parent or next friend and may bring an action in the minor's own name upon reaching majority. The action must be commenced before the minor reaches 38 years of age.
(4) An action under [sections 1 through 5] may be commenced and relief granted in a judicial proceeding regardless of whether the person commencing the action has sought or exhausted available administrative remedies.
(5) In an action or proceeding to enforce a provision of [sections 1 through 5], a prevailing party who establishes a violation of [sections 1 through 5] is entitled to recover reasonable attorney fees.
(6) The attorney general may bring an action to enforce compliance with [sections 1 through 5]. Nothing in [sections 1 through 5] may be construed to deny, impair, or otherwise affect a right or authority of the attorney general, the state of Montana, or an agency, officer, or employee of the state to institute or intervene in a proceeding.
NEW SECTION. Section 7. Severability. If a part of [this act] is invalid, all valid parts that are severable from the invalid part remain in effect. If a part of [this act] is invalid in one or more of its applications, the part remains in effect in all valid applications that are severable from the invalid applications.
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