2023 -- S 0959

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LC001682

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     STATE OF RHODE ISLAND

IN GENERAL ASSEMBLY

JANUARY SESSION, A.D. 2023

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A N   A C T

RELATING TO HEALTH AND SAFETY -- MEDICAL ETHICS DEFENSE ACT

     Introduced By: Senator E Morgan

     Date Introduced: May 01, 2023

     Referred To: Senate Judiciary

     It is enacted by the General Assembly as follows:

     SECTION 1. Title 23 of the General Laws entitled "HEALTH AND SAFETY" is hereby

amended by adding thereto the following chapter:

CHAPTER 99

MEDICAL ETHICS DEFENSE ACT

     23-99-1. Short title.

     This chapter shall be known and may be cited as the "Medical Ethics Defense Act".

     23-99-2. Definitions.

     As used in this chapter:

     (1) "Conscience" means the ethical, moral, or religious belief or principles held by any

medical practitioner, healthcare institution, or healthcare payer. Conscience with respect to

institutional entities or corporate bodies, as opposed to individual persons, is determined by

reference to that entity or body’s governing documents, including, but not limited to, any published

ethical, moral or religious guidelines or directives, mission statements, constitutions, articles of

incorporation, bylaws, policies, or regulations.

     (2) "Disclosure" means a formal or informal communication or transmission, but does not

include a communication or transmission concerning policy decisions that lawfully exercise

discretionary authority unless the medical practitioner providing the disclosure or transmission

reasonably believes that the disclosure or transmission evinces:

     (i) Any violation of any law, rule, or regulation;

     (ii) Any violation of any ethical guidelines for the provision of any medical procedure or

service; or

     (iii) Gross mismanagement, a gross waste of funds, an abuse of authority, practices or

methods of treatment that may put patient health at risk, or a substantial and specific danger to

public health or safety.

     (3) "Discrimination" means any adverse action taken against, or any threat of adverse

action communicated to, any medical practitioner, healthcare institution, or healthcare payer as a

result of their decision to decline to participate in a medical procedure or service on the basis of

conscience. Discrimination includes, but is not limited to, termination of employment; transfer from

current position; demotion from current position; adverse administrative action; reassignment to a

different shift or job title; increased administrative duties; refusal of staff privileges; refusal of

board certification; loss of career specialty; reduction of wages, benefits or privileges; refusal to

award a grant, contract or other program; refusal to provide residency training opportunities; denial,

deprivation, or disqualification of licensure; withholding or disqualifying from financial aid and

other assistance; impediments to creating any healthcare institution or payer or expanding or

improving said healthcare institution or payer; impediments to acquiring, associating with, or

merging with any other healthcare institution or payer; the threat thereof with regard to any of the

preceding; or any other penalty, disciplinary, or retaliatory action, whether executed or threatened.

Discrimination excludes the negotiation or purchase of insurance by a non-government entity.

     (4) "Healthcare institution" means any organization, corporation, partnership, association,

agency, network, sole proprietorship, joint venture, or other entity that provides medical procedures

or services. The term includes, but is not limited to, any public or private hospital, clinic, medical

center, physician organization, professional association, ambulatory surgical center, private

physician’s office, pharmacy, nursing home, medical school, nursing school, medical training

facility, or any other entity or location in which medical procedures or services are performed.

     (5) "Healthcare payer" means any employer, health plan, health maintenance organization,

insurance company, management services organization, or any other entity that pays for or arranges

for the payment of any medical procedure or service provided to any patient, whether that payment

is made in whole or in part.

     (6) "Medical practitioner" means any person or individual who may be or is asked to

participate in any way in any medical procedure or service. This includes, but is not limited to,

doctors, nurse practitioners, physician’s assistants, nurses, nurses’ aides, allied health professionals,

medical assistants, hospital employees, clinic employees, nursing home employees, pharmacists,

pharmacy technicians and employees, medical school faculty and students, nursing school faculty

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and students, psychology and counseling faculty and students, medical researchers, laboratory

technicians, psychologists, psychiatrists, counselors, mental health professionals, social workers,

or any other person who facilitates or participates in the provision of a medical procedure or service.

     (7) "Medical procedure or service" means medical care provided to any patient at any time

over the entire course of treatment, or medical research. This includes, but is not limited to, testing;

diagnosis; referral; dispensing and/or administering any drug, medication, or device; psychological

therapy or counseling; research; prognosis; therapy; record making procedures; notes related to

treatment; set up or performance of a surgery or procedure; or any other care or services performed

or provided by any medical practitioner including, but not limited to, physicians, nurses, allied

health professionals, paraprofessionals, contractors, or employees of healthcare institutions.

     (8) "Participate" in a medical procedure or service means to provide, perform, assist with,

facilitate, refer for, counsel for, advise with regard to, admit for the purposes of providing, or take

part in any way in providing any medical procedure or service, or any form of such service.

     (9) "Pay" or "payment" means to pay for, contract for, arrange for the payment of, whether

in whole or in part, reimburse or remunerate.

     23-99-3. Rights of conscience of medical practitioners, healthcare institutions and

healthcare payers.

     (a) Freedom of conscience. A medical practitioner, healthcare institution, or healthcare

payer has the right not to participate in or pay for any medical procedure or service which violates

their conscience.

     (b) Limitations. The exercise of the right of conscience is limited to conscience-based

objections to a particular medical procedure or service. This section shall not be construed to waive

or modify any duty a health care practitioner, health care institution, or health care payer may have

to provide other medical procedures or services that do not violate the practitioner’s, institution’s

or payer’s conscience.

     (c) Immunity from liability. No medical practitioner, healthcare institution, or healthcare

payer shall be civilly, criminally, or administratively liable for exercising their right of conscience

not to participate in or pay for a medical procedure or service. No healthcare institution shall be

civilly, criminally, or administratively liable for the exercise of conscience rights not to participate

in a medical procedure or service by a medical practitioner employed, contracted, or granted

admitting privileges by the healthcare institution.

     (d) Discrimination. No medical practitioner, healthcare institution, or healthcare payer

shall be discriminated against in any manner as a result of their decision to decline to participate in

or pay for a medical procedure or service on the basis of conscience.

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     (e) Exception. Notwithstanding any other provision of this chapter to the contrary, a

religious medical practitioner, healthcare institution, or healthcare payer that holds itself out to the

public as religious, states in its governing documents that it has a religious purpose or mission, and

has internal operating policies or procedures that implement its religious beliefs, shall have the right

to make employment, staffing, contracting, and admitting privilege decisions consistent with its

religious beliefs.

     (f) Opt-in required. A health care practitioner may not be scheduled for, assigned, or

requested to directly or indirectly perform, facilitate, refer for, or participate in an abortion unless

the practitioner first affirmatively consents in writing to perform, facilitate, refer for, or participate

in the abortion.

     (g) Emergency medical treatments. This chapter shall not be construed to override the

requirement to provide emergency medical treatment to all patients as set forth in 42 U.S.C. §

1395dd.

     23-99-4. Whistleblower protection.

     (a) No medical practitioner shall be discriminated against in any manner because the

medical practitioner:

     (1) Provided, caused to be provided, or is about to provide or cause to be provided to their

employer, the attorney general, department of health, any state agency charged with protecting

health care rights of conscience, the U.S. Department of Health and Human Services, Office of

Civil Rights, or any other federal agency charged with protecting health care rights of conscience

information relating to any violation of, or any act or omission the medical practitioner reasonable

believes to be a violation of, any provision of this chapter;

     (2) Testified or is about to testify in a proceeding concerning such violation; or

     (3) Assisted or participated, or is about to assist or participate, in such a proceeding.

     (b) Unless the disclosure is specifically prohibited by law, no medical practitioner shall be

discriminated against in any manner because the medical practitioner disclosed any information

that the medical practitioner reasonably believes evinces:

     (1) Any violation of any law, rule, or regulation;

     (2) Any violation of any ethical guidelines for the provisions of any medical procedure or

service; or

     (3) Gross mismanagement, a gross waste of funds, an abuse of authority, practices or

methods of treatment that may put patient health at risk, or a substantial and specific danger to

public health or safety.

     (c) The board of medical licensure and discipline shall not reprimand, sanction, or revoke

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or threaten to revoke a license, certificate, or registration of a health care practitioner for engaging

in speech or expressive activity protected under the first amendment of the U.S. Constitution, unless

the board demonstrates beyond a reasonable doubt that the practitioner’s speech was the direct

cause of physical harm to a person with whom the health care practitioner had a practitioner-patient

relationship within the three (3) years immediately preceding the incident of physical harm.

     (1) The board of medical licensure and discipline shall provide a medical practitioner with

any complaints it has received which may result in the revocation of the medical practitioner’s

license, certification, or registration, within seven (7) days after receipt of the complaint.

     (2) The board of medical licensure and discipline shall pay the medical practitioner an

administrative penalty of five hundred dollars ($500) for each day the complaint is not provided to

the medical practitioner after the seven (7) day period set forth in subsection (c)(1) of this section.

     23-99-5. Civil remedies.

     (a) Civil action for violation of right of conscience. A civil action for damages or injunctive

relief, or both, may be brought by any medical practitioner, healthcare institution, or healthcare

payer for any violation of this chapter. Any additional burden or expense on another medical

practitioner, healthcare institution, or healthcare payer arising from the exercise of the right of

conscience shall not be a defense to any violation of this chapter. However, no civil action may be

brought against an individual who declines to use or purchase medical procedure or services from

a specific medical practitioner, healthcare institution, or healthcare payer for exercising the rights

set forth in § 23-99-3.

     (b) Other remedies. Any party aggrieved by any violation of this chapter may commence a

civil action and upon a finding of a violation, shall be entitled to recover threefold their actual

damages sustained, along with the costs of the action and reasonable attorneys' fees. Such damages

shall be cumulative and in no way limited by any other remedies which may be available under any

other federal, state, or municipal law. A court considering such civil action may also award

injunction relief, which may include, but it not limited to, reinstatement of a medical practitioner

to their previous position, reinstatement of board certification, and re-licensure of a healthcare

institution or healthcare payer.

     23-99-6. Severability.

     Any provision of this chapter held to be invalid or unenforceable by its terms, or as applied

to any person or circumstance, shall be construed so as to give it the maximum effect permitted by

law, unless such holding shall be one of utter invalidity or unenforceability, in which event such

provision shall be deemed severable herefrom and shall not affect the remainder hereof or the

application of such provision to other persons not similarly situated or to other, dissimilar

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circumstances.

     SECTION 2. This act shall take effect upon passage.

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LC001682

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EXPLANATION

BY THE LEGISLATIVE COUNCIL

OF

A N   A C T

RELATING TO HEALTH AND SAFETY -- MEDICAL ETHICS DEFENSE ACT

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     This act would establish the right of a medical practitioner, healthcare institution, or

healthcare payer not to participate in or pay for any medical procedure or service that violates their

conscience. This act would further protect medical practitioners and institutions from lawsuits or

criminal charges for exercising their right of conscience. This act would ensure that a doctor or

nurse cannot be fired, demoted, or otherwise discriminated against by their employer for declining

to participate in a procedure that violates his or her conscience.

     This act would take effect upon passage.

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LC001682

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