The House Committee on Public and Community Health offers the following substitute
to SB 30:
A BILL TO BE ENTITLED
AN ACT
To amend Article 1 of Chapter 7 of Title 31 and Article 1 of Chapter 34 of Title 43 of the
Official Code of Georgia Annotated, relating to regulation of hospitals and related
institutions and the Georgia Composite Medical Board, respectively, so as to prohibit
prescribing or administering certain hormone therapies and puberty-blocking medications
for certain purposes to minors; to provide for definitions; to provide for exceptions; to
provide for limited civil actions; to provide for related matters; to repeal conflicting laws; and
for other purposes.
BE IT ENACTED BY THE GENERAL ASSEMBLY OF GEORGIA:
SECTION 1.
Article 1 of Chapter 7 of Title 31 of the Official Code of Georgia Annotated, relating to
regulation of hospitals and related institutions, is amended by revising Code Section
31-7-3.5, relating to treatment of minors for gender dysphoria and penalty for violations, as
follows:
"31-7-3.5.
<ins>(a) As used in this Code section, the term:
</ins>
<ins>(1) 'Hormone therapy' means therapy that adds, blocks, or removes hormones for the
purpose of assisting a minor with attempting to alter such minor's sex or to alter the
appearance of and affirm such minor's perception of his or her sex if such appearance and
perception are inconsistent with such minor's sex. Such term includes, but is not limited
to, the provision of supraphysiologic estrogen or progesterone to a minor who is male or
supraphysiologic testosterone to a minor who is female, whether such hormones are
biological, bioidentical, or synthetic.
(2) 'Puberty-blocking medication' means medication, whether biological, bioidentical,
or synthetic, used to delay or suppress pubertal development in a minor for the purpose
of assisting such minor with attempting to alter such minor's sex or to alter the
appearance of and affirm such minor's perception of his or her sex if such appearance and
perception are inconsistent with such minor's sex. Such term includes
gonadotropin-releasing hormone analogues or other synthetic drugs used in males to stop
luteinizing hormone secretion, and therefore testosterone production, and synthetic drugs
used in females to stop the production of estrogen and progesterone.
(3) 'Sex' means the biological state of being male or female, in the context of
reproductive potential or capacity, based on an individual's sex organs, chromosomes,
naturally occurring sex hormones, gonads, and internal and external genitalia present at
birth, including secondary sex characteristics.
(4) 'Sex reassignment surgery' means any surgical procedure that seeks to surgically alter
or remove healthy or nondiseased physical or anatomical characteristics or features that
are typical for an individual's sex in order to instill or create physiological or anatomical
characteristics that resemble a sex different from a minor's sex. Such term means genital
or nongenital surgery performed for the purpose of assisting a minor with attempting to
alter such minor's sex or to alter the appearance of and affirm such minor's perception of
his or her sex if such appearance and perception are inconsistent with such minor's sex.
Such term includes, but is not limited to, castration, clitorectomy, clitoroplasty,
</ins>
<ins>hysterectomy, mammoplasty, mastectomy, metoidioplasty, oophorectomy, orchiectomy,
penectomy, phalloplasty, vaginectomy, vaginoplasty, vasectomy, and vulvoplasty.
(a)(b)</ins> Except as provided in subsection <del>(b)</del> <ins>(c)</ins> of this Code section, <del>none of</del> the following
irreversible procedures or <del>therapies</del> <ins>irreversible or reversible treatments</ins> shall <ins>not</ins> be
performed on <del>a minor for the treatment of gender dysphoria</del> <ins>and shall not be prescribed or
administered to a minor if such procedure or treatment is performed, prescribed, or
administered for the purpose of attempting to alter the appearance of and affirm such
minor's perception of his or her sex if such appearance and perception are inconsistent with
such minor's sex</ins> in an institution licensed pursuant to this article:
(1) Sex reassignment surgeries, or any other surgical procedures, that are performed for
the purpose of altering primary or secondary <del>sexual</del> <ins>sex</ins> characteristics; <del>or
</del> (2) Hormone <del>replacement</del> therapies <ins>that are prescribed or administered for the purpose
of altering primary or secondary sex characteristics; or
(3) Puberty-blocking medications that are prescribed or administered for the purpose of
delaying or suppressing puberty; provided, however, that puberty-blocking medications
may be prescribed or administered to a minor if:
(A) Such minor has been diagnosed with gender dysphoria by two independent
behavioral health professionals, including one licensed psychiatrist and one licensed
psychiatrist or psychologist;
(B) The prescribing physician is a licensed physician who is board certified in
pediatrics and board certified in either pediatric endocrinology or adolescent medicine
and, prior to prescribing or administering any puberty-blocking medications, has
conducted a comprehensive assessment of such minor's medical history, mental health,
and any underlying conditions, such as autism spectrum disorder;
(C) All parents or legal guardians who have the legal authority to make such decisions
on such minor's behalf provide written informed consent acknowledging the potential
risks and benefits of and alternatives to puberty-blocking medications; provided,
</ins>
<ins>however, that, if such parents or legal guardians do not consent to the prescription or
administration of puberty-blocking medications to such minor and resolution is not
provided in a parenting plan, either party may petition a court of competent jurisdiction
to determine what is in the best interest of such minor and such court order shall be
provided to the prescribing physician;
(D) The prescribing physician submits an annual treatment progress report to the
Georgia Composite Medical Board for review; and
(E) Such minor undergoes quarterly psychological counseling throughout the course
of such treatment.
</ins> <del>(b)(c)</del> The provisions of subsection <del>(a)</del> <ins>(b)</ins> of this Code section shall not apply to treatment
provided pursuant to an exception contained in subsection <del>(b)</del> <ins>(c)</ins> of Code
Section 43-34-15.
<ins>(c)(d)</ins> The department shall establish sanctions, by rule and regulation, for violations of
this Code section up to and including the revocation of an institution's permit issued
pursuant to Code Section 31-7-3.
<ins>(e) A minor's parent or legal guardian who has the legal authority to consent to medical
treatment on behalf of such minor may bring a civil action against an institution in which
a procedure or treatment is performed on or prescribed or administered to such minor in
violation of this Code section, provided that such civil action shall be brought within two
years of the date on which the violation occurred. An institution shall not be subject to
civil liability under this Code section for the prescription or administration of
puberty-blocking medications in accordance with the conditions provided for in
subparagraphs (b)(3)(A) through (b)(3)(E) of this Code section."
</ins> SECTION 2.
Article 1 of Chapter 34 of Title 43 of the Official Code of Georgia Annotated, relating to the
Georgia Composite Medical Board, is amended by revising Code Section 43-34-15, relating
to prohibition on certain therapies and procedures for treatment of gender dysphoria in
minors, regulations, exceptions, and accountability, as follows:
"43-34-15.
<ins>(a) As used in this Code section, the term:
(1) 'Hormone therapy' means therapy that adds, blocks, or removes hormones for the
purpose of assisting a minor with attempting to alter such minor's sex or to alter the
appearance of and affirm such minor's perception of his or her sex if such appearance and
perception are inconsistent with such minor's sex. Such term includes, but is not limited
to, the provision of supraphysiologic estrogen or progesterone to a minor who is a male
or supraphysiologic testosterone to a minor who is a female, whether such hormones are
biological, bioidentical, or synthetic.
(2) 'Puberty-blocking medication' means medication, whether biological, bioidentical,
or synthetic, used to delay or suppress pubertal development in a minor for the purpose
of assisting such minor with attempting to alter such minor's sex or to alter the
appearance of and affirm such minor's perception of his or her sex if such appearance and
perception are inconsistent with such minor's sex. Such term includes
gonadotropin-releasing hormone analogues or other synthetic drugs used in males to stop
luteinizing hormone secretion, and therefore testosterone production, and synthetic drugs
used in females to stop the production of estrogen and progesterone.
(3) 'Sex' means the biological state of being male or female, in the context of
reproductive potential or capacity, based on an individual's sex organs, chromosomes,
naturally occurring sex hormones, gonads, and internal and external genitalia present at
birth, including secondary sex characteristics.
(4) 'Sex reassignment surgery' means any surgical procedure that seeks to surgically alter
or remove healthy or nondiseased physical or anatomical characteristics or features that
are typical for an individual's sex in order to instill or create physiological or anatomical
characteristics that resemble a sex different from a minor's sex. Such term means genital
</ins>
<ins>or nongenital surgery performed for the purpose of assisting a minor with attempting to
alter such minor's sex or to alter the appearance of and affirm such minor's perception of
his or her sex if such appearance and perception are inconsistent with such minor's sex.
Such term includes, but is not limited to, castration, clitorectomy, clitoroplasty,
hysterectomy, mammoplasty, mastectomy, metoidioplasty, oophorectomy, orchiectomy,
penectomy, phalloplasty, vaginectomy, vaginoplasty, vasectomy, and vulvoplasty.
(a)(b)</ins> Except as otherwise provided in subsection <del>(b)</del> <ins>(c)</ins> of this Code section, the
following irreversible procedures and <del>therapies performed on a minor for the treatment of
gender dysphoria are prohibited</del> <ins>irreversible or reversible treatments shall not be performed
on and shall not be prescribed or administered to a minor by a physician if such procedure
or treatment is performed, prescribed, or administered for the purpose of attempting to alter
the appearance of and affirm such minor's perception of his or her sex if such appearance
and perception are inconsistent with such minor's sex</ins> in this state:
(1) Sex reassignment surgeries, or any other surgical procedures, that are performed for
the purpose of altering primary or secondary <del>sexual</del> <ins>sex</ins> characteristics; and
(2) Hormone <del>replacement</del> therapies <ins>that are prescribed or administered for the purpose
of altering primary or secondary sex characteristics; or
(3) Puberty-blocking medications that are prescribed or administered for the purpose of
delaying or suppressing puberty; provided, however, that puberty-blocking medications
may be prescribed or administered to a minor if:
(A) Such minor has been diagnosed with gender dysphoria by two independent
behavioral health professionals, including one licensed psychiatrist and one licensed
psychiatrist or psychologist;
(B) The prescribing physician is a licensed physician who is board certified in
pediatrics and board certified in either pediatric endocrinology or adolescent medicine
and, prior to prescribing or administering any puberty-blocking medications, has
</ins>
<ins>conducted a comprehensive assessment of such minor's medical history, mental health,
and any underlying conditions, such as autism spectrum disorder;
(C) All parents or legal guardians who have the legal authority to make such decisions
on such minor's behalf provide written informed consent acknowledging the potential
risks and benefits of and alternatives to puberty-blocking medications; provided,
however, that, if such parents or legal guardians do not consent to the prescription or
administration of puberty-blocking medications to such minor and resolution is not
provided in a parenting plan, either party may petition a court of competent jurisdiction
to determine what is in the best interest of such minor and such court order shall be
provided to the prescribing physician;
(D) The prescribing physician submits an annual treatment progress report to the
Georgia Composite Medical Board for review; and
(E) Such minor undergoes quarterly psychological counseling throughout the course
of such treatment.
</ins> <del>(b)(c)</del> The board shall adopt rules and regulations regarding the prohibitions contained in
subsection <del>(a)</del> <ins>(b)</ins> of this Code section, which shall contain limited exceptions for:
(1) Treatments for medical conditions other than gender dysphoria or for the purpose of
sex reassignment where such treatments are deemed medically necessary;
(2) Treatments for individuals born with a medically verifiable disorder of sex
development, including individuals born with ambiguous genitalia or chromosomal
abnormalities resulting in ambiguity regarding the individual's biological sex;
(3) Treatments for individuals with partial androgen insensitivity syndrome; <del>and
</del> (4) Continued treatment of minors who are, prior to July 1, 2023, being treated with
<del>irreversible</del> hormone <del>replacement</del> therapies;
<ins>(5) Continued treatment of minors who are, prior to July 1, 2025, being treated with
puberty-blocking medications; provided, however, that the conditions provided for in
</ins>
<ins>subparagraphs (b)(3)(A) and (b)(3)(B) of this Code section shall not be required to be
satisfied; and
(6) Other treatments consistent with the provisions of this Code section.
(c)(d)</ins> A licensed physician who violates this Code section shall be held administratively
accountable to the board for such violation.
<ins>(e) A minor's parent or legal guardian who has the legal authority to consent to medical
treatment on behalf of such minor may bring a civil action against a physician who
performed, prescribed, or administered a procedure or treatment on such minor in violation
of this Code section, provided that such civil action shall be brought within two years of
the date on which the violation occurred. A physician shall not be subject to civil liability
under this Code section for prescribing or administering puberty-blocking medications in
accordance with the conditions provided for in subparagraphs (b)(3)(A) through (b)(3)(E)
of this Code section."
</ins> SECTION 3.
All laws and parts of laws in conflict with this Act are repealed.