By: Lucio, et al. S.B. No. 394
  relating to abortion complication reporting and the regulation of
  drug-induced abortion procedures, providers, and facilities;
  creating a criminal offense.
         SECTION 1.  The legislature finds that:
               (1)  this state has an interest to protect the health
  and welfare of every woman considering a drug-induced abortion;
               (2)  the use of Mifeprex or mifepristone presents
  significant medical complications including, but not limited to,
  uterine hemorrhage, viral infections, abdominal pain, cramping,
  vomiting, headache, fatigue, and pelvic inflammatory disease; and
               (3)  the risk of failure rate and complications
  increases with advancing gestational age.
         SECTION 2.  Sections 171.006(a) and (b), Health and Safety
  Code, as added by Chapter 4 (H.B. 13), Acts of the 85th Legislature,
  1st Called Session, 2017, are amended to read as follows:
         (a)  In this section, "abortion complication" or "adverse
  event" means any harmful event or adverse outcome with respect to a
  patient related to an abortion that is performed or induced on the
  patient and that is diagnosed or treated by a health care
  practitioner or at a health care facility and includes:
               (1)  shock;
               (2)  uterine perforation;
               (3)  cervical laceration;
               (4)  hemorrhage;
               (5)  aspiration or allergic response;
               (6)  infection;
               (7)  sepsis;
               (8)  death of the patient;
               (9)  incomplete abortion;
               (10)  damage to the uterus; [or]
               (11)  an infant born alive after the abortion;
               (12)  blood clots resulting in pulmonary embolism or
  deep vein thrombosis; 
               (13)  failure to actually terminate the pregnancy;
               (14)  pelvic inflammatory disease;
               (15)  endometritis;
               (16)  missed ectopic pregnancy;
               (17)  cardiac arrest;
               (18)  respiratory arrest;
               (19)  renal failure;
               (20)  metabolic disorder;
               (21)  embolism;
               (22)  coma;
               (23)  placenta previa in subsequent pregnancies;
               (24)  preterm delivery in subsequent pregnancies;
               (25)  fluid accumulation in the abdomen;
               (26)  hemolytic reaction resulting from the
  administration of ABO-incompatible blood or blood products;
               (27)  adverse reactions to anesthesia or other drugs;
               (28)  any other adverse event as defined by the United
  States Food and Drug Administration's criteria provided by the
  MedWatch Reporting System.
         (b)  The reporting requirements of this section apply only
               (1)  a physician who:
                     (A)  performs or induces at an abortion facility
  an abortion that results in an abortion complication diagnosed or
  treated by that physician; or
                     (B)  diagnoses or treats [at an abortion facility]
  an abortion complication that is the result of an abortion
  performed or induced by another physician [at the facility]; or
               (2)  a health care facility that is a hospital,
  abortion facility, freestanding emergency medical care facility,
  or health care facility that provides emergency medical care, as
  defined by Section 773.003.
         SECTION 3.  Section 171.061, Health and Safety Code, is
  amended by amending Subdivisions (2) and (5) and adding
  Subdivisions (2-a) and (8-a) to read as follows:
               (2)  "Abortion-inducing drug" means a drug, a medicine,
  or any other substance, including a regimen of two or more drugs,
  medicines, or substances, prescribed, dispensed, or administered
  with the intent of terminating a clinically diagnosable pregnancy
  of a woman and with knowledge that the termination will, with
  reasonable likelihood, cause the death of the woman's unborn child.
  The term includes off-label use of drugs, medicines, or other
  substances known to have abortion-inducing properties that are
  prescribed, dispensed, or administered with the intent of causing
  an abortion, including the Mifeprex regimen, misoprostol
  (Cytotec), and methotrexate. The term does not include a drug,
  medicine, or other substance that may be known to cause an abortion
  but is prescribed, dispensed, or administered for other medical
               (2-a)  "Adverse event"  or "abortion complication" 
  means any harmful event or adverse outcome with respect to a patient
  related to an abortion, including the abortion complications listed
  in Section 171.006, as added by Chapter 4 (H.B. 13), Acts of the
  85th Legislature, 1st Called Session, 2017.
               (5)  "Medical abortion" means the administration or use
  of an abortion-inducing drug to induce an abortion, and may also be
  referred to as a "medication abortion," a "chemical abortion," a
  "drug-induced abortion," "RU-486," or the "Mifeprex regimen".
               (8-a)  "Provide" means, when used regarding
  abortion-inducing drugs, any act of giving, selling, dispensing,
  administering, transferring possession, or otherwise providing or
  prescribing an abortion-inducing drug.
         SECTION 4.  Section 171.063, Health and Safety Code, is
  amended by amending Subsections (a), (c), and (e) and adding
  Subsection (b-1) to read as follows:
         (a)  A person may not knowingly [give, sell, dispense,
  administer,] provide[, or prescribe] an abortion-inducing drug to a
  pregnant woman for the purpose of inducing an abortion in the
  pregnant woman or enabling another person to induce an abortion in
  the pregnant woman unless:
               (1)  the person who [gives, sells, dispenses,
  administers,] provides[, or prescribes] the abortion-inducing drug
  is a physician; and
               (2)  [except as otherwise provided by Subsection (b),]
  the provision[, prescription, or administration] of the
  abortion-inducing drug satisfies the protocol [tested and]
  authorized by this subchapter [the United States Food and Drug
  Administration as outlined in the final printed label of the
  abortion-inducing drug].
         (b-1)  A manufacturer, supplier, physician, or any other
  person may not provide to a patient any abortion-inducing drug by
  courier, delivery, or mail service.
         (c)  Before the physician [gives, sells, dispenses,
  administers,] provides[, or prescribes] an abortion-inducing drug,
  the physician must:
               (1)  examine the pregnant woman in person;
               (2)  independently verify that a pregnancy exists;
               (3)  [and] document, in the woman's medical record, the
  gestational age and intrauterine location of the pregnancy to
  determine if an ectopic pregnancy exists;
               (4)  determine the pregnant woman's blood type, and for
  a woman who is Rh negative, offer to administer Rh immunoglobulin
  (RhoGAM) at the time the abortion is performed or induced to prevent
  Rh incompatibility, complications, or miscarriage in future
               (5)  document whether the pregnant woman received
  treatment for Rh negativity, as diagnosed by the most accurate
  standard of medical care; and
               (6)  ensure the physician does not provide an
  abortion-inducing drug for a pregnant woman whose pregnancy is more
  than 49 days of gestational age.
         (e)  A [The] physician who [gives, sells, dispenses,
  administers,] provides[, or prescribes] the abortion-inducing
  drug, or the physician's agent, must schedule a follow-up visit for
  the woman to occur not later [more] than the 14th day [14 days]
  after the earliest date on which the abortion is performed or
  induced or the drug is administered [administration] or used [use
  of the drug]. At the follow-up visit, the physician must:
               (1)  confirm that the woman's pregnancy is completely
  terminated; and
               (2)  assess any continued blood loss [the degree of
         SECTION 5.  Subchapter D, Chapter 171, Health and Safety
  Code, is amended by adding Sections 171.0631, 171.0632, 171.065,
  and 171.066 to read as follows:
  person may not provide an abortion-inducing drug to a pregnant
  woman without satisfying the applicable informed consent
  requirements of Subchapter B.
         Sec. 171.0632.  REPORTING REQUIREMENTS. A physician who
  provides an abortion-inducing drug must comply with the applicable
  physician reporting requirements under Section 245.011.
         Sec. 171.065.  CRIMINAL OFFENSE. (a)  A person who
  intentionally, knowingly, or recklessly violates this subchapter
  commits an offense. An offense under this subsection is a state
  jail felony.
         (b)  A pregnant woman on whom a drug-induced abortion is
  attempted, induced, or performed in violation of this subchapter is
  not criminally liable for the violation.
         (c)  Conduct constituting an offense under this section may
  also be the basis for an administrative violation under Section
         Sec. 171.066.  ENFORCEMENT OF SUBCHAPTER. A state executive
  or administrative official may not decline to enforce this
  subchapter, or adopt a construction of this subchapter in a way that
  narrows its applicability, based on the official's own beliefs on
  the requirements of the state or federal constitution, unless the
  official is enjoined by a state or federal court from enforcing this
         SECTION 6.  The following provisions of the Health and
  Safety Code are repealed:
               (1)  Sections 171.061(3) and (6); and
               (2)  Section 171.063(b).
         SECTION 7.  (a)  Nothing in this Act shall be construed as
  creating or recognizing a right to abortion.
         (b)  It is not the intention of this Act to make lawful an
  abortion that is otherwise unlawful.
         (c)  Nothing in this Act repeals, replaces, or otherwise
  invalidates existing Texas laws, regulations, or policies.
         SECTION 8.  Any provision of this Act held to be invalid or
  unenforceable by its terms or as applied to any person or
  circumstance shall be construed so as to give the provision the
  maximum effect permitted by law, unless such holding is one of utter
  invalidity or unenforceability, in which event the provision shall
  be considered severable from the other provisions of this Act and
  shall not affect the remainder or the application of the provisions
  to other persons not similarly situated or to other, dissimilar
         SECTION 9.  (a)  Except as provided by Subsection (b) of this
  section, the changes in law made by this Act apply only to an
  abortion performed or induced on or after the effective date of this
         (b)  Section 171.065, Health and Safety Code, as added by
  this Act, applies only to an abortion performed or induced on or
  after September 1, 2021.
         SECTION 10.  This Act takes effect immediately if it
  receives a vote of two-thirds of all the members elected to each
  house, as provided by Section 39, Article III, Texas Constitution.  
  If this Act does not receive the vote necessary for immediate
  effect, this Act takes effect September 1, 2021.