Amendments	Fiscal Memos
SA0003	Amendment 1-0 to SB0001
SA0008	Amendment 2-0 to SB0001
SA0015	Amendment 3-0 to SB0001

	Amendments	Fiscal Memos
HA0002	Amendment 1-1 to HB0001
HA0012	Amendment 2-1 to HB0001
HA0025	Amendment 3- to HB0001
HA0027	Amendment 4- to HB0001
HA0028	Amendment 5- to HB0001

NOTE: Each fiscal memorandum applies only to the amendment(s) identified in the memorandum. The fiscal memorandum must be matched to any amendments that have been adopted.

Fiscal Summary

NOT SIGNIFICANT

Bill Summary

Present law generally prohibits healthcare prescribers from prescribing a course of treatment that involves hormone treatment for gender dysphoric or gender incongruent prepubertal minors. This bill replaces present law and instead establishes prohibitions related to the performance on minors of certain medical procedures related to gender identity, creates private causes of action for violations, and establishes additional penalties for violations.

General Prohibitions

This bill generally prohibits licensed healthcare professionals, establishments, and facilities (collectively referred to as a "healthcare provider") from performing or offering to perform on a person under 18 years of age (a "minor"), or administering or offering to administer to a minor, a medical procedure if the performance or administration of the procedure is for the purpose of:

(1) Enabling a minor to identify with, or live as, a purported identity inconsistent with the immutable characteristics of the reproductive system that define the minor as male or female, as determined by anatomy and genetics existing at the time of birth (the minor's "sex"); or

(2) Treating purported discomfort or distress from a discordance between the minor's sex and asserted identity.

For purposes of this bill, a "medical procedure" includes both surgical procedures and the prescribing, administering, or dispensing of a drug or device.

It is not a violation of this bill's general prohibition for a healthcare provider to perform, or offer to perform, a medical procedure on or administer, or offer to administer, a medical procedure to a minor if:

(1) The performance or administration of the medical procedure is to treat a physical or chemical abnormality present in a minor that is inconsistent with the normal development of a human being of the minor's sex (a "congenital defect"), or a minor's disease or physical injury. For purposes of this bill, gender dysphoria, gender identity disorder, gender incongruence, or any mental condition, disorder, disability, or abnormality are not a congenital defect or a disease; or

(2) The performance or administration of the medical procedure on the minor began prior to July 1, 2023; provided, that the treating physician must make a written certification that ending the medical procedure would be harmful to the minor and the medical procedure is not different from the medical procedure performed prior to July 1, 2023, when the sole purpose of the different procedure is to enable the minor to identify with, or live as, a purported identity inconsistent with the minor's sex or treat purported discomfort or distress from a discordance between the minor's sex and asserted identity.

Private Rights of Action

This bill creates a cause of action whereby a minor who is injured as a result of a violation of this bill's prohibitions concerning medical procedures may bring a lawsuit against the:

(1) Healthcare provider alleged to have made the violation; and

(2) Minor's parent if the parent of the minor consented to the conduct that constituted the violation on behalf of the minor.

This bill creates a cause of action whereby the parent of a minor who is injured as a result of a violation of this bill's prohibitions concerning medical procedures may bring a lawsuit against the healthcare provider alleged to have made the violation; provided, that the parent will not have standing to bring any such lawsuit if the parent consented to the conduct that constituted the violation on behalf of the minor.

This bill creates a cause of action whereby the parent or next of kin of a minor may bring a wrongful death action against a healthcare provider alleged to have this bill's prohibitions concerning medical procedures, if the injured minor is deceased and:

(1) The minor's death is the result of the physical or emotional harm inflicted upon the minor by the violation; and

(2) The parent of the minor did not consent to the conduct that constituted the violation on behalf of the minor.

The full text of this bill specifies types of damages that may be awarded in lawsuits that are based on the causes of action created by this bill.

The statute of limitations for lawsuits that are based on the causes of action created by this bill is:

(1) Within 30 years from the date the minor reaches 18 years of age; or

(2) Within 10 years of the minor's death if the minor dies.


It is not a defense to any legal liability incurred as a result of a violation of this bill's prohibitions concerning medical procedures, that the minor, or a parent of the minor, consented to the conduct that constituted the violation.

Additional Penalties

In any lawsuit that is based on the causes of action created by this bill, if the court finds that a healthcare provider knowingly violated this bill's prohibitions concerning medical procedures, this bill requires the court to notify the appropriate regulatory authority and the attorney general and reporter by mailing a certified copy of the court's order to the regulatory authority and the attorney general and reporter.

This bill requires the attorney general and reporter to establish a process by which violations of this bill's prohibitions concerning medical procedures may be reported. This bill authorizes the attorney general and reporter to bring an action against a healthcare provider that knowingly violates this bill's prohibitions concerning medical procedures, within 20 years of the violation, to enjoin further violations, to disgorge any profits received due to the medical procedure, and to recover a civil penalty of $25,000 per violation. The jurisdiction for an action brought by the attorney general and reporter pursuant to this bill is in the chancery or circuit court of Williamson County or circuit court in the county where the violation occurred.

This bill specifies that a violation of this bill's prohibitions concerning medical procedures constitutes a potential threat to public health, safety, and welfare and requires emergency action by an alleged violator's appropriate regulatory authority. Upon becoming aware of an alleged violation of this bill's prohibitions concerning medical procedures, this bill requires the appropriate regulatory authority to proceed pursuant to present law concerning administrative discipline of licensed health care workers and facilities.

This bill specifies that a minor upon whom a medical procedure is performed or administered must not be held liable for violating this bill's prohibitions concerning medical procedures.

ON FEBRUARY 13, 2023, THE SENATE ADOPTED AMENDMENTS #2 AND #3 AND PASSED SENATE BILL 1, AS ADOPTED.

AMENDMENT #2 revises some of the legislative findings that precede the substantive provisions of this bill and makes the following substantive changes:

(1) Replaces this bill's provisions that generally prohibit prescribing, administering, or dispensing any drug or device to a minor for purposes of enabling a minor to identify with, or live as, a purported identity inconsistent with the minor's sex or treating purported discomfort or distress from a discordance between the minor's sex and asserted identity. This amendment instead specifically prohibits prescribing, administering, or dispensing a puberty blocker or hormone for such purposes, subject to the exceptions specified in this bill. This amendment also prohibits a person from knowingly providing a hormone or puberty blocker by any means to a minor if the provision of the hormone or puberty blocker is not in compliance with this bill;

(2) Specifies that this bill's prohibitions against administering, performing, or offering to perform certain medical procedures on a minor, including medical procedures described in (1), apply to medical procedures that are performed or administered either in Tennessee or on a Tennessee resident via telehealth;

(3) Adds that a healthcare provider must act knowingly in order to commit an offense under this bill;

(4) Adds treatment of precocious puberty to the list of conditions the treatment of which are excepted from this bill's prohibition concerning medical procedures offered to, or administered or performed on a minor;

(5) With regard to the exception for finishing a medical procedure that began prior to this bill's effective date, adds that such procedure must conclude by March 31, 2024, in order for the exemption to apply;

(6) Revises the cause of action under this bill by replacing authorization for a minor to a parent of the minor who consented to the conduct that constituted a violation of this bill. This amendment instead authorizes a minor to sue any person alleged to have violated this amendment's prohibition against knowingly providing a hormone or puberty blocker by any means to a minor, described in (1);

(7) For purposes of actions brought by the attorney general and reporter against a healthcare provider under this bill, this amendment specifies that each performance or administration of a medical procedure in violation of this bill is a separate violation for which profits may be disgorged and a $25,000 civil penalty may be assessed. This amendment also broadens the class of persons against whom the attorney general and reporter will be authorized to bring an action for a violation of this bill to include any person instead of only a healthcare provider;

(8) Specifies that this bill will not prohibit or restrict psychological practice, the practice of professional counseling, or the practice of social work; and

(9) Makes this bill applicable to actions occurring on or after July 1, 2023.

AMENDMENT #3 revises Senate Amendment #2, such that the prohibition against administering, performing, or offering to perform certain medical procedures on a minor, applies to medical procedures that are performed or administered either in Tennessee or on "a minor located in Tennessee via telehealth", not "a resident of Tennessee via telehealth".

This amendment also changes a section header.