HEALTH AND SAFETY CODE

TITLE 2. HEALTH

SUBTITLE H. PUBLIC HEALTH PROVISIONS

CHAPTER 171. ABORTION

SUBCHAPTER A. GENERAL PROVISIONS

Sec. 171.001.  SHORT TITLE.  This chapter may be called the Woman's Right to Know Act.
Acts 2003, 78th Leg., ch. 999, Sec. 1, eff. Sept. 1, 2003.

Sec. 171.002.  DEFINITIONS.  In this chapter:
(1)  "Abortion" means the use of any means to terminate the pregnancy of a female known by the attending physician to be pregnant with the intention that the termination of the pregnancy by those means will, with reasonable likelihood, cause the death of the fetus.
(2)  "Abortion provider" means a facility where an abortion is performed, including the office of a physician and a facility licensed under Chapter 245.
(3)  "Medical emergency" means a life-threatening physical condition aggravated by, caused by, or arising from a pregnancy that, as certified by a physician, places the woman in danger of death or a serious risk of substantial impairment of a major bodily function unless an abortion is performed.
(4)  "Sonogram" means the use of ultrasonic waves for diagnostic or therapeutic purposes, specifically to monitor an unborn child.
Acts 2003, 78th Leg., ch. 999, Sec. 1, eff. Sept. 1, 2003.
Amended by: 
Acts 2011, 82nd Leg., R.S., Ch. 73, Sec. 1, eff. September 1, 2011.

Sec. 171.003.  PHYSICIAN TO PERFORM.  An abortion may be performed only by a physician licensed to practice medicine in this state.
Acts 2003, 78th Leg., ch. 999, Sec. 1, eff. Sept. 1, 2003.

Sec. 171.004.  ABORTION OF FETUS AGE 16 WEEKS OR MORE.  An abortion of a fetus age 16 weeks or more may be performed only at an ambulatory surgical center or hospital licensed to perform the abortion.
Added by Acts 2003, 78th Leg., ch. 999, Sec. 1, eff. Sept. 1, 2003.

Sec. 171.005.  DEPARTMENT TO ENFORCE.  The department shall enforce this chapter.
Acts 2003, 78th Leg., ch. 999, Sec. 1, eff. Sept. 1, 2003.

SUBCHAPTER B. INFORMED CONSENT

Sec. 171.011.  INFORMED CONSENT REQUIRED.  A person may not perform an abortion without the voluntary and informed consent of the woman on whom the abortion is to be performed.
Acts 2003, 78th Leg., ch. 999, Sec. 1, eff. Sept. 1, 2003.

Sec. 171.012.  VOLUNTARY AND INFORMED CONSENT.  (a)  Consent to an abortion is voluntary and informed only if:
(1)  the physician who is to perform the abortion informs the pregnant woman on whom the abortion is to be performed of:
(A)  the physician's name;
(B)  the particular medical risks associated with the particular abortion procedure to be employed, including, when medically accurate:
(i)  the risks of infection and hemorrhage;
(ii)  the potential danger to a subsequent pregnancy and of infertility; and
(iii)  the possibility of increased risk of breast cancer following an induced abortion and the natural protective effect of a completed pregnancy in avoiding breast cancer;
(C)  the probable gestational age of the unborn child at the time the abortion is to be performed; and
(D)  the medical risks associated with carrying the child to term;
(2)  the physician who is to perform the abortion or the physician's agent informs the pregnant woman that:
(A)  medical assistance benefits may be available for prenatal care, childbirth, and neonatal care;
(B)  the father is liable for assistance in the support of the child without regard to whether the father has offered to pay for the abortion; and
(C)  public and private agencies provide pregnancy prevention counseling and medical referrals for obtaining pregnancy prevention medications or devices, including emergency contraception for victims of rape or incest;
(3)  the physician who is to perform the abortion or the physician's agent:
(A)  provides  the pregnant woman with the printed materials described by Section 171.014; and
(B)  informs the pregnant woman that those materials:
(i)  have been provided by the Department of State Health Services;
(ii)  are accessible on an Internet website sponsored by the department;
(iii)  describe the unborn child and list agencies that offer alternatives to abortion; and
(iv)  include a list of agencies that offer sonogram services at no cost to the pregnant woman;
(4)  before any sedative or anesthesia is administered to the pregnant woman and at least 24 hours before the abortion or at least two hours before the abortion if the pregnant woman waives this requirement by certifying that she currently lives 100 miles or more from the nearest abortion provider that is a facility licensed under Chapter 245 or a facility that performs more than 50 abortions in any 12-month period:
(A)  the physician who is to perform the abortion or an agent of the physician who is also a sonographer certified by a national registry of medical sonographers performs a sonogram on the pregnant woman on whom the abortion is to be performed;
(B)  the physician who is to perform the abortion displays the sonogram images in a quality consistent with current medical practice in a manner that the pregnant woman may view them;
(C)  the physician who is to perform the abortion provides, in a manner understandable to a layperson, a verbal explanation of the results of the sonogram images, including a medical description of the dimensions of the embryo or fetus, the presence of cardiac activity, and the presence of external members and internal organs; and
(D)  the physician who is to perform the abortion or an agent of the physician who is also a sonographer certified by a national registry of medical sonographers makes audible the heart auscultation for the pregnant woman to hear, if present, in a quality consistent with current medical practice and provides, in a manner understandable to a layperson, a simultaneous verbal explanation of the heart auscultation;
(5)  before receiving a sonogram under Subdivision (4)(A) and before the abortion is performed and before any sedative or anesthesia is administered, the pregnant woman completes and certifies with her signature an election form that states as follows:
"ABORTION AND SONOGRAM ELECTION

(1)  THE INFORMATION AND PRINTED MATERIALS DESCRIBED BY SECTIONS 171.012(a)(1)-(3), TEXAS HEALTH AND SAFETY CODE, HAVE BEEN PROVIDED AND EXPLAINED TO ME.
(2)  I UNDERSTAND THE NATURE AND CONSEQUENCES OF AN ABORTION.
(3)  TEXAS LAW REQUIRES THAT I RECEIVE A SONOGRAM PRIOR TO RECEIVING AN ABORTION.
(4)  I UNDERSTAND THAT I HAVE THE OPTION TO VIEW THE SONOGRAM IMAGES.
(5)  I UNDERSTAND THAT I HAVE THE OPTION TO HEAR THE HEARTBEAT.
(6)  I UNDERSTAND THAT I AM REQUIRED BY LAW TO HEAR AN EXPLANATION OF THE SONOGRAM IMAGES UNLESS I CERTIFY IN WRITING TO ONE OF THE FOLLOWING:
___ I AM PREGNANT AS A RESULT OF A SEXUAL ASSAULT, INCEST, OR OTHER VIOLATION OF THE TEXAS PENAL CODE THAT HAS BEEN REPORTED TO LAW ENFORCEMENT AUTHORITIES OR THAT HAS NOT BEEN REPORTED BECAUSE I REASONABLY BELIEVE THAT DOING SO WOULD PUT ME AT RISK OF RETALIATION RESULTING IN SERIOUS BODILY INJURY.
___ I AM A MINOR AND OBTAINING AN ABORTION IN ACCORDANCE WITH JUDICIAL BYPASS PROCEDURES UNDER CHAPTER 33, TEXAS FAMILY CODE.
___ MY FETUS HAS AN IRREVERSIBLE MEDICAL CONDITION OR ABNORMALITY, AS IDENTIFIED BY RELIABLE DIAGNOSTIC PROCEDURES AND DOCUMENTED IN MY MEDICAL FILE.
(7)  I AM MAKING THIS ELECTION OF MY OWN FREE WILL AND WITHOUT COERCION.
(8)  FOR A WOMAN WHO LIVES 100 MILES OR MORE FROM THE NEAREST ABORTION PROVIDER THAT IS A FACILITY LICENSED UNDER CHAPTER 245 OR A FACILITY THAT PERFORMS MORE THAN 50 ABORTIONS IN ANY 12-MONTH PERIOD ONLY:
I CERTIFY THAT, BECAUSE I CURRENTLY LIVE 100 MILES OR MORE FROM THE NEAREST ABORTION PROVIDER THAT IS A FACILITY LICENSED UNDER CHAPTER 245 OR A FACILITY THAT PERFORMS MORE THAN 50 ABORTIONS IN ANY 12-MONTH PERIOD, I WAIVE THE REQUIREMENT TO WAIT 24 HOURS AFTER THE SONOGRAM IS PERFORMED BEFORE RECEIVING THE ABORTION PROCEDURE.  MY PLACE OF RESIDENCE IS:__________.
____________________
____________________
SIGNATURE                        DATE";
(6)  before the abortion is performed, the physician who is to perform the abortion receives a copy of the signed, written certification required by Subdivision (5); and
(7)  the pregnant woman is provided the name of each person who provides or explains the information required under this subsection.
(a-1)  During a visit made to a facility to fulfill the requirements of Subsection (a), the facility and any person at the facility may not accept any form of payment, deposit, or exchange or make any financial agreement for an abortion or abortion-related services other than for payment of a service required by Subsection (a).  The amount charged for a service required by Subsection (a) may not exceed the reimbursement rate established for the service by the Health and Human Services Commission for statewide medical reimbursement programs.
(b)  The information required to be provided under Subsections (a)(1) and (2) may not be provided by audio or video recording and must be provided at least 24 hours before the abortion is to be performed:
(1)  orally and in person in a private and confidential setting if the pregnant woman currently lives less than 100 miles from the nearest abortion provider that is a facility licensed under Chapter 245 or a facility that performs more than 50 abortions in any 12-month period; or
(2)  orally by telephone or in person in a private and confidential setting if the pregnant woman certifies that the woman currently lives 100 miles or more from the nearest abortion provider that is a facility licensed under Chapter 245 or a facility that performs more than 50 abortions in any 12-month period.
(c)  When providing the information under Subsection (a)(3), the physician or the physician's agent must provide the pregnant woman with the address of the Internet website on which the printed materials described by Section 171.014 may be viewed as required by Section 171.014(e).
(d)  The information provided to the woman under Subsection (a)(2)(B) must include, based on information available from the Office of the Attorney General and the United States Department of Health and Human Services Office of Child Support Enforcement for the three-year period preceding the publication of the information, information regarding the statistical likelihood of collecting child support.
(e)  The department is not required to republish informational materials described by Subsection (a)(2)(B) because of a change in information described by Subsection (d) unless the statistical information in the materials changes by five percent or more.
Added by Acts 2003, 78th Leg., ch. 999, Sec. 1, eff. Sept. 1, 2003.
Amended by: 
Acts 2011, 82nd Leg., R.S., Ch. 73, Sec. 2, eff. September 1, 2011.

Sec. 171.0121.  MEDICAL RECORD.  (a)  Before the abortion begins, a copy of the signed, written certification received by the physician under Section 171.012(a)(6) must be placed in the pregnant woman's medical records.
(b)  A copy of the signed, written certification required under Sections 171.012(a)(5) and (6) shall be retained by the facility where the abortion is performed until:
(1)  the seventh anniversary of the date it is signed; or
(2)  if the pregnant woman is a minor, the later of:
(A)  the seventh anniversary of the date it is signed; or
(B)  the woman's 21st birthday.
Added by Acts 2011, 82nd Leg., R.S., Ch. 73, Sec. 3, eff. September 1, 2011.

Sec. 171.0122.  VIEWING PRINTED MATERIALS AND SONOGRAM IMAGE; HEARING HEART AUSCULTATION OR VERBAL EXPLANATION.  (a)  A pregnant woman may choose not to view the printed materials provided under Section 171.012(a)(3) after she has been provided the materials.
(b)  A pregnant woman may choose not to view the sonogram images required to be provided to and reviewed with the pregnant woman under Section 171.012(a)(4).
(c)  A pregnant woman may choose not to hear the heart auscultation required to be provided to and reviewed with the pregnant woman under Section 171.012(a)(4).
(d)  A pregnant woman may choose not to receive the verbal explanation of the results of the sonogram images under Section 171.012(a)(4)(C) if:
(1)  the woman's pregnancy is a result of a sexual assault, incest, or other violation of the Penal Code that has been reported to law enforcement authorities or that has not been reported because she has a reason that she declines to reveal because she reasonably believes that to do so would put her at risk of retaliation resulting in serious bodily injury;
(2)  the woman is a minor and obtaining an abortion in accordance with judicial bypass procedures under Chapter 33, Family Code; or
(3)  the fetus has an irreversible medical condition or abnormality, as previously identified by reliable diagnostic procedures and documented in the woman's medical file.
(e)  The physician and the pregnant woman are not subject to a penalty under this chapter solely because the pregnant woman chooses not to view the printed materials or the sonogram images, hear the heart auscultation, or receive the verbal explanation, if waived as provided by this section.
Added by Acts 2011, 82nd Leg., R.S., Ch. 73, Sec. 3, eff. September 1, 2011.

Sec. 171.0123.  PATERNITY AND CHILD SUPPORT INFORMATION.  If, after being provided with a sonogram and the information required under this subchapter, the pregnant woman chooses not to have an abortion, the physician or an agent of the physician shall provide the pregnant woman with a publication developed by the Title IV-D agency that provides information about paternity establishment and child support, including:
(1)  the steps necessary for unmarried parents to establish legal paternity;
(2)  the benefits of paternity establishment for children;
(3)  the steps necessary to obtain a child support order;
(4)  the benefits of establishing a legal parenting order; and
(5)  financial and legal responsibilities of parenting.
Added by Acts 2011, 82nd Leg., R.S., Ch. 73, Sec. 3, eff. September 1, 2011.

Sec. 171.0124.  EXCEPTION FOR MEDICAL EMERGENCY.  A physician may perform an abortion without obtaining informed consent under this subchapter in a medical emergency.  A physician who performs an abortion in a medical emergency shall:
(1)  include in the patient's medical records a statement signed by the physician certifying the nature of the medical emergency; and
(2)  not later than the 30th day after the date the abortion is performed, certify to the Department of State Health Services the specific medical condition that constituted the emergency.
Added by Acts 2011, 82nd Leg., R.S., Ch. 73, Sec. 3, eff. September 1, 2011.

Sec. 171.013.  DISTRIBUTION OF STATE MATERIALS.  (a)  The physician or the physician's agent shall furnish copies of the materials described by Section 171.014 to the pregnant woman at least 24 hours before the abortion is to be performed and shall direct the pregnant woman to the Internet website required to be published under Section 171.014(e).  The physician or the physician's agent may furnish the materials to the pregnant woman by mail if the materials are mailed, restricted delivery to addressee, at least 72 hours before the abortion is to be performed.
(b)  A physician or the physician's agent is not required to furnish copies of the materials if the woman provides the physician with a written statement that she chooses to view the materials on the Internet website sponsored by the department.
(c)  The physician and the physician's agent may disassociate themselves from the materials and may choose to comment on the materials or to refrain from commenting.
Added by Acts 2003, 78th Leg., ch. 999, Sec. 1, eff. Sept. 1, 2003.
Amended by: 
Acts 2011, 82nd Leg., R.S., Ch. 73, Sec. 4, eff. September 1, 2011.

Sec. 171.014.  INFORMATIONAL MATERIALS.  (a)  The department shall publish informational materials that include:
(1)  the information required to be provided under Sections 171.012(a)(1)(B) and (D) and (a)(2)(A), (B), and (C);  and
(2)  the materials required by Sections 171.015 and 171.016.
(b)  The materials shall be published in:
(1)  English and Spanish;
(2)  an easily comprehensible form;  and
(3)  a typeface large enough to be clearly legible.
(c)  The materials shall be available at no cost from the department on request.  The department shall provide appropriate quantities of the materials to any person.
(d)  The department shall annually review the materials to determine if changes to the contents of the materials are necessary.  The department shall adopt rules necessary for considering and making changes to the materials.
(e)  The department shall develop and maintain an Internet website to display the information required to be published under this section.  In developing and maintaining the website the department shall, to the extent reasonably practicable, safeguard the website against alterations by anyone other than the department and shall monitor the website each day to prevent and correct tampering.  The department shall ensure that the website does not collect or maintain information regarding access to the website.
(f)  In addition to any other organization or entity, the department shall use the American College of Obstetricians and Gynecologists as the resource in developing information required to be provided under Sections 171.012(a)(1)(B) and (D), Sections 171.012(a)(2)(A), (B), and (C), and Section 171.016, and in maintaining the department's Internet website.
Added by Acts 2003, 78th Leg., ch. 999, Sec. 1, eff. Sept. 1, 2003.

Sec. 171.015.  INFORMATION RELATING TO PUBLIC AND PRIVATE AGENCIES.  The informational materials must include:
(1)  geographically indexed materials designed to inform the pregnant woman of public and private agencies and services that:
(A)  are available to assist a woman through pregnancy, childbirth, and the child's dependency, including:
(i)  a comprehensive list of adoption agencies;
(ii)  a description of the services the adoption agencies offer;
(iii)  a description of the manner, including telephone numbers, in which an adoption agency may be contacted; and
(iv)  a comprehensive list of agencies and organizations that offer sonogram services at no cost to the pregnant woman;
(B)  do not provide abortions or abortion-related services or make referrals to abortion providers; and
(C)  are not affiliated with organizations that provide abortions or abortion-related services or make referrals to abortion providers; and
(2)  a toll-free, 24-hour telephone number that may be called to obtain an oral list and description of agencies described by Subdivision (1) that are located near the caller and of the services the agencies offer.
Added by Acts 2003, 78th Leg., ch. 999, Sec. 1, eff. Sept. 1, 2003.
Amended by: 
Acts 2011, 82nd Leg., R.S., Ch. 73, Sec. 5, eff. September 1, 2011.

Sec. 171.016.  INFORMATION RELATING TO CHARACTERISTICS OF UNBORN CHILD.  (a)  The informational materials must include materials designed to inform the woman of the probable anatomical and physiological characteristics of the unborn child at two-week gestational increments from the time when a woman can be known to be pregnant to full term, including any relevant information on the possibility of the unborn child's survival.
(b)  The materials must include color pictures representing the development of the child at two-week gestational increments.  The pictures must contain the dimensions of the unborn child and must be realistic.
(c)  The materials provided under this section must be objective and nonjudgmental and be designed to convey only accurate scientific information about the unborn child at the various gestational ages.
Added by Acts 2003, 78th Leg., ch. 999, Sec. 1, eff. Sept. 1, 2003.

Sec. 171.017.  PERIODS RUN CONCURRENTLY.  If the woman is an unemancipated minor subject to Chapter 33, Family Code, the 24-hour periods established under Sections 171.012(b) and 171.013(a) may run concurrently with the period during which actual or constructive notice is provided under Section 33.002, Family Code.
Added by Acts 2003, 78th Leg., ch. 999, Sec. 1, eff. Sept. 1, 2003.

Sec. 171.018.  OFFENSE.  A physician who intentionally performs an abortion on a woman in violation of this subchapter commits an offense.  An offense under this section is a misdemeanor punishable by a fine not to exceed $10,000. In this section, "intentionally" has the meaning assigned by Section 6.03(a), Penal Code.
Added by Acts 2003, 78th Leg., ch. 999, Sec. 1, eff. Sept. 1, 2003.