HB 44

By: Geren
  H.B. No. 44
  A BILL TO BE ENTITLED
  AN ACT
  relating to exceptions to otherwise prohibited abortions based on a
  physician's reasonable medical judgment.
         BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
         SECTION 1.  This Act may be cited as the Life of the Mother
  Act.
         SECTION 2.  Amend Section 74.551, Civil Practice and
  Remedies Code, to read as follows:
         Sec. 74.551.  APPLICATION.  An action to which Section
  74.552 applies isA civil action brought against a physician or
  health care provider for a violation of a provision of Chapter 170,
  170A, or 171, Health and Safety Code, or Chapter 6-1/2, Title 71,
  Vernon's Texas Civil Statutes, subject to an exception provided by
  the chapter alleged to have been violated or other law, is a health
  care liability claim for purposes of this chapter and is subject to
  the same requirements as any other health care liability claim.
  This section does not affect a health care liability claim based on
  any other ground than a violation of Chapters 170, 170A, or 171,
  Health and Safety Code, or Chapter 6-1/2, Title 71, Vernon's Texas
  Civil Statutes.
         SECTION 3.  Section 170A.002(b), Health and Safety Code, is
  amended to read as follows:
         (b)  The prohibition underIt is an exception to the
  application of Subsection (a) thatdoes not apply if:
               (1)  the person performing, inducing, or attempting the
  abortion is a licensed physician:; and
               (2)  in the exercise of reasonable medical judgment,
  the pregnant female on whom the abortion is performed, induced, or
  attempted has a life-threatening physical condition aggravated by,
  caused by, or arising from a pregnancy that places the female at
  risk of death or poses a serious risk of substantial impairment of a
  major bodily function unless the abortion is performed or induced;
  and
               (3)  the person performs, induces, or attempts the
  abortion in a manner that, in the exercise of reasonable medical
  judgment, provides the best opportunity for the unborn child to
  survive unless, in the reasonable medical judgment, that manner
  would create:
                     (A)  a greater risk of the pregnant female's
  death; or
                     (B)  a serious risk of substantial impairment of a
  major bodily function of the pregnant female.
         SECTION 4.  Chapter 170A, Health and Safety Code, is amended
  by adding new Sections 170A.0021, 170A.0022, and 170A.0023 to read
  as follows:
         Sec. 170A.0021.  TREATMENT AFFECTING UNBORN CHILD;
  EXCEPTION.  (a)  Notwithstanding any other law, a physician who
  treats a condition described by Subsection 170A.002(b)(2) shall do
  so in a manner that, in the exercise of reasonable medical judgment,
  provides the best opportunity for survival of an unborn child.
         (b)  It is an exception to the application of Subsection (a)
  that, in a physician's reasonable medical judgment, the manner of
  treatment required by that subsection would create a greater risk
  of:
               (1)  the pregnant female's death; or
               (2)  substantial impairment of a major bodily function
  of the pregnant female.
         (c)  This chapter does not require a physician to delay,
  alter or withhold medical treatment provided to a pregnant female
  if doing so would create a greater risk of:
               (1)  the pregnant female's death; or
               (2)  substantial impairment of a major bodily function
  of the pregnant female.
         (d)  Nothing in Subsection (c) authorizes the performance of
  an abortion that is prohibited by law.
         Sec. 170A.0022.  REASONABLE MEDICAL JUDGMENT.  Reasonable
  medical judgment in providing medical treatment to a pregnant
  female includes removing:
               (1)  an ectopic pregnancy as defined by Section
  245.002(4-a); and
               (2)  a dead, unborn child whose death was caused by
  spontaneous abortion.
         Sec. 170A.0023.  ACCIDENTAL OR UNINTENTIONAL DEATH.  (a)
  This section applies to any law that provides an exception to an
  otherwise prohibited abortion based on a condition described by
  Section 170A.002(b)(2).
         (b)  It is an exception to the application of each law
  described by Subsection (a) that the death or injury of an unborn
  child resulted from treatment provided to a pregnant female based
  on a physician's reasonable medical judgment if the death of or
  injury to the unborn child was accidental or unintentional.
         SECTION 5.  Section 171.002(3), Health and Safety Code, is
  amended to read as follows:
               (3)  "Medical emergency" means a condition described by
  Section 170A.002(b)(2)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.
         SECTION 6.  Section 171.046(a) and (b), Health and Safety
  Code, are amended to read as follows:
         (a)  The prohibitions and requirements under Sections
  171.043, 171.044, and 171.045(b) do not apply to an abortion
  performed if there exists a condition that, in the physician's
  reasonable medical judgment, the abortion is necessary due to a
  medical emergency andso complicates the medical condition of the
  woman that, to avert the woman's death or a serious risk of
  substantial and irreversible physical impairment of a major bodily
  function, other than a psychological condition, it necessitates, as
  applicable:
               (1)  the immediate abortion of her pregnancy without
  the delay necessary to determine the probable post-fertilization
  age of the unborn child;
               (2)  the abortion of her pregnancy even though the
  post-fertilization age of the unborn child is 20 or more weeks; or
               (3)  the use of a method of abortion other than a method
  described by Section 171.045(b).
         (b)  A physician may not take an action authorized under
  Subsection (a) if the medical emergencyrisk of death or a
  substantial and irreversible physical impairment of a major bodily
  function arises from a claim or diagnosis that the woman will engage
  in conduct that may result in her death or in substantial and
  irreversible physical impairment of a major bodily function.
         SECTION 7.  Section 171.063(c), Health and Safety Code, is
  amended to read as follows:
         (c)  Before the physician provides an abortion-inducing
  drug, the physician must:
               (1)  examine the pregnant woman in person;
               (2)  independently verify that a pregnancy exists;
               (3)  document, in the woman's medical record, the
  gestational age and intrauterine location of the pregnancy to
  determine whether an ectopic pregnancy exists as defined by Section
  245.002(4-a);
               (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-inducing drug is administered or
  used or the abortion is performed or induced to prevent Rh
  incompatibility, complications, or miscarriage in future
  pregnancies;
               (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.
         SECTION 8.  Subchapter H, Chapter 171, Health and Safety
  Code, is amended by adding a new Section 171.2011 to read as
  follows:
         Sec.171.2011. APPLICABILITY. (a) This subchapter applies
  only to an abortion that is otherwise prohibited by law and that is
  not subject to an exception provided by law.
         (b)  The following activities do not constitute aiding or
  abetting under this subchapter:
               (1)  providing services by a physician or health care
  provider to a treating physician, or communication between a
  physician or health care provider and a treating physician, for the
  purposes of arriving at a reasonable medical judgment as required
  by an exception to an otherwise prohibited abortion;
               (2)  communicating between a physician or health care
  provider and a patient, or providing services by a physician or
  health care provider to a patient, for the purpose of arriving at
  reasonable medical judgment as required by an exception to an
  otherwise prohibited abortion;
               (3)  communicating between an attorney and a physician
  or health care provider related to an exception to an otherwise
  prohibited abortion;
               (4)  communicating between a treating physician and any
  other person or providing services to a treating physician or
  patient relating to performing, inducing or attempting an abortion
  for which the treating physician has determined that, in reasonable
  medical judgment, an exception to an otherwise prohibited abortion
  is applicable;
               (5)  providing products to a patient or treating
  physician relating to performing, inducing or attempting an
  abortion for which the treating physician has determined that, in
  reasonable medical judgment, an exception to an otherwise
  prohibited abortion is applicable.
         SECTION 9.  Amend Section 245.002(4-a), Health and Safety
  Code, to read as follows:
               (4-a)  "Ectopic pregnancy" means the implantation of a
  fertilized egg or embryo:
                     (A)  outside of the uterus;
                     (B)  in an abnormal location in the uterus causing
  the fertilized egg or embryo to be non-viable; or
                     (C)  in a scarred portion of the uterus.
         SECTION 10.  Amend Section 245.016, Health and Safety Code,
  to read as follows:
         Sec. 245.016.  ABORTION IN UNLICENSED ABORTION FACILITY TO
  PREVENT DEATH OR SERIOUS IMPAIRMENT.  It is an exception to the
  application of Section 245.014 that the abortion was performed in
  an unlicensed abortion facility due to a medical emergency
  described by Section 170A.002(b)(2)This chapter does not remove
  the responsibility or limit the ability of a physician to perform an
  abortion in an unlicensed abortion facility if, at the commencement
  of the abortion, the physician reasonably believes that the
  abortion is necessary to prevent the death of the patient or to
  prevent serious impairment of the patient's physical health.  In
  this section, the term "unlicensed abortion facility" does not
  include an individual or entity to which funds appropriated by the
  legislature in the general appropriations act are prohibited from
  being distributed.
         SECTION 11.  Amend Section 164.052, Occupations Code, by
  adding a new Subsection (d) to read as follows:
         (d)  This section may not be construed to prohibit, and the
  board may not take action against a physician regarding, the
  performance of an abortion in response to a medical emergency
  described by Section 170A.002(b)(2), Health and Safety Code.
         SECTION 12.  Amend Section 164.055, Occupations Code, by
  adding by amending Subsection (c) to read as follows:
         (c)  Notwithstanding Subsection (a), the board may not take
  disciplinary action against a physician who exercised reasonable
  medical judgment in providing medical treatment to a pregnant woman
  as described by Section 74.552, Civil Practice and Remedies Code
  170A.002, Health and Safety Code.
         SECTION 13.  Amend Section 165.152, Occupations Code, by
  adding a new Subsection (e) to read as follows:
         (e)  It is an exception to the application of Subsection (a)
  if the person is a physician who performs, induces, or attempts an
  abortion due to a medical emergency described by Section
  170A.002(b)(2), Health and Safety Code.
         SECTION 14.  Article 4512.6, Chapter 6-1/2, Title 71,
  Vernon's Civil Statutes, is amended to read as follows:
         Art. 4512.6.  BYEXCEPTION FOR MEDICAL EMERGENCYADVICE.
  Nothing in this chapter applies to(a)  It is an exception to the
  application of this chapter that an abortion is procured, performed
  or attempted due to a medical emergencyby medical advice for the
  purpose of saving the life of the mother.
         (b)  In this article, "medical emergency" means a condition
  described by Section 170A.002(b)(2), Health and Safety Code.
         SECTION 15.  The exceptions to otherwise prohibited
  abortions described by this Act:
               (1)  shall be construed as consistent with the opinion
  of the Texas Supreme Court in In re State, 682 S.W.3d 890 (Tex.
  2023), including with respect to providing that any threat posed by
  a female's pregnancy to her life or major bodily functions need not
  be imminent or irreversible; and
               (2)  except as provided by the change in law made by
  this Act to Section 170A.002(b)(2), Health and Safety Code, shall
  be construed as consistent with the opinion of the Texas Supreme
  Court in State v. Zurawski, 690 S.W.3d 644 (Tex. 2024), including
  with respect to the state's burden of proof in any enforcement
  action.
         SECTION 16.  The following statutes are repealed:
               (1)  Section 74.552, Civil Practice and Remedies Code;
               (2)  Section 170A.002(d), Health and Safety Code;
               (3)  Section 9.35, Penal Code.
         SECTION 17.  (a)  To increase the understanding of the legal
  profession regarding the laws regulating abortion following the
  changes in law made by this Act, the State Bar of Texas shall
  develop, or solicit the development of, and offer to attorneys
  licensed in this state a comprehensive program of continuing legal
  education regarding the regulation of abortion in this state, with
  a focus on the exceptions to otherwise prohibited abortions. The
  program shall include legal education regarding:
               (1)  statutory terminology applicable to the
  definition and regulation of abortion;
               (2)  prohibited abortions and prohibited medical
  techniques related to the performance of abortions;
               (3)  state law establishing statutory exceptions to
  otherwise prohibited abortions;
               (4)  the civil and criminal implications of abortion
  regulation in this state and the implications of statutory
  exceptions to otherwise prohibited abortions;
               (5)  the definition of "medical emergency" as defined
  by Section 170A.002(b)(2), Health and Safety Code;
               (6)  the responsibility of a physician to exercise
  reasonable medical judgment in determining whether a condition or
  conditions exist allowing the performance of an abortion during a
  medical emergency; and
               (7)  the circumstances under which a physician is
  required under Section 170A.0021, Health and Safety Code, to treat
  a pregnant female who experiences such conditions in a manner that
  maximizes an unborn child's opportunity to survive if doing so does
  not increase the threat to the mother presented by those
  conditions.
         (b)  The program required by Subsection (a) shall be:
               (1)  developed in cooperation with the Health Law
  Section of the State Bar of Texas, physician and health care
  provider organizations, and other non-State Bar of Texas
  stakeholders with a demonstrated interest and expertise in the
  required subject matter; and
               (2)  be promoted by communications made by the State
  Bar to all attorneys in this state, organizations representing
  physicians and health care providers whose members treat pregnant
  women, and health care institutions as defined by Section 74.001,
  Civil Practice and Remedies Codes.
         (c)  The course of instruction required by Subsection (a)
  must be offered at no cost to attorneys licensed in this state and
  shall be offered on the Internet provided through the state bar in
  addition to any other method approved by the state bar.
         (d)  The program required by Subsection (a) shall be offered
  no later than January 1, 2026.
         SECTION 18.  (a)(1)  No later than January 1, 2026, the Texas
  Medical Board shall make available one or more approved courses
  regarding the laws relating to pregnancy-related medical
  emergencies as the term "medical emergency" is used in Title 2,
  Subtitle H, Health and Safety Code.
               (2)  The board may solicit the development of a course
  required by Subsection (1) by organizations representing
  physicians, institutions of higher education with medical schools,
  or other providers of continuing education to physicians acceptable
  to the board.
               (3)  After approval of a continuing education course
  required by this subsection, the board shall inform all licensed
  physicians in this state of the availability of the course and
  request organizations representing physicians in general and
  physicians who practice in specialties that treat pregnant women to
  make the availability of the course known to their members.
         (b)  Completion of a course described by Subsection (a) shall
  be credited to the requirements for continuing medical education
  enforced by the Texas Medical Board.
         (c)  A course approved under Subsection (a) shall address:
               (1)  what does and does not constitute an abortion,
  including exclusions from that term for ectopic pregnancy and
  spontaneous abortion;
               (2)  the laws prohibiting abortion and any procedures
  prohibited by law for performing an abortion;
               (3)  the statutory exceptions to laws prohibiting
  abortion with an emphasis on exceptions based on a medical
  emergency as the term "medical emergency" is used in Title 2,
  Subtitle H, Health and Safety Code; and
               (4)  the laws regarding reasonable medical judgment as
  used in connection with the medical emergency exceptions to laws
  prohibiting abortions.
         (d)  Continuing medical education described in whole or in
  part by Subsection (c) does not constitute aiding or abetting as
  those terms are used in Subchapter H, Chapter 171, Health and Safety
  Code.
         (e)(1)  A physician licensed to practice medicine under
  Subtitle B, Title 3, Occupations Code, who provides obstetric care
  shall complete no later than June 1, 2027, a course described by
  Subsection (a) that equals at least one hour of continuing medical
  education. This is a one-time requirement.
               (2)  The license of a physician described by Subsection
  (1) shall not be renewed if the physician has not complied with that
  subsection.
               (3)  The Texas Medical Board shall adopt rules to
  implement this subsection.
         (f)  The board shall make available at least one course
  required by this section at no cost to physicians licensed in this
  state and include on its internet website a list of courses of
  continuing medical education approved under Subsection (a).
         (g)  Nothing in Subsections (a) through (f):
               (1)  creates a cause of action or a standard of care,
  obligation or duty that provides the basis for a cause of action; or
               (2)  affects a health care liability claim, as defined
  by Section 74.001(13), Civil Practice and Remedies Code, based on
  any ground other than a violation of Chapters 170, 170A, or 171,
  Health and Safety Code, or Chapter 6-1/2, Title 71, Vernon's Texas
  Civil Statutes.
         SECTION 19.  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, 2025.