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Any person who willfully administers to any pregnant woman any drug or substance or uses or employs any instrument or other means to induce an abortion, miscarriage or premature delivery or aids, abets or prescribes for the same, unless the same is necessary to preserve her life or health and done for that purpose, shall on conviction be fined not less than $100.00 nor more than $1,000.00 and may also be imprisoned in the county jail or sentenced to hard labor for the county for not more than 12 months.
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(a) The Office of Women's Health is established within the Alabama Department of Public Health for the following purposes:
(1) To educate the public and be an advocate for women's health by requesting that the State Department of Public Health, either on its own or in partnership with other entities, establish appropriate forums, programs, or initiatives designed to educate the public regarding women's health, with an emphasis on preventive health and healthy lifestyles.
(2) To assist the State Health Officer in identifying, coordinating, and establishing priorities for programs, services, and resources the state should provide for women's health issues and concerns relating to the reproductive, menopausal, and postmenopausal phases of a woman's life, with an emphasis on postmenopausal health.
(3) To serve as a clearinghouse and resource for information regarding women's health data, strategies, services, and programs that address women's health issues, including, but not limited to, all of the following:
a. Diseases that significantly impact women, including heart disease, cancer, hypertension, diabetes, and osteoporosis.
b. Mental health.
c. Substance abuse.
d. Sexually transmitted diseases.
e. Sexual assault and domestic violence.
(4) To collect, classify, and analyze relevant research information and data concerning women's health conducted or compiled by either of the following:
a. The State Department of Public Health.
b. Other entities in collaboration with the State Department of Public Health.
(5) To provide interested persons with information regarding the research results, except as prohibited by law.
(6) To develop and recommend funding and program activities for educating the public on women's health initiatives and information, including the following:
a. Health needs throughout an
b. Diseases that significantly affect
c. Access to health care for
d. Poverty and women's health in
e. The leading causes of morbidity and mortality for
f. Special health concerns of minority women.
(7) To seek funding from private or governmental entities to carry out the purposes of this chapter.
(8) To prepare materials for publication and dissemination to the public on women's health.
(9) To conduct public educational forums in
(10) To coordinate the activities and programs of the Office of Women's Health with other entities that focus on women's health or women's issues.
(11) To provide that the State Health Officer, within his or her annual
report to the Governor and the Legislature, shall
include information regarding the successes of the programs of the Office of
Women's Health, priorities and services needed for women's health in
(b) The Office of Women's Health will not advocate, promote or otherwise advance abortion or abortifacients.
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(a) It is the intent of the legislature in enacting this parental consent provision to further the important and compelling state interests of: (1) protecting minors against their own immaturity, (2) fostering the family structure and preserving it as a viable social unit, and (3) protecting the rights of parents to rear children who are members of their household.
(b) The legislature finds as fact that: (1) immature minors often lack the ability to make fully informed choices that take account of both immediate and long-range consequences, (2) the medical, emotional and psychological consequences of abortion are serious and can be lasting, particularly when the patient is immature, (3) the capacity to become pregnant and the capacity for mature judgment concerning the wisdom of an abortion are not necessarily related, (4) parents ordinarily possess information essential to a physician's exercise of his best medical judgment concerning the child, and (5) parents who are aware that their minor daughter has had an abortion may better insure that she receives adequate medical attention after her abortion. The legislature further finds that parental consultation is usually desirable and in the best interests of the minor.
For purposes of this chapter, the following definitions shall apply:
(1) MINOR. Any person under the age of 18 years;
(2) EMANCIPATED MINOR. Any minor who is or has been married or has by court order otherwise been legally freed from the care, custody and control of her parents;
(3) ABORTION. The use of any instrument, medicine, drug or any other substance or device with intent to terminate the pregnancy of a woman known to be pregnant, with intent other than to increase the probability of a live birth, to preserve the life or health of the child after live birth, or to remove a dead or dying unborn child.
(a) Except as otherwise provided in subsections (b) and (e) of this section and Sections 26-21-4 and 26-21-5 hereof, no person shall perform an abortion upon an unemancipated minor unless he or his agent first obtains the written consent of either parent or the legal guardian of the minor.
(b) If the minor's pregnancy was caused by sexual intercourse with the minor's natural father, adoptive father or stepfather or legal guardian, then written notice to the minor's mother by certified mail shall be sufficient.
(c) The person who shall perform the abortion or his agent shall obtain or be provided with the written consent from either parent or legal guardian stating the names of the minor, parent or legal guardian, that he or she is informed that the minor desires an abortion and does consent to the abortion, the date, and shall be signed by either parent or legal guardian. The unemancipated minor shall verify on the same form, by her signature and in the presence of such person who shall perform the abortion or his agent, that said signature of the parents, parent or legal guardian is authentic. The consent shall be kept as a part of the minor's patient file for four years.
(d) If the minor is emancipated, the person who shall perform the abortion or his agent shall obtain a written statement stating the name of the emancipated minor, that the minor is emancipated, the type of emancipation, the date and shall be signed by the minor. The written statement shall be signed in the presence of the person who shall perform the abortion or his agent and witnessed by him or the agent. The emancipated minor shall also provide a license or certificate of marriage, judgment or decree of divorce, order of emancipation or relieving her of the disabilities of nonage, or other court document evidencing her marriage, divorce, or emancipation. A copy of any such document shall be attached to the written statement and kept as a part of the minor's patient file for four years.
(e) A minor who elects not to seek or does not or cannot for any reason, including unavailability or refusal by either or both parents or legal guardian, obtain consent from either of her parents or legal guardian under this section, may petition, on her own behalf, the juvenile court, or court of equal standing, in the county in which the minor resides or in the county in which the abortion is to be performed for a waiver of the consent requirement of this section pursuant to the procedure of Section 26-21-4.
(a) A minor who elects not to seek or does not or cannot for any reason, obtain consent from either of her parents or legal guardian, may petition, on her own behalf, the juvenile court, or the court of equal standing, in the county in which the minor resides or in the county in which the abortion is to be performed for a waiver of the consent requirement of this chapter. Notice by the court to the minor's parents, parent or legal guardian shall not be required or permitted. The requirements and procedures under this chapter shall apply and are available to minors whether or not they are residents of this state.
(b) The minor may participate in proceedings in the court on her own behalf.
The court shall advise her that she has a right to be represented by an
attorney and that if she is unable to pay for the services of an attorney one
will be appointed for her. If the court appoints an attorney to represent her such attorney shall be compensated as provided in
(c) The court shall insure that the minor is given assistance in preparing and filing the petition and shall insure that the minor's identity is kept confidential. Such assistance may be provided by court personnel including intake personnel of juvenile probation services.
(d) The petition required in Section 26-21-3(e) shall be made under oath and shall include all of the following:
(1) A statement that the petitioner is pregnant;
(2) A statement that the petitioner is unmarried, under 18 years of age, and unemancipated;
(3) A statement that the petitioner wishes to have an abortion without the consent of either parent or legal guardian.
(4) An allegation of either or both of the following:
a. That the petitioner is sufficiently mature and well enough informed to intelligently decide whether to have an abortion without the consent of either of her parents or legal guardian.
b. That one or both of her parents or her guardian has engaged in a pattern of physical, sexual, or emotional abuse against her, or that the consent of her parents, parent or legal guardian otherwise is not in her best interest.
(5) A statement as to whether the petitioner has retained an attorney and the name, address and telephone number of her attorney.
(e) Court proceedings shall be given such precedence over other pending matters as is necessary to insure that the court may reach a decision promptly, but in no case, except as provided herein, shall the court fail to rule within 72 hours of the time the petition is filed, Saturdays, Sundays, and legal holidays excluded. Provided, however, this time requirement may be extended on the request of the minor. If a juvenile court judge is not available for the hearing provided herein, the clerk of the court in which the petition was filed shall forthwith notify the presiding circuit court judge and the presiding circuit court judge of the circuit shall immediately appoint a district or circuit court level judge to hear the petition.
(f) The required consent shall be waived if the court finds either:
(1) That the minor is mature and well-informed enough to make the abortion decision on her own; or
(2) That performance of the abortion would be in the best interest of the minor.
(g) A court that conducts proceedings under this section shall issue written and specific factual findings and legal conclusions supporting its decision and shall order that a confidential record of the evidence be maintained for at least four years. A transcript of the proceedings shall be recorded and if there is an appeal as provided in subsection (h), a transcript of the proceedings shall be prepared forthwith.
(h) An expedited confidential and anonymous appeal shall be available to any minor to whom the court denies a waiver of consent. If notice of appeal is given, the record of appeal shall be completed and the appeal shall be perfected within five days from the filing of the notice of appeal. Briefs shall not be required but may be permitted. Because time may be of the essence regarding the performance of the abortion, the Alabama Supreme Court shall issue promptly such additional rules as it deems are necessary to insure that appeals under this section are handled in an expeditious, confidential and anonymous manner.
(i) All proceedings under this chapter shall be confidential and anonymous. In all pleadings or court documents, the minor shall be identified by initials only.
(j) No fees or costs shall be required of any minor who avails herself of the procedures provided by this section.
This chapter shall not apply when, in the best clinical judgment of the attending physician on the facts of the case before him, a medical emergency exists that so compromises the health, safety or well-being of the mother as to require an immediate abortion. A physician who does not comply with Sections 26-21-3 and 26-21-4 by reason of this exception shall state in the medical record of the abortion, the medical indications on which his judgment was based.
Any person who intentionally performs or causes to be performed an abortion in violation of the provisions of this chapter or intentionally fails to conform to any requirement of this chapter, shall be guilty of a Class A misdemeanor. Any person found guilty under this section shall immediately forfeit any professional license they may hold.
No physician who complies with the parental consent requirement(s) of this chapter shall be liable in any manner to the minor upon whom the abortion was performed for any claim whatsoever arising out of or based on the disclosure of any information concerning the medical condition of such minor to her parent(s) or legal guardian(s); provided that a physician who performs an abortion pursuant to a court order obtained under the provisions of this chapter, shall not disclose any information regarding same to the parent(s) or legal guardian(s) of the minor unless such disclosure is made pursuant to a court order. In no event shall the physician be under any duty to initiate proceedings in any court to secure a waiver of the parental consent requirement on behalf of any minor who has requested that an abortion be performed.
(a) Records and information involving court proceedings conducted pursuant to Section 26-21-4 shall be confidential and shall not be disclosed other than to the minor, her attorney and necessary court personnel. Nothing in this subsection shall prohibit the keeping of statistical records and information as long as the anonymity of the minor is in no way compromised.
(b) Any person who shall disclose any records or information made confidential pursuant to subsection (a) of this section shall be guilty of a Class C misdemeanor.
(c) Provided, however, any person who performs abortions, or his agent, shall furnish to the Bureau of Vital Statistics, on confidential forms furnished by the bureau, the following: (1) the number of abortions performed on each unemancipated and emancipated minor with written consent; (2) the number of abortions performed on each unemancipated and emancipated minor pursuant to juvenile or other court proceedings pursuant to Section 26-21-3(e); and (3) the number of abortions performed pursuant to Section 26-21-5 on each unemancipated and emancipated minor. Such reporting shall be provided annually as prescribed by the Bureau of Vital Statistics which shall be retained by the bureau for at least seven years. Such information prescribed shall include nonconfidential statistics, including but not limited to: age, race and education level of minor.
(a) The public policy of the State of
(b) The Legislature specifically finds the following:
(1) Medical evidence shows there is a survival rate of babies born between ages 23 weeks to 29 weeks gestational age of 64 percent to 94 percent.
(2) In Webster v. Reproductive Health Services, 492 U.S. 499 (1989), the United States Supreme Court determined that viability may occur as early as 23 to 24 weeks gestational age. Also, the United States Supreme Court determined that requiring fetal viability testing at 20 weeks gestational age is constitutional, because there is up to a four week margin of error in determining gestational age.
(3) In the latest year of
(c) Subject to life and health exceptions to the mother, it is the intent of the Legislature to ban abortions of any unborn child that is capable of living outside the womb. To permit otherwise is a wanton disregard of human life.
The following words shall have the following meanings:
(1) ABORTION. The use of any means to terminate the clinically diagnosable pregnancy of a woman with knowledge that the termination by those means will, with reasonable likelihood, cause the death of the unborn child.
(2) FERTILIZATION. The fusion of a human spermatozoon with a human ovum.
(3) GESTATIONAL AGE. The age of the unborn child as calculated from the first day of the last menstrual period of the pregnant woman.
(4) HOSPITAL. An institution licensed pursuant to the provisions of the law of this state.
(5) LIVE BIRTH. When used with regard to a human being, means that the human being was completely expelled or extracted from his or her mother and after such separation, breathed or showed evidence of any of the following: beating of the heart, pulsation of the umbilical cord, definite movement of voluntary muscles, or any brain-wave activity.
(6) MEDICAL EMERGENCY. The condition, which, on the basis of the physician's good-faith clinical judgment, so complicates a pregnancy as to necessitate the immediate abortion of her pregnancy to avert her death or for which a delay will create serious risk of substantial and irreversible impairment of a major bodily function.
(7) PREGNANT. The female reproductive condition of having a developing fetus in the body and commences with fertilization.
(8) UNBORN CHILD and FETUS. An individual organism of the species homo sapiens from fertilization until live birth.
(9) VIABLE and VIABILITY. The stage of fetal development when, in the judgment of the physician based upon the particular facts of the case before him or her and in light of the most advanced medical technology and information available to him or her, there is a reasonable likelihood of sustained survival of the unborn child outside the body of his or her mother, with or without artificial support.
(a) Prohibition. Except as provided in subsection (b), no person shall intentionally, knowingly, or recklessly perform or induce an abortion when the unborn child is viable.
(1) It shall not be a violation of subsection (a) if an abortion is performed by a physician and that physician reasonably believes that it is necessary to prevent either the death of the pregnant woman or the substantial and irreversible impairment of a major bodily function of the woman. No abortion shall be deemed authorized under this paragraph if performed on the basis of a claim or a diagnosis that the woman will engage in conduct which would result in her death or in substantial and irreversible impairment of a major bodily function.
(2) It shall not be a violation of subsection (a) if the abortion is performed by a physician and that physician reasonably believes, after making a determination of the viability of the unborn child in compliance with Section 26-22-4 relating to the determination of viability, that the unborn child is not viable.
(c) Abortion regulated. Except in the case of a medical emergency which, in the reasonable medical judgment of the physician performing the abortion, prevents compliance with a particular requirement of this subsection, no abortion which is authorized under subsection (b)(1) shall be performed unless each of the following conditions are met:
(1) The physician performing the abortion certifies in writing that, based upon his or her medical examination of the pregnant woman and his or her medical judgment, the abortion is necessary to prevent either the death of the pregnant woman or serious risk of substantial and irreversible impairment of a major bodily function.
(2) The physician's judgment with respect to the necessity for the abortion has been concurred in by one other licensed physician who certifies in writing that, based upon his or her separate personal medical examination of the pregnant woman and his or her medical judgment, the abortion is necessary to prevent either the death of the pregnant woman or the substantial and irreversible impairment of a major bodily function of the woman.
(3) The abortion is performed in a hospital.
(4) The physician terminates the pregnancy in a manner which provides the best opportunity for the unborn child to survive, unless the physician determines, in his or her good faith medical judgment, that termination of the pregnancy in that manner poses a significantly greater risk either of the death of the pregnant woman or the substantial and irreversible impairment of a major bodily function of the woman than would other available methods.
(5) The physician performing the abortion arranges for the attendance, in the same room in which the abortion is to be completed, of a second physician who shall take control of the child immediately after complete extraction from the mother and shall provide immediate medical care for the child, taking all reasonable steps necessary to preserve the child's life and health.
(d) Penalty. Any person who violates subsection (a) commits a Class A felony. Any person who violates subsection (c) commits a Class C felony.
Except in the case of a medical emergency, prior to performing an abortion upon a woman subsequent to her first 19 weeks of pregnancy, the physician shall determine whether, in his or her good faith medical judgment, the child is viable. When the physician has determined that a child is viable, he or she shall report the basis for his or her determination that the abortion is necessary to prevent either the death of the pregnant woman or the substantial and irreversible impairment of a major bodily function of the woman. When the physician has determined that a child is not viable after the first 19 weeks of pregnancy, he or she shall report the basis for such determination.
Nothing in this chapter shall be construed to recognize a right to abortion or to make legal an abortion that is otherwise unlawful.
This chapter may be cited as the "Alabama Partial-Birth Abortion Ban Act of 1997." [These provisions, Sections 26-23-1 to 26-23-6, have been held to be unconstitutional and unenforceable. However, There is also a Federal Abortion Ban, which applies nationwide. The federal ban prohibits the performance of certain second trimester abortions and does not contain an exception for a woman's health.]
As used in this chapter, the following terms shall have the following meanings:
(1) FATHER. The biological father of the human fetus.
(2) MOTHER. The female who is pregnant with a live human fetus which may be subject to a partial-birth abortion under this chapter.
(3) PARTIAL-BIRTH ABORTION. An abortion in which the person performing the abortion partially vaginally delivers a living fetus before killing the fetus and completing the delivery.
(4) PHYSICIAN. A doctor of medicine or osteopathy legally authorized to practice medicine and surgery by the state or any other individual legally authorized by the state to perform abortions. This definition shall also include any individual who is not a physician or is not otherwise legally authorized by the state to perform abortions, but who nevertheless performs a partial-birth abortion.
Any physician who knowingly performs a partial-birth abortion within this state and thereby kills a human fetus shall be guilty of a Class C felony and upon conviction thereof shall be punished as prescribed by law.
Section 26-23-3 shall not apply to a partial-birth abortion that is necessary to save the life of a mother.
The father, if married to the mother at the time she receives a partial-birth abortion procedure, and if the mother has not attained the age of 18 years at the time of the abortion, the maternal grandparents of the fetus, may in a civil action obtain appropriate relief, unless the pregnancy resulted from the plaintiff's criminal conduct or the plaintiff consented to the abortion. The relief shall be limited to monetary compensation for all injuries, psychological and physical, occasioned by a violation under this chapter and monetary punitive compensation as allowed by law.
A woman upon whom a partial-birth abortion is performed may not be prosecuted under this chapter for a conspiracy to violate this chapter or for any other offense which is unlawful under this chapter.
This chapter shall be known and cited as "The Woman's Right to Know Act."
(a) The Legislature of the State of
(1) It is essential to the psychological and physical well-being of a woman considering an abortion that she receive complete and accurate information on her alternatives.
(2) Most abortions are performed in clinics devoted solely to providing abortions and family planning services. Most women who seek abortions at these facilities do not have any relationship with the physician who performs the abortion, before or after the procedure. Most women do not return to the facility for post-surgical care. In most instances, the woman's only actual contact with the physician occurs simultaneously with the abortion procedure, with little opportunity to receive counseling concerning her decision.
(3) The decision to abort is an important, and often a stressful one, and it is desirable and imperative that it be made with full knowledge of its nature and consequences. The medical, emotional, and psychological consequences of an abortion are serious and can be lasting or life threatening.
(b) Based on the findings in subsection (a), it is the purpose of this chapter to ensure that every woman considering an abortion receives complete information on the procedure, risks, and her alternatives and to ensure that every woman who submits to an abortion procedure does so only after giving her voluntary and informed consent to the abortion procedure.
For the purposes of this chapter, the following terms have the following meanings:
(1) ABORTION. The use or prescription of any instrument, medicine, drug, or any other substance or device with the intent to terminate the pregnancy of a woman known to be pregnant. Such use or prescription is not an abortion if done with the intent to save the life or preserve the health of an unborn child, remove a dead unborn child, or to deliver an unborn child prematurely in order to preserve the health of both the mother (pregnant woman) and her unborn child.
(2) CONCEPTION. The fusion of a human spermatozoon with a human ovum.
(3) EMANCIPATED MINOR. Any minor who is or has been married or has by court order otherwise been legally freed from the care, custody, and control of her parents.
(4) GESTATIONAL AGE. The time that has elapsed since the first day of the woman's last menstrual period.
(5) MEDICAL EMERGENCY. That condition which, on the basis of the physician's good faith clinical judgment, so complicates the medical condition of a pregnant woman as to necessitate the immediate abortion of her pregnancy to avert her death or in which a delay will create serious risk of substantial and irreversible impairment of a major bodily function.
(6) MINOR. Any person under the age of 18 years.
(7) PHYSICIAN. Any person licensed to practice medicine in this state. The term includes medical doctors and doctors of osteopathy.
(8) PREGNANT or PREGNANCY. The female reproductive condition of having an unborn child in the mother's (woman's) body.
(9) QUALIFIED PERSON. An agent of the physician who is a psychologist, licensed social worker, licensed professional counselor, registered nurse, or physician.
(10) UNBORN CHILD. The offspring of any human person from conception until birth.
(11) VIABLE. That stage of fetal development when the life of the unborn child may be continued indefinitely outside the womb by natural or artificial life-supportive systems.
(12) WOMAN. Any female person.
Except in the case of a medical emergency, no abortion shall be performed or induced without the voluntary and informed consent of the woman upon whom the abortion is to be performed or induced. Except in the case of a medical emergency, consent to an abortion is voluntary and informed if and only if:
(a) At least 24 hours before the abortion, the physician who is to perform the abortion, the referring physician, or a qualified person has informed and provided the woman in person, or by return receipt certified mail restricted delivery, and if by mail, again in person prior to the abortion, a copy of the printed materials in Section 26-23A-5 which list agencies that offer assistance, adoption agencies, development of the unborn child, methods and risks of abortion and childbirth, father's obligations, and alternatives to abortion. Mailing of the materials in Section 26-23A-5 may be arranged by telephone.
(b) Prior to an abortion, the physician who is to perform the abortion, the referring physician, or a qualified person has informed the woman in person:
(1) The name of the physician who will perform the abortion in writing or a business card.
(2) The nature of the proposed abortion method and associated risks and alternatives that a reasonable patient would consider material to the decision of whether or not to undergo the abortion.
(3) The probable gestational age of the unborn child at the time the abortion is to be performed, and the probable anatomical and physiological characteristics of the unborn child at the time the abortion is to be performed. If the unborn child is viable or has reached a gestational age of more than 19 weeks, that:
a. The unborn child may be able to survive outside the womb.
b. The woman has the right to request the physician to use the method of abortion that is most likely to preserve the life of the unborn child, provided such abortion is not otherwise prohibited by law.
c. If the unborn child is born alive, the attending physician has the legal obligation to take all reasonable steps necessary to maintain the life and health of the child.
(4) The physician who is to perform the abortion or the referring physician is required to perform an ultrasound on the unborn child before the abortion. The woman has a right to view the ultrasound before an abortion. The woman shall complete a required form to acknowledge that she either saw the ultrasound image of her unborn child or that she was offered the opportunity and rejected it.
(5) She has the right to view the videotape and ultrasound of her unborn child as described in Section 26-23A-6.
(6) Any need for anti-Rh immune globulin therapy, and if she is Rh negative, the likely consequences of refusing such therapy and the cost of the therapy.
(7) She cannot be forced or required by anyone to have an abortion. She is free to withhold or withdraw her consent for an abortion without affecting her right to future care or treatment and without the loss of any state or federally funded benefits to which she might otherwise be entitled.
(c) The woman shall complete and sign a form that she has received the information of subsections (a) and (b), and does provide her informed consent for an abortion on her unborn child.
(d) Prior to the performance of an abortion, the physician who is to perform the abortion or his or her agent shall receive the signed receipt of the certified mail dated 24 hours before the abortion, if mailed, and the signed forms that she has received the information of subsections (a) and (b) before the abortion, had the opportunity to view the video and the ultrasound of her unborn child, and provided her informed consent for an abortion. The abortion facility shall retain the signed receipt, signed forms, and the ultrasound in the woman's medical file for the time required by law, but not less than four years.
(a) The Department of Public Health shall publish within 180 days after
(1) Geographically indexed printed materials designed to inform the woman of public and private agencies and services available to provide medical and financial assistance to a woman through pregnancy, prenatal care, upon childbirth, and while her child is dependent. The materials shall include a comprehensive list of the agencies, a description of the services offered, and the telephone numbers and addresses of the agencies.
(2) The printed materials shall include a list of adoption agencies geographically indexed and that the law permits adoptive parents to pay the cost of prenatal care, childbirth and neonatal care.
(3) Printed materials that inform the pregnant woman of the probable anatomical and physiological characteristics of the unborn child at two-week gestational increments from fertilization to full term. It shall include color photographs of the developing child at each of the two-week gestational increments, a clear description of the unborn child's development, any relevant information on the possibility of the unborn child's survival, and dimensions of the unborn child. The materials shall be realistic, clear, objective, non-judgmental, and designed to convey only accurate scientific information about the unborn child at the various gestational ages.
(4) The materials shall contain objective information describing the methods of abortion procedures commonly employed and the medical risks of each, and the medical risks associated with carrying a child to term.
(5) The printed materials shall list the support obligations of the father of a child who is born alive.
(6) The printed materials shall state that it is unlawful for any individual to coerce a woman to undergo an abortion, that any physician who performs an abortion upon a woman without her informed consent may be liable to her for damages in a civil action at law.
(7) The material shall include the following statement: "There are many
public and private agencies willing and able to help you to carry your child to
term, and to assist you and your child after your child is born, whether you
choose to keep your child or place him or her for adoption. The State of
(b) The materials in subsection (a) shall be in a bound booklet, shall contain large clear photographs, and shall be printed in a typeface large enough to be clearly legible.
(c) The materials required under this section and the videotape described in Section 26-23A-6 shall be available to the general public, from the Department of Public Health upon request, and appropriate number to any person, facility, or hospital. The department may charge a reasonable fee based on the cost of producing the materials and videotape.
(a) All facilities where abortions are performed and all facilities of physicians who refer for abortion shall have video viewing equipment. The video that may be shown to those who want to see it shall be identified by title, updated from time to time by the Department of Public Health, and shall be objective, non-judgmental, and designed to convey accurate scientific and medical information, and shall contain at a minimum, the information required in subdivisions (3), (4), (5), (6), and (7) of subsection (a) of Section 26-23A-5.
(b) All facilities where abortions are performed and all facilities of physicians who refer for abortion shall have ultrasound equipment. An ultrasound shall be performed on each unborn child before an abortion is performed.
(c) The Department of Public Health shall develop a signature form for verifying that she has received the complete information as described in Section 26-23A-4, was offered the opportunity of viewing the video and ultrasound image of her unborn child, and provides her informed consent for an abortion on her unborn child.
(d) Facilities as used in this section shall not include hospitals that do not regularly or routinely perform abortions or are otherwise not defined by any statute or regulation as an abortion or reproductive health center. This shall not, however, relieve any facility or physician to whom this section is applicable from the obligations stated herein.
Only a physician may perform an abortion.
(a) Where a medical emergency compels the performance of an abortion, the physician shall inform the woman, before the abortion if possible, of the medical indications supporting his or her judgment that an abortion is necessary to avert her death or to avert substantial and irreversible impairment of a major bodily function.
(b) The Department of Public Health shall develop a signature form for recording the medical conditions associated with a medical emergency abortion. A signed copy of the abortion, and the original copy retained in the woman's medical file for the time required by law, but not less than four years.
(a) Any person who intentionally, knowingly, or recklessly violates this chapter is guilty on a first offense of a Class B misdemeanor, on a second offense of a Class A misdemeanor, and on a third or subsequent offense of a Class C felony.
(b) After two convictions within a 12-month period of any person or persons at a specific abortion or reproductive health center, the license of such center shall be suspended for a period of 24 months and may be reinstated after that time only on conditions as the Department of Public Health requires to assure compliance with this chapter.
In addition to whatever remedies are available under the common or statutory law of this state, failure to comply with the requirements of this chapter shall:
(1) Provide a basis for a civil action for compensatory and punitive damages. Any conviction under this chapter shall be admissible in a civil suit as prima facie evidence of a failure to obtain an informed consent or parental or judicial consent. The civil action may be based on a claim that the act was a result of simple negligence, gross negligence, wantonness, willfulness, intention, or other legal standard of care.
(2) Provide a basis for professional disciplinary action under any applicable statutory or regulatory procedure for the suspension or revocation of any license for physicians, psychologists, licensed social workers, licensed professional counselors, registered nurses, or other licensed or regulated persons. Any conviction of any person for any failure to comply with the requirements of this chapter shall result in the automatic suspension of his or her license for a period of at least one year and shall be reinstated after that time only on such conditions as the appropriate regulatory or licensing body shall require to insure compliance with this chapter.
(3) Provide a basis for recovery for the woman for the wrongful death of the child, whether or not the unborn child was viable at the time the abortion was performed or was born alive.
In every civil or criminal proceeding or action brought under this chapter, the court shall rule whether the anonymity of any woman upon whom an abortion has been performed or attempted, shall be preserved from public disclosure if she does not give her consent to such disclosure. The court, upon motion or sua sponte, shall issue written orders to the parties, witnesses, and counsel and shall direct the sealing of the record and exclusion of individuals from courtrooms or hearing rooms to the extent necessary to safeguard her identity from public disclosure. In the absence of written consent of the woman upon whom an abortion has been performed or attempted, anyone, other than a public official, who brings an action under Section 26-23A-10 shall do so under a pseudonym. This section may not be construed to conceal the identity of the plaintiff or of witnesses from the defendant.
Nothing in this chapter shall be construed as creating or recognizing a right to abortion. It is not the intention of this chapter to make lawful an abortion that is currently unlawful nor to deny a woman an abortion that is lawful. Following abortion counseling, the withdrawal of consent to an abortion must be followed with appropriate referrals to ensure adequate care for a child that is to be delivered.
If any one or more provision, section, subsection, sentence, clause, phrase, or word of this chapter or the application thereof to any person or circumstance is found to be invalid or unconstitutional, the same is hereby declared to be severable and the balance of this chapter shall remain effective. The Legislature hereby declares that it would have passed this chapter, and each provision, section, subsection, sentence, clause, phrase, or word thereof, irrespective of the fact that any one or more provision, section, subsection, sentence, clause, phrase, or word be declared invalid or unconstitutional.
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ALABAMA DEPARTMENT OF PUBLIC HEALTH
DIVISION OF LICENSURE AND CERTIFICATION
TABLE OF CONTENTS[
420-5-1-.03 Patient Care
420-5-1-.04 Physical Environment
(1) Legal Authority for adoption of Rules. Under and by virtue of
authority vested in it by the Legislature of Alabama (Code of Ala. 1975,
Section 22-21-20, et seq., Act 2002-419), the State Board of Health does hereby
adopt and promulgate the following rules governing outpatient abortion or
reproductive health centers licensed to operate in the State of
(2) Definitions (a list of selected terms often used in connection with these Rules):
(a) "AAC Rule" means Alabama Administrative Code Rule.
(b) "Abortion or
1. The health care facility performs thirty or more abortion procedures per month during any two months of a calendar year;
2. The health care facility holds itself out to the public as an abortion provider by advertising by some public means, such as a newspaper, telephone directory, magazine, or electronic media, that it performs abortions; or
3. The health care facility applies to the State Board of Health for licensure as an abortion or reproductive health center.
(c) "Abortion" means the use or prescription of any instrument, medicine, drug, or any other substance or device with the intent to terminate the pregnancy of a woman known to be pregnant. Such use or prescription is not an abortion if done with the intent to save the life or preserve the health of an unborn child, remove a dead unborn child, or to deliver an unborn child prematurely in order to preserve the health of both the mother (pregnant woman) and her unborn child. The term, abortion, as used in these rules, does not include a procedure or act to terminate the pregnancy of a woman with an ectopic pregnancy, nor does it include the procedure or act to terminate the pregnancy of a woman when the fetus has a lethal anomaly. For purposes of these rules a lethal fetal anomaly means that the child would die at birth or be still born.
(e) "Abortion Clinic", "Clinic", "Abortion
Facility", or "Facility" means Abortion or
(f) "Gestational Age" means the time that has elapsed since the first day of the woman’s last menstrual period.
(g) "Clinic Director" means a natural person who is the governing authority of a health care facility or a natural person who is designated by the governing authority of a health care facility. Such person must have sufficient authority to interpret and implement all policies of the owner or proprietor, and must be qualified to perform those tasks. Such person shall be the addressee of all correspondence and inquiries from the State Board of Health.
(h) "Governing Authority" means the owner or proprietor of a health care facility, or the body, such as a board of directors, which exercises control over a health care facility on behalf of its owner or proprietor.
(i) "Viable" and "Viability" means that stage of fetal development when, the life of the fetus may be continued indefinitely outside the womb by natural or artificial life-supportive systems.
(j) "Physician" means a person currently licensed by the Medical
Licensure Commission, State of
(k) "Registered Professional Nurse (RN)" means a person currently
licensed in the State of
(l) "Qualified person" means an agent of the physician who is a psychologist, licensed social worker, licensed professional counselor, registered professional nurse, or physician.
(m) "Medical emergency" means a condition which, on the basis of the treating physician's good faith clinical judgment, so complicates the medical condition of a pregnant woman as to necessitate the immediate abortion of her pregnancy to avert her death or in which a delay will create serious risk of substantial and irreversible impairment of a major bodily function. An ectopic pregnancy is per se a medical emergency.
(n) "These Rules" means Rules 420-5-1-.01 through 420-5-1-.04,
Chapter 420-5-1, Abortion or
(3) Type of License.
(a) Regular License. A regular license shall be issued by the State Board of Health after the Board has determined that the abortion or reproductive health center is in substantial compliance with the Rules herein adopted.
(b) Probational License. The State Board of Health may issue a probational license when the Board is satisfied that appropriate measures have been taken to minimize any threat to the health and safety of patients and personnel. A probational license may not be granted for more than one year.
(a) Application for License. All abortion or reproductive health centers
shall apply for licensure on a form designated by the State Board of Health.
The application will reflect all data required by Code of
(b) Application Fee. Each application for license shall be accompanied by an application fee as mandated by statute. No application fee shall be refunded. Application fees shall be paid by cash, check or money order made payable to the Alabama Department of Public Health.
(c) Name of Facility. Every abortion or reproductive health center shall be designated by a permanent and distinctive name which shall not be changed once an application has been completed and approved.
(d) Separate License. When more than one facility is operated under the same operating entity, a separate license shall be required for each facility. Separate licenses are not required for separate buildings on the same ground used by the same facility.
(e) Reissuance of License.
1. The following changes in the status of the facility will require issuance of a new license.
(i) Change in facility ownership or operating entity (application fee required).
(ii) Change in facility name (no application fee required).
2. The governing authority shall file with the State Board of Health an application for license and application fee (if applicable) 30 days before any proposed change requiring a new license in order to permit processing of the application and issuance of the license prior to the desired effective date of the change.
(5) Right of Appeal. Any licensee dissatisfied with administrative
decision made in the application of these rules may appeal under the procedures
of the Alabama Administrative Procedure Act, Code of
(6) Waivers. The State Health Officer may approve a waiver to these rules in the following manner:
(a) The State Health Officer may approve a waiver to any provision of these rules, except for any provision which restates a statutory requirement, or which defines any term.
(b) To be eligible for a waiver, the licensee must be affected by the provision for which the waiver is requested, and must demonstrate by clear and convincing evidence that:
1. Local conditions are such that the licensee cannot or need not meet the provision for which the waiver is applied; and
2. Approval of the waiver will not unreasonably increase the risk of harm that the affected rule provision is intended to protect the public against.
(c) An application for a waiver shall also contain the name and address of the licensee, a statement of purpose, the period of time for which the waiver is requested and evidence demonstrating that the requirements of subsection (b) above are met.
(d) An application for a waiver must be presented in writing to the State Health Officer. All supporting evidence referenced in the application must be attached.
(e) The State Health Officer shall deny any application for a waiver which does not comply with the requirements of this section. Moreover, the Department of Public Health may make periodic evaluations of any waiver that has been granted. The State Health Officer may revoke a waiver if the statements, representations or supporting documentation that are part of the application are discovered to be false or inaccurate, or if local conditions upon which it was based change, or if public health, safety or welfare is adversely affected by a continuation of the waiver.
(f) Waivers issued by the State Health Officer shall be valid for a finite period of time as specified in the waiver.
(7) Disclosure of Information. Official reports, such as statements of deficiencies generated by the State Board of Health as a result of on-site inspections, and plans of correction submitted in response to those statements of deficiencies, are subject to public disclosure. Information received through other means and reports, other than statements of deficiencies, shall be deemed to be confidential and shall not be publicly disclosed except in response to a valid subpoena or court order or in proceedings involving the affected facility’s license or proceedings involving the license of another facility operated by the same governing authority. Inspection reports will never contain the name or other identification of any patient or client in the inspected facility.
(1) Governing Authority.
(a) Responsibility. The governing authority is the person or persons responsible for the management, control, and operation of the facility, including the appointment of persons to fill the minimum staffing requirements. The governing authority shall ensure that the facility is organized, equipped, staffed and administered in a manner to provide adequate care for each patient admitted.
(b) Notification of Clinic Administrator. The State Board of Health shall be advised of the clinic administrator's name within fifteen days of appointment.
(2) Policies and Procedures. Policies and procedures for operation of the facility shall be formulated and reviewed annually by the governing authority. They shall include at least the following:
(a) Purpose of the facility, to include scope and quality of services;
(b) Method to ensure compliance with all relevant federal, state, and local laws that govern operations of the facility;
(c) Inservice training requirements;
(d) The person to whom responsibility for operation and maintenance of the facility is assigned and methods established by the licensee for holding such individual accountable;
(e) Provision for annual review and evaluation of the facility’s policies, procedures, management and operation;
(f) Provision for a facility-wide quality improvement program.
(g) Patient rights and grievance procedures;
(h) Functional safety and maintenance policies and procedures;
(i) Incident reporting;
(j) Informed Consent;
(k) Patient Care Policies and Procedures.
(l) Handling of confidential records.
(3) There shall be a facility-wide quality improvement program to evaluate patient care and facility services. The program shall be ongoing, have statistical summaries and a written plan of implementation.
(4) Clinic Schedule. A schedule listing the days during which the clinic will perform procedures shall be furnished to the Alabama Department of Public Health, Division of Health Care Facilities. Any changes to the schedule shall be reported to the Division prior to the schedule change taking effect.
(a) Each abortion clinic shall utilize personnel to provide services who have appropriate training and qualifications for the services that they provide.
(b) Personnel Files. There shall be a personnel file for each employee which shall include:
1. Job Description. A written job description that describes the duties and responsibilities, position title, authority, and qualifications for each employee.
2. Application. The licensee shall obtain written applications for employment from all employees. The licensee shall obtain and verify information on the application as to education, training, experience, and appropriate licensure, if applicable.
3. Orientation. There shall be a written orientation program to familiarize each new staff member with the facility and its policies and procedures, to include at a minimum, fire and disaster safety, medical emergencies, infection control, and patient confidentiality. There shall be documentation of completion of this orientation maintained in the personnel file.
(c) Medical Director. Each abortion or reproductive health center shall employ or shall have under contract a medical director who shall be responsible for overseeing the medical affairs of the facility. Physicians performing abortions in the facility shall not perform any medical procedures unless authorized by the medical director, who shall certify that each physician has sufficient training and experience to perform the procedures authorized. Each medical director shall be board eligible or board certified in obstetrics and gynecology and shall have had at least 12 months experience in treatment of gynecological problems in a surgical environment.
(d) Required Professional Nursing Personnel. Nursing care shall be under the
supervision of a registered professional nurse currently licensed in
(e) Non-Nursing Service Personnel. Non-nursing service personnel; i.e., counselors, housekeeping workers, office workers, etc., shall be assigned in sufficient numbers and shall have sufficient training to meet the needs of all patients.
(f) Employees who develop signs or symptoms of infectious skin lesions or diseases that would be capable of transmission to patients through normal staff to patient contact shall not be permitted to have patient contact until free from such signs and symptoms.
(6) Fire Evacuation Plan.
(a) Written Evacuation Plan. A written fire control and evacuation plan shall be maintained by each facility. In addition, instructions and fire evacuation routes shall be posted in conspicuous places in the facility and shall be kept current.
(b) Fire Drills. Fire drills shall be conducted at least semi-annually for the staff and written observations of the effectiveness of these rehearsals shall be filed and kept at least three years.
(7) Communication Facilities.
(a) Call System. Arrangements shall be provided within the facility to summon additional personnel or help when or if needed in the event of emergency conditions. Requirements will depend on the size of physical configuration of the facility. In general, if all personnel (or occupants) are within hearing distance of any area of the facility, this would be deemed sufficient. Otherwise, there shall be a call system to all portions of the building normally occupied by personnel of the facility.
(b) Telephones. There shall be two or more telephones to summon help in case of fire or other emergency, and these shall be located so as to be accessible from all parts of the building.
(8) Records and Reports.
(a) Medical Records to be Kept. An abortion facility shall keep adequate records, including procedure schedules, histories, results of examinations, nurses' notes, records of tests performed and all forms required by law.
(b) Authentication of Records. All records shall be legibly written, dated, and signed in an indelible manner with the identity of the writer indicated.
(c) Filing of Records. All patient medical records shall be filed in a manner which will facilitate easy retrieval of any individual's record.
(d) Storage of Records. Records shall be stored in filing cabinets.
(e) Title to Records. Records of patients are the physical property of the licensee and responsibility for control and maintenance shall rest with the governing authority. Information in the patient’s record shall be disclosed to the patient or her designee upon written request within a reasonable amount of time. This may be conditioned upon the payment of a reasonable copying charge.
(f) Disposition of Records. When an abortion or reproductive health center ceases to operate either voluntarily or by revocation of its license, the governing body (licensee) at or prior to such action shall develop a proposed plan for the disposition of its medical records. Such plan shall be submitted to the State Board of Health and shall contain provisions for the proper storage, safeguarding and confidentiality, transfer or disposal of medical records. Any abortion or reproductive health center that fails to develop a plan of disposition of its records acceptable to the State Board of Health shall dispose of its records as directed by a court of appropriate jurisdiction.
(g) Records shall be Confidential. Records and information regarding patients shall be confidential. Access to these records shall be determined by the governing authority of the facility. Inspectors for licensure shall be permitted to review medical records to determine compliance with these Rules.
(h) Preservation of Records. Medical records shall be preserved either in the original or by microfilm for a period of not less than four years.
(9) Patient Referral.
(a) Referral. Licensee shall maintain a 24-hour answering service. Patients shall receive a return call within a reasonable time.
420-5-1-.03 Patient Care.
(1) Patient Care Policies and Procedures. Patient Care Policies and Procedures shall be developed, reviewed yearly, and revised as necessary. Patient care policies and procedures shall be consistent with professionally recognized standards of practice and shall be in accordance with the Alabama Nurse Practice Act. Copies of the policy and procedures manual shall be available to the nursing staff.
(2) Patients’ Rights.
(a) The facility shall have written policies and procedures to ensure the patient the rights to dignity, privacy, and safety.
(b) The telephone number to register complaints with the Alabama Department of Public Health, Division of Health Care Facilities shall be posted in a prominent location and shall be included in the written material given to the patient upon discharge.
(3) Admission and Examination Procedures.
(a) Pre-admission for Abortion. Every woman seeking to have an abortion shall be registered by the facility and shall be seen by a physician or a qualified staff member for a history, physical examination, and laboratory tests.
(b) Verification of Pregnancy. Pregnancy testing shall be available to the patient and may precede actual registration by the facility. No abortion shall be performed unless the examining physician verifies that the patient is pregnant. Pregnancy test results shall be filed in the patient's medical record.
(c) History and Physical Examination. Prior to the abortion, a medical history shall be obtained and recorded. The patient shall be given an appropriate physical examination, as determined by the physician, which may include testing for sexually transmitted diseases, as indicated below. The facility shall report positive test results for sexually transmitted diseases to the Department of Public Health. Provided that if such results are reported within two business days after receipt to the Department of Public Health, then the Department, and not the abortion clinic, shall be responsible for follow-up and counseling of patients with test results which are positive for sexually transmitted diseases.
(d) Laboratory Tests.
1. The following laboratory tests are required prior to an abortion procedure: hematocrit or hemoglobin, Rh typing, urinalysis as directed by the treating physician, and pregnancy test. A syphilis test, neisseria gonorrhea culture, and HIV test shall be performed if such STD tests are properly consented to by the patient.
2. If a prophylactic course of antibiotic medications is not administered or dispensed to a patient in connection with the abortion procedure, then an abortion shall not be performed until the results from the gonorrhea culture have been obtained or a waiver of such treatment is signed by the patient. In the case of a medical emergency, as defined in these rules, laboratory tests are not required prior to the procedure.
3. If the above tests are performed by the facility, the facility's
laboratory personnel any requirements which are in effect and which apply to
the facility under Rules promulgated by the Centers for Medicare and Medicaid
Services under the Clinical Laboratory Improvement Act Amendments of 1988. If
the tests are referred, they shall be referred to a hospital, to a pathologist
certified, or deemed Board eligible by the American Board of Pathology, who is
currently licensed to practice medicine in
4. Each abortion and reproductive health center must develop and retain on file a written quality assurance plan governing the performance of all laboratory procedures performed on-premises. Facilities will be subject to unannounced inspections by the Department of Public Health to determine that on-premises laboratory procedures are being correctly and accurately performed.
(e) Provision for Transfusion. Blood transfusions shall not be administered in an abortion facility.
(f) Informed consent. Except in the case of a medical emergency, as defined in these rules, no abortion shall be performed or induced without the voluntary and informed consent of the woman upon whom the abortion is to be performed or induced. Except in the case of a medical emergency, as defined in these rules, consent to an abortion is voluntary and informed if and only if:
1. At least 24 hours before the abortion, the physician who is to perform the abortion, the referring physician, or a qualified person has informed and provided the woman in person, or by return receipt certified mail restricted delivery, and if by mail, again in person prior to the abortion, a copy of the printed materials developed by the Department of Public Health which list agencies that offer assistance, adoption agencies, development of the fetus, methods and risks of abortion and childbirth, father’s obligations, alternatives to abortion and available methods of birth control. Mailing of the printed materials may be arranged by telephone.
2. Prior to an abortion, the physician who is to perform the abortion, the referring physician, or a qualified counselor has informed the woman in person:
(i) The name of the physician who will perform the abortion in writing or a business card.
(ii) The nature of the proposed abortion method and associated risks and alternatives that a reasonable patient would consider material to the decision of whether or not to undergo the abortion.
(iii) The probable gestational age of the embryo or fetus at the time the abortion is to be performed, and the probable anatomical and physiological characteristics of the embryo or fetus at the time the abortion is to be performed. If the fetus is viable or has reached a gestational age, as defined in these rules, of more than 19 weeks, that:
(I) The fetus may be able to survive outside the womb. The person giving this information may advise the patient fully and in good faith of his or her understanding of these terms, and of the nature of any such survival, including that survival may be merely a possibility or may be of extremely limited duration.
(II) The woman has the right to request the physician to use the method of abortion that is most likely to preserve the life of the child, provided such abortion is not otherwise prohibited by law.
(III) If the child is born alive, the attending physician has the legal obligation to take all reasonable steps necessary to maintain the life and health of the child.
(IV) If at the time of the counseling an ultrasound has been performed and it is the physician’s good faith clinical judgment that the fetus is not viable, then the physician need not inform the woman of the information described in (I), (II), and (III).
3. The physician who is to perform the abortion or the referring physician is required to perform an ultrasound before the abortion. The woman has right to view the ultrasound before an abortion. The woman shall complete a required form to acknowledge that she either saw the ultrasound image or that she was offered the opportunity and rejected it.
4. She has the right to view a videotape prepared by the Department of Public Health and the ultrasound.
5. Any need for anti-Rh immune globulin therapy, and if she is Rh negative, the likely consequences of refusing such therapy and the cost of the therapy.
6. She cannot be forced or required by anyone to have an abortion. She is free to withhold or withdraw her consent for an abortion without affecting her right to future care or treatment and without the loss of any state or federally funded benefits to which she might otherwise be entitled.
(i) The patient shall complete and sign the form in Appendix A to these rules.
(ii) Prior to the performance of an abortion, the physician who is to perform the abortion or his or her agent shall receive the signed receipt of the certified mail dated 24 hours before the abortion, if mailed, and the signed forms that she has received the information of subsections (1) and (2) before the abortion, had the opportunity to view the video and the ultrasound, and provided her informed consent for an abortion. The abortion or reproductive health center shall retain the signed receipt, signed forms, and a printed copy of the ultrasound image in the woman’s medical file for the time required by law, but not less than four years.
7. When a physician using good faith clinical judgment determines that some specific information required to be given under these informed consent provisions would cause a woman severe non-temporary psychological harm, the physician may forego providing this specific information to the woman. This conclusion does not, however, exempt the physician from otherwise complying with these informed consent provisions or the twenty-four hour waiting period.
(4) Operative Procedures.
(a) Medical Services. Only physicians duly licensed in the State of
(b) Patients shall not be admitted for the performance of abortion procedures for which the expected time for surgery and recovery exceeds twelve hours.
(c) Before a physician performs an abortion, the physician shall examine the fetus by use of ultrasound and by such other techniques as to produce a reasonably accurate method of determining the gestational age and viability of the fetus. After such examination, the physician shall enter into the patient's medical record the tests or examinations performed, and his findings regarding viability. If the physician determines that the fetus is viable, the pregnancy shall not be terminated at the abortion or reproductive health center except when an immediate abortion is necessary to preserve the life or physical health of the mother.
(d) Anesthesia. Anesthesia shall be administered to patients only by a Certified Registered Professional Nurse Anesthetist or by a physician deemed qualified by the facility's medical director. The anesthesia must be administered only under the direct physical supervision of a licensed physician. After the administration of an anesthesia, patients shall remain under the physical observation of a Physician, Registered Professional Nurse, or Licensed Practical Nurse (the LPN must be directly supervised by an RN) until the patient is sufficiently alert and able to summon aid.
(e) Additional Requirements for Facilities Rendering Patients Incapable of Self Preservation. If the facility treats four or more patients at the same time and meets either subsection 1. or subsection 2. below, then the facility shall be classified as Ambulatory Health Care Occupancy. Flammable anesthetics are prohibited in such facilities except when construction, storage, equipment, and the operating room meet the standards of the National Fire Protection Association (N.F.P.A.) incorporated in Bulletin No. 56A "Standards for the Use of Inhalation Anesthetics."
1. The facility provides treatment for any patient that would make her incapable of taking action for self-preservation under emergency conditions without assistance from others; or
2. The facility provides treatment requiring general anesthesia.
(f) Examination of Tissue Removed. Tissue removed during an abortion shall be examined by a pathologist certified, or deemed Board eligible, by the American Board of Pathology, in anatomical pathology and, if sent to a physician in Alabama, currently licensed to practice medicine and surgery in Alabama, or if sent to a physician in another state, currently licensed to practice medicine in such state. A report of the examination shall be placed in the patient's medical record. If the examination reveals that no fetal tissue was removed during the abortion, the patient shall be contacted by the facility and she shall be offered or referred for appropriate medical treatment. All medical waste, except such tissue as is sent to a pathologist and not returned to the facility, shall be disposed of in accordance with procedures set forth in the Rules of the Alabama Department of Environmental Management governing medical waste.
(g) Anti-Rh immune globulin therapy with required laboratory procedures shall be given to all Rh negative abortion patients within 72 hours of completion of the termination procedure when, in the professional judgment of the physician performing the abortion, lack of such treatment will have an adverse effect on the patient's future childbearing potential. If the treating physician does not consider the treatment necessary, a signed statement to this effect shall be entered in the patient's medical record. Women seeking abortions, if Rh negative, shall be counseled about the necessity or likely necessity of obtaining such therapy, the likely consequences of refusing such therapy, and the cost of such therapy, prior to undergoing the abortion procedure. If for any reason a patient refuses the administration of such treatment when recommended by the physician, the refusal shall be entered in the clinical record, documented and supported by the patient's signature on an appropriate release or waiver form.
(5) Post Operative Procedures.
(a) Post Operative Observation. After an abortion procedure, patients shall be observed until a determination can be made whether any immediate post operative complications are present. Patients shall either be discharged within twelve hours of admission in an ambulatory condition without need for further observation or acute care, or shall be offered transportation to a local hospital for further treatment.
(b) The medical director or another physician associated with each abortion or reproductive health center shall have admitting privileges at an acute care hospital within the same standard metropolitan statistical area, or alternatively, the abortion or reproductive health center shall have a contractual arrangement with a physician who has admitting privileges at an acute care hospital within the same standard metropolitan statistical area. The physician shall provide or make appropriate arrangements for the provision for continuing medical care for patients who develop complications medically related to an abortion procedure performed at the center.
(c) A physician must remain on the premises until all patients are stable, and are ready for discharge. A physician must sign the discharge order.
(d) Written Plan of Care. Each facility shall develop a written plan of care providing for appropriate, continuing medical care of patients who, within 7 days of the abortion procedure, develop complications medically related to the abortion procedure. Such plans shall be approved by the Board of Health.
(e) Adverse Conditions. Any patient whom the treating physician knows or suspects that a complication has occurred during or after the performance of the abortion shall remain in the abortion facility until she may safely be discharged in an ambulatory condition, or shall be offered transportation to a back-up hospital. Any patient requiring care for more than 12 hours following admission shall be offered transportation to a hospital, unless, because of her medical condition, transportation to another facility would present a substantial danger to her life or health, or unless all hospitals within a reasonable proximity refuse to accept the patient for treatment. Any patient held in the facility as a result of adverse conditions shall remain under the care of a physician within the facility until she can be moved. All adverse conditions, and the treatment rendered therefor, shall be noted and described in the patient's medical record.
(f) A person designated to perform cardio-pulmonary resuscitation and at least one other person shall remain on the premises of the facility at all times during the work day or evening from the commencement of the first abortion procedure until all patients are discharged. Individuals designated to perform cardio-pulmonary resuscitation shall be properly certified and shall attend a training course in cardio-pulmonary resuscitation at least annually. Each facility shall maintain adequate staffing records to demonstrate that this requirement is met.
(g) Patient Instruction. Written instructions shall be issued to all patients upon discharge and shall include as a minimum the following:
1. A list of possible complications, the symptoms for each such complication, and recommended procedures to be followed in the event of such complication.
2. Activities to be avoided, and the period of time during which the activities should be avoided.
3. A telephone number or numbers at which the operating physician, contract physician or other knowledgeable professional staff member from the facility may be contacted by the patient during working hours and after working hours should any complication occur or question arise.
4. Date for a follow-up or return visit after the performance of the abortion, if medically indicated.
(h) Reports to the Center for Health Statistics. The administrator of each abortion or reproductive health center shall report each abortion to the Center for Health Statistics no later than ten days after the last day of the month during which the procedure was performed. A copy of the report shall be kept in the patient's medical record. All reports shall be on such form as the State Board of Health may prescribe. Such forms shall in no event contain the name or the address of the patient whose pregnancy was terminated, nor shall they contain any other information identifying the patient. Individual report forms shall not be available for public inspection, shall be maintained in strict confidence by the Center for Health Statistics, and shall be destroyed after information from the forms is transferred to the Center's database. The Center for Health Statistics shall periodically make available to the public aggregate data about the number of abortions performed in clinical settings statewide. The Director of the Center for Health Statistics may authorize the release of other aggregate statistical data for official government use. In no event shall the Center release the names of individual physicians or other staff members employed by abortion or reproductive health centers, nor shall the Center release the number of procedures performed at any particular facility.
(6) Pharmaceutical Services.
(a) Safety. Drug rooms shall be provided with safeguards to prevent entrance of unauthorized persons, including bars on accessible windows and locks on doors. Controlled drugs and ethyl alcohol, if stocked, shall be stored under double locks and in accordance with applicable Federal and State laws.
(b) Administering, Dispensing, and Prescribing Drugs and Medicines. All oral or telephone orders for medications shall be received by a physician, a registered professional nurse, licensed practical nurse, or a registered pharmacist and shall be reduced to writing on the physician's order reflecting the prescribing physician and the name and title of the person who wrote the order. Telephone or oral orders shall be signed by the prescribing physician within 48 hours. Standing orders shall be used only when in accordance with a policy of the facility reduced to writing. Drugs and medications shall not be dispensed, except by or under the supervision of a physician or pharmacist. Any patient requiring medications outside the facility shall be given a written prescription permitting her to obtain the medications from a licensed pharmacy.
(c) Controlled Substances Permit. Each abortion clinic shall procure a controlled drug permit from the Drug Enforcement Agency if a stock of controlled drugs is to be maintained. The permit shall be displayed in a prominent location.
(d) Records. Records shall be kept of all stock controlled substances giving an account of all items received and administered. Records shall be kept in a manner which allows accurate reconciliation.
(e) Poisonous Substances. All poisonous substances must be plainly labeled and kept in a cabinet or closet separate from medicines and drugs to be prepared for administration.
(f) Emergency Kit or Emergency Drugs.
1. Each abortion clinic shall maintain upon the advice and written approval of the facility's medical director an emergency kit or stock supply of drugs and medicines for treating the emergency needs of patients.
2. The kit or medicine shall be stored in such a manner as to be inaccessible to unauthorized personnel while allowing quick retrieval by authorized personnel.
3. Each emergency kit or stock supply of drugs shall contain a written list of its contents, approved by the medical director, including the name and strength of each drug (with generic equivalents, where appropriate), and amounts to be maintained.
4. At all times when patients are in the facility, there shall be at least one staff member on the premises who has the knowledge, skills and abilities to operate the emergency equipment. Protocols shall be in place to ensure ongoing training of staff in the use of emergency equipment, the management of emergencies and the indications for emergency transport.
5. Emergency kits and the stock supply of drugs shall be inspected with sufficient frequency to permit the removal of all outdated drugs. Each kit shall contain a log documenting such inspections.
(g) Drug Reference Sources. Each abortion clinic shall maintain reference sources for identifying and describing drugs and medicines.
(7) Infection Control.
(a) Infection Control Committee.
1. There shall be an infection control committee composed of a physician and registered professional nurse who shall be responsible for investigating, controlling, and preventing infections in the facility.
2. There shall be procedures to govern the use of sterile and aseptic techniques in all areas of the facility.
3. There shall be continuing education provided to all staff on causes, effects, transmission, prevention, and elimination of infection at least annually.
(b) Sterilization. Definitive written procedures governing sterilization techniques shall be developed. All equipment must be sterilized either by pressurized steam sterilization or gas sterilization. Procedures are to include:
1. Technique to be used for a particular instrument or group of instruments.
2. Length of time to accomplish sterilization.
3. Prohibition against re-use of one-time-use (disposable) items.
4. Temperature, time and pressure for steam sterilization.
5. Proper methods of preparation of items for sterilization (cleaning, wrapping and dating).
6. Shelf storage time for sterile items.
7. Use of sterilizer indicators.
8. Use of routine (at least monthly) bacteriological sterilizer culture records.
(c) Abortion or reproductive health centers shall adhere to regulations of the United States Occupational Safety and Health Administration for handling medical waste, and regulations of the Alabama Department of Environmental Management and other applicable federal regulations for disposal of medical waste (medical waste includes, but is not limited to disposable gowns, soiled dressings, sponges, surgical gloves, bacteriological cultures, blood and blood products, excretions, secretions, other bodily fluids, catheters, needles, IV tubing with needles attached, scalpel blades, glassware, and syringes that have been removed from their original sterile containers).
(d) Investigation of Infections.
1. Reports of infections observed during any follow-up or return visit of the patient shall be made and kept as a part of the patient's medical record. Each facility shall maintain a surveillance logbook recording all follow-up visits and telephone inquiries in which infections or other complaints are reported or observed. This logbook shall be reviewed at least quarterly by the facility's medical director. The facility's medical director may specify certain patient complaints, such as mild cramps, which, in his professional opinion and judgment, do not warrant being recorded in the logbook. The logbook shall in all events contain documentation of the following:
(i) Any report by a patient of severe cramps;
(ii) Any report by a patient of passage of a blood clot as large or larger than three centimeters, or one and one fourth inches, in diameter (the approximate size of a fifty cent piece);
(iii) Any report by a patient that she has passed tissue;
(iv) Any report by a patient of foul-smelling discharge;
(v) Any report by a patient that she has soaked two or more sanitary pads in one hour;
(vi) Any report by a patient of a body temperature of 100 degrees Fahrenheit or more;
(vii) Any diagnosis of perforation of the uterus; and
(viii) Any hospitalization of a patient for adverse conditions resulting from a procedure performed at the facility.
2. Efforts shall be made to determine the origin of any infection and if the abortion procedure was found to be related to acquiring the infection, remedial action shall be taken to prevent recurrence. In the event of sustained numbers of infections (three or more patients in one week), the State Health Department shall be immediately notified. Upon order of the Health Department, operation of the facility shall be discontinued until approval for continuation of operation is granted by the State Health Department.
3. If the facility wishes to contest such closure, the Health Department shall provide an opportunity for a hearing under the contested case provisions of the Alabama Administrative Procedures Act. Such hearing shall be held not more than two working days after notice of appeal is given to the Health Department, unless the facility agrees otherwise. The facility shall be entitled to full rights of appeal from any adverse decision rendered as a result of the hearing, as set forth by law.
(e) Environment. The abortion facility shall provide a safe and sanitary environment, and shall be properly constructed, equipped, and maintained to protect the health and safety of patients and staff.
420-5-1-.04 Physical Environment.
(1) Submission of Plans and Specifications.
(a) Scope. Except as provided in Section 420-5-1.03(4)(e), a facility constructed or renovated after the effective date of these rules shall be classified as Business Occupancy. The facility shall comply with the code and standards adopted by the State Board of Health in effect at the time of plan submission.
(b) New Construction, Additions, and Major Alterations. When construction is contemplated, either for new buildings, conversions, additions to existing buildings coming within the scope of these Rules, plans and specifications shall be submitted for review by the Alabama Department of Public Health, in accordance with Alabama Administrative Code Rule 420-5-22, "Submission of Plans and Specifications for Health Care Facilities."
(c) Minor Alterations and Remodeling. Minor alterations and remodeling which do not affect the structural integrity of the building, which do not change functional operation, which do not affect fire safety, and which do not add beds or facilities over those for which the clinic is licensed, need not be submitted for review.
(d) Inspections. The State Board of Health and its authorized representatives shall have access to the work for inspection wherever it is in preparation or progress.
(a) Location. The abortion or reproductive health center shall be located with sufficient parking space provided.
(b) Local Restrictions. The abortion or reproductive health center shall comply with local zoning, building, and fire ordinances in addition to these Rules.
(c) Structural Soundness. The building shall be structurally sound, free from leaks and excessive moisture, in good repair, and painted at intervals to be reasonably attractive inside and out.
(d) Fire Extinguisher. An all-purpose fire extinguisher shall be provided at each exit, special hazard areas and located so that a person will not have to travel more than 75 feet from any point to reach the nearest extinguisher. Fire extinguishers shall be of a type approved by the local fire department or State Fire Marshal and shall be inspected in accordance with the manufacturer's specifications, but not less than annually. An attached tag shall bear the initials or name of the inspector and date inspected.
(e) Ventilation. The building shall be well ventilated at all times with a comfortable temperature maintained.
(f) Garbage Disposal. Space and facilities shall be provided for the sanitary storage and disposal of waste by incineration, containerization or removal, or by a combination of these techniques. Infectious waste materials shall be rendered non-infectious on the premises by appropriate measures.
(g) Elevators. In multi-story (more than two stories) buildings, at least one elevator for patient use shall be provided.
(h) Doors. Minimum width of doors to all rooms needing access for stretchers shall be 3 feet.
(j) Corridors. Corridors must be of sufficient width to allow stretchers to be maneuvered without impediment. All corridors used as a means of exit shall be a minimum of 48 inches in width and not be obstructed.
(k) Occupancy. No part of an abortion or reproductive health center may be rented, leased, or used for any commercial purpose, or for any purpose not necessary for the operation of the center.
(l) Lighting. All areas of the center shall have sufficient lighting to prevent accidents and promote efficiency of service.
(m) Emergency Lighting. Emergency lighting systems shall be provided to adequately light corridors, procedures rooms, exit signs, stairways and lights at exterior of each exit in case of electrical power failure.
(n) Exits. Each floor of an abortion clinic shall have two or more exit ways remote from each other, leading directly to the outside or to a two-hour fire resistant passage to the outside. Exits shall be so located that the maximum distance from any point in a floor area, room or space to an exit doorway shall not exceed 200 feet. If the building is sprinklered, distance may be increased to 300 feet.
(o) Exit Doors. Exit doors shall meet the following criteria:
1. Shall be no less than 36 inches wide.
2. Shall swing in the direction of exit and shall not obstruct the travel along any required fire exit.
(p) Exit Signs. Exits, except for the front door, shall be equipped with approved illuminated signs bearing the word "Exit" or "Fire Escape" in letters at least 4˝ inches high. Exit signs shall be placed in corridors and passageways to indicate the direction of exit.
(q) Interior Finish. Interior finish shall meet the following criteria:
1. Interior finish, including combustible, decorative and acoustical material, of exits and of enclosed corridors furnishing access thereto or ways of travel therefrom shall have a flame spread rating of 75 or less or a flame spread rating of 200 or less if facility is sprinklered throughout.
2. In other areas within facility, the flame spread rating shall be 200 or less.
(r) Floors. All floors shall be covered wall-to-wall with resilient tile, hard tile, carpet, or the equivalent.
(s) Carpet. Carpet and/or carpet and pad shall carry a flame spread rating of 75 or less and a smoke density rating of 450 or less in accordance with ASTM E-84.
(t) Physically Handicapped. The facility shall comply with ANSI 117.1 making buildings and facilities accessible to, and usable by, the physically handicapped.
(u) An abortion or reproductive health center shall be equipped with ultrasound equipment, a television, and a video cassette player capable of playing VHS video cassettes, or such other video equipment as is compatible with the video format in which the Department of Public Health’s abortion educational video program is distributed. All such equipment shall be maintained in good operating condition.
(3) Service Facilities.
(a) Admission Office. There shall be a room designated as the admission office where patients may discuss personal matters in private. The admission office may be combined with the business office and medical records room if privacy can be maintained when confidential matters are being discussed.
(b) Waiting Room. A waiting room in the administrative section shall be provided with sufficient seating for the maximum number of persons that may be waiting at any time. Public toilets, accessible to the physically handicapped, shall be available.
(c) Storage. A janitor's closet and ample storage space shall be provided in the administrative area.
(4) Treatment Facilities.
(a) Examining Facilities. An examining room of sufficient size to have three feet of clearance at the end and sides of the examining table shall be provided. The examining room will contain a desk suitable for writing, a chair, a lavatory or sink for handwashing, instrument table and shelves or other equipment for storage of equipment as needed. The examining room and procedure room may be the same.
(b) Procedure Room. The procedure room shall have walls and floors covered with a washable surface, a scrub sink with knee, elbow, or foot controls, soap dispenser, and single service towel dispenser.
(c) Recovery Room. One or more recovery rooms containing sufficient beds for recovering patients shall be provided. Reclining type vinyl upholstered chairs may be substituted in lieu of beds. Other items for the patients' comfort may be provided in the room.
(d) Clean Workroom. A clean workroom shall be provided sufficient in size to process and store clean and sterile supply materials and equipment, and must contain a work counter and sink. An autoclave or gas sterilizer must be provided adequate in size to sterilize the equipment in use.
(e) Soiled Workroom. The soiled workroom shall contain a sink, work counter, waste receptacle. The clean and soiled workroom may be combined if aseptic techniques can be provided.
(f) Toilets. At least one toilet and lavatory with a soap dispenser and towel dispenser shall be provided for each multi-bed recovery room. Toilet facilities shall be provided at no less than one water closet and lavatory per ten recovery beds.
(g) Refrigerator. A refrigerator shall be provided with provisions for safeguarding drugs. The refrigerator shall be capable of maintaining drugs at a temperature of 42 degrees Fahrenheit plus or minus 6 degrees Fahrenheit. If food or beverages are to be stored with drugs, they must be clearly labeled and precautions must be taken to prevent moisture produced by foods and beverages from contaminating drug container contents or defacing labels.
(h) Preventive Maintenance. There shall be a schedule of preventive maintenance developed for all equipment in the facility to assure satisfactory operation. This equipment shall be checked and tested in accordance with manufacturer’s specifications at periodic intervals, not less than annually, to insure proper operation and a state of good repair. After repairs or alterations are made to any equipment, the equipment shall be thoroughly tested for proper operation before returning it to service. Records shall be maintained on each piece of equipment to indicate its history of testing and maintenance.
(5) Housekeeping Services.
(a) Personnel. Sufficient personnel are to be employed to maintain the facility clean and orderly.
(b) Techniques. There shall be written procedures outlining techniques to be followed in routine housekeeping and decontamination are to be developed and maintained.
CERTIFICATION OF RECEIPT OF ABORTION INFORMATION
I certify that I have received the printed materials entitled "Did You
Know" and "
by mail on _____________ and again in person on _____________.
only in person on ______________.
I understand that
Signature of Patient Date
I certify that Dr._____________________________, who is the referring physician or the physician who is to perform the abortion, has performed an ultrasound of my unborn child. I certify that I have been offered the opportunity to see this ultrasound and (check only one):
____ I have reviewed the ultrasound before the abortion.
____ I rejected the opportunity to view the ultrasound before the abortion.
Signature of Patient Date
CERTIFICATION OF VOLUNTARY AND
INFORMED CONSENT FOR ABORTION
On __________________, I was informed in person by __________________________________ of
(date) (name of physician or other qualified person)
the following (check all that apply):
____ The abortion will be performed by _________________________________________________.
____ The details of the medical or surgical method to be used in performing the abortion, and the medical risks associated with this particular procedure.
____ That I have the right to view an ultrasound of my unborn child, as well as a video entitled "Did You Know," and I have been offered the opportunity to view both.
____ Whether there is a need for me to receive anti-Rh immune globulin therapy, the cost of such therapy, and if I am Rh negative, the likely consequences of refusing such therapy.
____ That I cannot be forced or required by anyone to have an abortion, and that I am free to withhold or withdraw my consent to abortion without affecting my right to any future care or treatment, and without the loss of any state or federally funded benefits to which I might otherwise be entitled.
____ The probable gestational age of my unborn child and the probable anatomical and physiological characteristics of my unborn child as of the date the abortion is to be performed. I have also been advised that (check only one):
____ My unborn child has a gestational age of more than 19 weeks or is viable and that: 1) my child may be able to survive outside the womb; 2) I have the right to request that the physician use the method of abortion that is most likely to preserve the life of my unborn child, provided that method is not prohibited by law; and 3) if my unborn child is born alive, the physician has the legal obligation to take all reasonable steps necessary to maintain the life and health of the child.
____ My unborn child has a gestational age of 19 weeks or less, or an ultrasound has been performed and the physician’s good faith clinical judgment is that my unborn child is not viable.
I certify and affirm that I have received the above information, that I have had the opportunity to consider the alternatives available to me, and that I do hereby voluntarily give my fully informed consent to the abortion of my unborn child.
Signature of Patient Date
Sections 1 and 2 must be completed by the physician performing the emergency medical abortion.
1. It is my good faith clinical judgment that a medical emergency exists that so complicates the medical condition of ____________________________, the patient and a pregnant woman, that an immediate abortion of her pregnancy is necessary. To delay performing this emergency abortion by obtaining informed consent, as otherwise required, would create a serious risk of substantial and irreversible impairment of a major bodily function, or could result in her death. The medical condition(s) that establish this as an emergency is:
Physician MD/DO Date
2. Complete 2A or 2B
A. The patient, _______________________, was informed prior to the abortion, of the medical conditions which necessitate the performance of an emergency abortion.
Physician MD/DO Date
B. The patient, _____________________, was not informed prior to the abortion of the medical conditions which necessitate the performance of the emergency abortion, due to the urgency of the situation and the severity of her condition.
Physician MD/DO Date
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AlABAMA MEDICAID AGENCY
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560‑X‑6‑.09 Consent Forms Required Before Payments Can Be Made.
(1) Abortions: A claim seeking payment for an abortion must be accompanied by one or more (depending on the circumstance) of the forms required by federal law and a copy of the medical records. Payment is available for abortions as provided under federal law.
(a) In the event the abortion does not meet the requirements of federal law, and the recipient elects to have the abortion, the provider may bill the recipient for the abortion.
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