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Sec. 10-16c. State board to develop family life education curriculum guides.
The State Board of Education shall, on or before
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DEPARTMENT OF PUBLIC HEALTH
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The Commissioner of Public Health shall adopt regulations, in accordance with chapter 54, establishing standards to control and ensure the quality of medical care provided to any pregnant woman undergoing an induced abortion at any outpatient clinic regulated under the Public Health Code. Such standards shall include, but are not limited to, provisions concerning:
(1) The verification of pregnancy and a determination of the duration of such pregnancy;
(2) preoperative instruction and counseling;
(3) operative permission and informed consent;
(4) postoperative counseling including family planning; and
(5) minimum qualifications for counselors.
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Sec. 19a-406. (Formerly Sec. 19-530). Powers and duties of Chief Medical Examiner. Certified pathologists. Autopsies.
(a) The Chief Medical Examiner shall investigate all human deaths in the following categories:
(1) Violent deaths, whether apparently homicidal, suicidal or accidental, including but not limited to deaths due to thermal, chemical, electrical or radiational injury and deaths due to criminal abortion, whether apparently self-induced or not;
(2) sudden or unexpected deaths not caused by readily recognizable disease;
(3) deaths under suspicious circumstances;
(4) deaths of persons whose bodies are to be cremated, buried at sea or otherwise disposed of so as to be thereafter unavailable for examination;
(5) deaths related to disease resulting from employment or to accident while employed;
(6) deaths related to disease which might constitute a threat to public health.
The Chief Medical Examiner may require autopsies in connection with deaths in the preceding categories when it appears warranted for proper investigation and, in the opinion of the Chief Medical Examiner, the Deputy Chief Medical Examiner, an associate medical examiner or an authorized assistant medical examiner, an autopsy is necessary. The autopsy shall be performed at the Office of the Chief Medical Examiner or by a designated pathologist at a community hospital. Where indicated, the autopsy shall include toxicologic, histologic, microbiologic and serologic examinations. If a medical examiner has reason to suspect that a homicide has been committed, the autopsy shall be performed at the Office of the Chief Medical Examiner or by a designated pathologist in the presence of at least one other designated pathologist if such other pathologist is immediately available. A detailed description of the findings of all autopsies shall be written or dictated during their progress. The findings of the investigation at the scene of death, the autopsy and any toxicologic, histologic, serologic and microbiologic examinations and the conclusions drawn therefrom shall be filed in the Office of the Chief Medical Examiner.
(b) The Chief Medical Examiner shall designate pathologists who are certified by the Department of Public Health to perform autopsies in connection with the investigation of any deaths in the categories listed in subsection (a) of this section. Any state's attorney or assistant state's attorney shall have the right to require an autopsy by a pathologist so designated in any case in which there is a suspicion that death resulted from a criminal act. The official requiring said autopsy shall make a reasonable effort to notify whichever one of the following persons, eighteen years of age or older, assumes custody of the body for purposes of burial: Father, mother, husband, wife, child, guardian, next of kin, friend or any person charged by law with the responsibility for burial, that said autopsy has been required, however performance of said autopsy need not be delayed pending such notice.
(c) If there are no other circumstances which would appear to require an autopsy and if the investigation of the circumstances and examination of the body enable the Chief Medical Examiner, the Deputy Chief Medical Examiner, an associate medical examiner or an authorized assistant medical examiner to conclude with reasonable certainty that death occurred from natural causes or obvious traumatic injury, the medical examiner in charge shall certify the cause of death and file a report of his findings in the Office of the Chief Medical Examiner.
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Sec. 19a-600. Definitions. For the purposes of sections 19a-601 and 19a-602:
(1) "Counselor" means: (A) A psychiatrist, (B) a psychologist licensed under chapter 383, (C) clinical social worker licensed under chapter 383b, (D) a marital and family therapist licensed under chapter 383a, (E) an ordained member of the clergy, (F) a physician's assistant licensed under section 20-12b, (G) a nurse-midwife licensed under chapter 377, (H) a certified guidance counselor, (I) a registered professional nurse licensed under chapter 378, or (J) a practical nurse licensed under chapter 378.
Sec. 19a-601. Information and counseling for minors required. Medical emergency exception.
(a) Prior to the performance of an abortion upon a minor, a physician or counselor shall provide pregnancy information and counseling in accordance with this section in a manner and language that will be understood by the minor. The physician or counselor shall:
(1) Explain that the information being given to the minor is being given objectively and is not intended to coerce, persuade or induce the minor to choose to have an abortion or to carry the pregnancy to term;
(2) Explain that the minor may withdraw a decision to have an abortion at any time before the abortion is performed or may reconsider a decision not to have an abortion at any time within the time period during which an abortion may legally be performed;
(3) Explain to the minor the alternative choices available for managing the pregnancy, including: (A) Carrying the pregnancy to term and keeping the child, (B) carrying the pregnancy to term and placing the child for adoption, placing the child with a relative or obtaining voluntary foster care for the child, and (C) having an abortion, and explain that public and private agencies are available to assist the minor with whichever alternative she chooses and that a list of these agencies and the services available from each will be provided if the minor requests;
(4) Explain that public and private agencies are available to provide birth control information and that a list of these agencies and the services available from each will be provided if the minor requests;
(5) Discuss the possibility of involving the minor's parents, guardian or other adult family members in the minor's decision-making concerning the pregnancy and whether the minor believes that involvement would be in the minor's best interests; and
(6) Provide adequate opportunity for the minor to ask any questions concerning the pregnancy, abortion, child care and adoption, and provide information the minor seeks or, if the person cannot provide the information, indicate where the minor can receive the information.
(b) After the person provides the information and counseling to a minor as required by this section, such person shall have the minor sign and date a form stating that:
(1) The minor has received information on alternatives to abortion and that there are agencies that will provide assistance and that a list of these agencies and the services available from each will be provided if the minor requests;
(3) The alternatives available for managing the pregnancy have been explained to the minor;
(4) The minor has received an explanation about agencies available to provide birth control information and that a list of these agencies and the services available from each will be provided if the minor requests;
(5) The minor has discussed with the person providing the information and counseling the possibility of involving the minor's parents, guardian or other adult family members in the minor's decision-making about the pregnancy;
(6) If applicable, the minor has determined that not involving the minor's parents, guardian or other adult family members is in the minor's best interests; and
(7) The minor has been given an adequate opportunity to ask questions.
(c) The person providing the information and counseling shall also sign and date the form and shall include such person's business address and business telephone number. The person shall keep a copy for such minor's medical record and shall give the form to the minor or, if the minor requests and if such person is not the attending physician, transmit the form to the minor's attending physician. Such medical record shall be maintained as otherwise provided by law.
(d) The provision of pregnancy information and counseling by a physician or counselor which is evidenced in writing containing the information and statements provided in this section and which is signed by the minor shall be presumed to be evidence of compliance with the requirements of this section.
(e) The requirements of this section shall not apply when, in the best medical judgment of the physician based on the facts of the case before him, a medical emergency exists that so complicates the pregnancy or the health, safety or well-being of the minor as to require an immediate abortion. A physician who does not comply with the requirements of this section by reason of this exception shall state in the medical record of the abortion the medical indications on which his judgment was based.
(a) The decision to terminate a pregnancy prior to the viability of the fetus shall be solely that of the pregnant woman in consultation with her physician.
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PROTECTED PERSONS AND THEIR PROPERTY
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Sec. 45a-677. (Formerly Sec. 45-329). Powers and duties of plenary or limited guardian. Report. Transfer of file.
(a) The court may assign to a limited guardian of a person with mental retardation any portion of the duties and powers listed in subsection (d) of this section for those particular areas in which the respondent lacks the capacity to meet the essential requirements for such respondent's physical or mental health or safety.
(b) A limited guardian may also be assigned the duty to assist the respondent in those particular areas in which the capacity of the respondent to meet the essential requirements of such respondent's physical or mental health or safety, protect such respondent's rights, obtain necessary services, or to fulfill such respondent's civil duties is impaired, as well as in other ways not specifically prohibited by sections 45a-669 to 45a-684, inclusive.
(c) A limited guardian of a person with mental retardation shall have only such of the duties and responsibilities and powers of a guardian of a person with mental retardation under subsection (d) of this section as the court shall specify based upon its findings with regard to the individual need of the respondent for supervision. The guardian shall have the duty to report to the probate court which appointed such limited guardian at least annually the condition of the respondent. The preceding duties, responsibilities and powers shall be carried out within the limitations of the resources available to the ward, either through the ward's own estate or by reason of private or public assistance.
(d) The court may assign to a limited guardian the custody of the ward for the purpose of exercising any, but not all, of the following limited duties and powers, in order to assist the ward in achieving self-reliance: (1) To assure and consent to a place of abode outside the natural family home, (2) to consent to specifically designed educational, vocational or behavioral programs, (3) to consent to the release of clinical records and photographs, (4) to assure and consent to routine, elective and emergency medical and dental care, and (5) other specific limited powers to assure and consent to services necessary to develop or regain to the maximum extent possible the ward's capacity to meet essential requirements. All plenary guardians and limited guardians appointed pursuant to sections 45a-669 to 45a-684, inclusive, shall also have a duty to assure the care and comfort of the ward within the limitations of their appointment, and within the limitations of the resources available to the ward either through the ward's own estate or by reason of private or public assistance.
(e) A plenary guardian or limited guardian of a person with mental retardation shall not have the power or authority: (1) To cause the ward to be admitted to any institution for treatment of the mentally ill, except in accordance with the provisions of sections 17a-75 to 17a-83, inclusive, 17a-456 to 17a-484, inclusive, 17a-495 to 17a-528, inclusive, 17a-540 to 17a-550, inclusive, 17a-560 to 17a-576, inclusive, 17a-615 to 17a-618, inclusive, and 17a-621 to 17a-664, inclusive, and chapter 420b; (2) to cause the ward to be admitted to any training school or other facility provided for the care and training of persons with mental retardation if there is a conflict concerning such admission between the guardian and the person with mental retardation or next of kin, except in accordance with the provisions of sections 17a-274 and 17a-275; (3) to consent on behalf of the ward to a sterilization, except in accordance with the provisions of sections 45a-690 to 45a-700, inclusive; (4) to consent on behalf of the ward to psychosurgery, except in accordance with the provisions of section 17a-543; (5) to consent on behalf of the ward to the termination of the ward's parental rights, except in accordance with the provisions of sections 45a-706 to 45a-709, inclusive, 45a-715 to 45a-718, inclusive, 45a-724 to 45a-737, inclusive, and 45a-743 to 45a-757, inclusive; (6) to consent on behalf of the ward to the performance of any experimental biomedical or behavioral medical procedure or participation in any biomedical or behavioral experiment, unless it (A) is intended to preserve the life or prevent serious impairment of the physical health of the ward, (B) is intended to assist the ward to regain the ward's abilities and has been approved for the ward by the court, or (C) has been (i) approved by a recognized institutional review board, as defined by 45 CFR 46, 21 CFR 50 and 21 CFR 56, as amended from time to time, which is not a part of the Department of Mental Retardation, (ii) endorsed or supported by the Department of Mental Retardation, and (iii) approved for the ward by such ward's primary care physician; (7) to admit the ward to any residential facility operated by an organization by whom such guardian is employed, except in accordance with the provisions of section 17a-274; (8) to prohibit the marriage or divorce of the ward; and (9) to consent on behalf of the ward to an abortion or removal of a body organ, except in accordance with applicable statutory procedures when necessary to preserve the life or prevent serious impairment of the physical or mental health of the ward.
(f) A plenary guardian or limited guardian shall submit a report to the court: (1) Annually; (2) when the court orders additional reports to be filed; (3) when there is a significant change in the capacity of the ward to meet the essential requirements for the ward's physical health or safety; (4) when the plenary guardian or limited guardian resigns or is removed; and (5) when the guardianship is terminated.
(g) Such reports shall be submitted on a form provided by the Office of the Probate Court Administrator and shall contain the following information: (1) Significant changes in the capacity of the ward to meet the essential requirements for the ward's physical health or safety; (2) the services being provided to the ward and the relationship of those services to the individual guardianship plan; (3) the significant actions taken by the limited guardian of a person with mental retardation or plenary guardian of a person with mental retardation during the reporting period; (4) any significant problems relating to the guardianship which have arisen during the reporting period; and (5) whether such guardianship, in the opinion of the guardian, should continue, be modified, or be terminated, and the reasons therefor.
(h) When any person with mental retardation for whom a guardian has been appointed becomes a resident of any town in the state in a probate district other than the one in which a guardian was appointed, or becomes a resident of any town in the state to which the guardianship file has been transferred under this section, such court in that district may, upon motion of any person deemed by the court to have sufficient interest in the welfare of the respondent, including, but not limited to, the guardian, the Commissioner of Mental Retardation or the commissioner's designee, or a relative of the person under guardianship, transfer the file to the probate district in which the person under guardianship resides at the time of the application, provided the transfer is in the best interest of the person with mental retardation. A transfer of the file shall be accomplished by the probate court in which the guardianship matter is on file by making copies of all documents in the court and certifying each of them and then causing them to be delivered to the court for the district in which the person under guardianship resides. When the transfer is made, the court of probate in which the person under guardianship resides at the time of transfer shall thereupon assume jurisdiction over the guardianship and all further accounts shall be filed with such court.
(i) A plenary guardian or limited guardian of a person with mental retardation and, to the extent appropriate, such person shall be the primary decision maker with respect to programs needed by such person and policies and practices affecting the well-being of such person within the authority granted by the court pursuant to this section, provided any such decision does not conflict with the requirements of section 17a-238. In making any such decision, the plenary guardian or limited guardian shall consult with the ward and appropriate members of the ward's family, where possible. A limited guardian shall be the primary decision maker only with respect to such duties assigned to the limited guardian by the court. The provisions of this subsection shall be included in any court order appointing a plenary guardian or limited guardian of a person with mental retardation.
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STATUTORY RIGHTS OF ACTION AND DEFENSES
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Sec. 52-571a. Action for deprivation of equal rights and privileges.
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OFFENSES AGAINST THE PERSON
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Sec. 53-37b. Deprivation of a person's equal rights and privileges by force or threat.
Any person who, acting alone or in conspiracy with another, for the purpose of depriving any person or class of persons of the equal protection of the laws of this state or the United States, or of equal privileges and immunities under the laws of this state or the United States, engages in the use of force or threat, as provided in section 53a-62, shall be guilty of a class A misdemeanor, except that if bodily injury results such person shall be guilty of a class C felony or if death results such person shall be guilty of a class B felony. [Legislative history indicates that this provision was designed to protect clinics from violence.]
Public Health Code.
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(a) No abortion
shall be performed at any stage of pregnancy except by a person licensed to
practice medicine and surgery in the State of
(b) All induced abortions will be reported within seven days by the physician performing the procedure to the state commissioner of public health who will maintain such reports in a confidential file and use them only for statistical purposes except in cases involving licensure. Such reports will specify date of abortion, place where performed, age of woman and town and state of residence, approximate duration of pregnancy, method of abortion, and explanation of any complications. The name of the woman will not be given. These records will be destroyed within two years after date of receipt. In addition, a fetal death certificate shall be filed for each fetus born dead which is the result of gestation of not less than twenty weeks, or a live birth certificate shall be filed for each fetus born alive regardless of gestational age, as provided in sections 7-48 and 7-60 of the Connecticut General Statutes. If a live born fetus subsequently dies, a death certificate shall be filed as provided in section 7-62b of the Connecticut General Statutes.
(c) All induced abortions after the second trimester as verified by ultrasound, last menstrual period and pelvic exam, shall be done only in a licensed hospital with a department of obstetrics and gynecology and a department of anesthesiology.
(d) All outpatient clinics operated by corporations or municipalities where abortions are performed shall develop standards to control the quality of medical care provided to women having abortions. These standards shall include but not necessarily be limited to:
(1) verification of pregnancy and determination of duration of pregnancy;
(2) pre-operative instruction and counseling;
(3) operative permission and informed consent;
(4) pre-operative history and physical examination;
(5) pre-operative laboratory procedure for blood Rh factor;
(6) prevention of Rh sensitization;
(7) examination of the tissue by a pathologist;
(8) receiving and recovery room facilities;
(9) a standard operating room;
(10) post-operative counseling including family planning; and
(11) a permanent record.
(e) There shall be a mechanism for continuing review to evaluate the quality of records and the quality of clinical work. This review shall include all deaths, complications, infections and such other cases as shall be determined by the chief of the department of obstetrics and gynecology of the hospital or the clinic medical director.
(f) No person shall be required to participate in any phase of an abortion that violates his or her judgment, philosophical, moral or religious beliefs.
(g) If the newborn shows signs of life following an abortion, those measures used to support life in a premature infant shall be employed.
(h) During the third trimester of pregnancy, abortions may be performed only when necessary to preserve the life or health of the expectant mother.
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19a-116-1. Abortion services in outpatient clinics
Outpatient clinics which offer abortion services shall comply with sections 19-13-D45 through 19-13-D54 of the Regulations of Connecticut State Agencies and in addition thereto, shall comply with the following provisions:
(a) Facilities, equipment and care shall be consistent with
the national standards of the
(b) Any women seeking an abortion shall be given:
(1) Verification of the diagnosis and duration of pregnancy, including preoperative history and physical examination;
(2) Information and an explanation of the procedure to be followed in accordance with subsection (c) of this section;
(3) Counseling about her decision;
(4) Laboratory tests, including blood grouping and Rh factor;
(5) Preventive therapy if at risk for Rh sensitization;
(6) Examination of tissue by a pathologist;
(7) Consultation as to the need for follow-up care;
(8) Information on family planning;
(9) A written discharge summary which indicates the patient's status and discharge plan, signed by both the patient and a licensed or certified health care provider, a copy of which shall be given to the patient and a copy shall be retained as part of the medical record; and
(10) Information regarding access to her medical record, which shall include a statement of patient confidentiality and the requirement for written consent for release of information to persons not otherwise authorized by law to access the record.
(c) Informed consent. Prior to performing an abortion, a counselor shall obtain informed consent from the woman seeking to have the abortion. Informed consent shall exist only when a consent form is completed voluntarily and in accordance with the following provisions:
(1) An individual who obtains informed consent from a woman for an abortion procedure shall:
(A) Offer to answer any questions the patient may have concerning the procedure;
(B) Provide a copy of the informed consent form to the patient as described in subdivision (2) of this subsection;
(C) Provide all of the following information orally to the patient:
(i) A thorough explanation of the procedures to be performed; and
(ii) A full description of the discomforts and risks that may accompany or follow the performance of the procedure; and
(D) Assure the patient that an interpreter is provided to assist the patient if she does not understand the language used on the consent form or the language used by the counselor obtaining consent.
(2) Consent form requirements
(A) A consent form shall clearly spell out in language the patient can understand the nature and consequences of the procedure which shall be used.
(B) The consent form shall be signed and dated by:
(i) the patient;
(ii) the interpreter, if one is provided;
(iii) the counselor who obtains the consent; and
(iv) the physician who will perform the procedure.
(d) Staff qualifications
(1) All counselors in an abortion clinic shall have background preparation in social work, psychology, counseling, nursing, or ministry. Such preparation shall have been obtained in formal course work or through in-service staff training.
(2) Those counselors who do not have a graduate degree in any of the above mentioned fields shall be supervised by a person with such a graduate degree. Such supervision shall consist of the direction, inspection, and on-site observation of the activities of the counselors in performance of their duties.
(e) Quality assurance and risk management. All abortion clinics shall implement a written quality assurance and risk management program which shall include but not necessarily be limited to the following components:
(1) annual program objectives and evaluation;
(2) quarterly clinical record review;
(3) annual documentation of clinical competence of professional staff; and
(4) annual outcome audits.
(f) Emergency preparedness. Each clinic shall formulate and implement when necessary a plan for the safety of the patients in the event of fire, natural and other disasters, and bomb threat.
(1) Fire. A written plan shall include but not necessarily be limited to:
(A) posted fire evacuation plans in prominent areas showing two evacuation routes;
(B) fire drills conducted at unexpected times, at least quarterly on each shift;
(C) a written record of each fire drill including date, time, personnel in attendance and evaluation;
(D) tasks and responsibilities assigned to all personnel; and,
(E) an annual review and acceptance of the plan by the local fire marshal.
(2) Natural and other disasters. A written plan shall include but not necessarily be limited to:
(A) policies for internal and external disasters;
(B) notification of designated persons;
(C) orderly patient removal and relocation if required;
(D) accountability of patients and staff during evacuation; and
(E) patient notification in the event of an interruption in services.
(3) Bomb threat. A written plan shall include but not necessarily be limited to:
(A) collection of all information from the caller by the recipient of the call;
(B) notification of emergency and administrative personnel;
(C) total communication and coordination between emergency and facility personnel;
(D) responsibilities of all staff during bomb threat;
(E) orderly patient removal and relocation if required; and
(f) accountability of patients and staff during evacuation.
Physician Services Regulation/Policy
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Section 173F.IV Abortions
The Department will pay for an abortion only when:
a. The attending physician has certified in writing that the
abortion is necessary because the life of the mother
would be endangered if the fetus were carried to term,
b. Effective October 9, 1981, the attending physician has
certified in writing that the abortion is medically
necessary for the patient’s health.
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Section 173G. III. Requirements for Abortions
a. Medical Necessity
The Department will pay for an abortion only when:
1. The attending physician has certified in writing on
Form W-484, “Physician’s Certification for
Abortion (Title XIX),” that the abortion is
necessary because the life of the mother would be
endangered if the fetus were carried to term, or
2. The attending physician has certified in writing on
Form W-484 that the abortion is medically
necessary for the patient’s health.
b. Submission of Certification
Form W-484 must be filled out completely including the
name and address of the patient. An original Form W-
484 must be on file with the Department before any
provider will be paid. Providers should submit Form W-
484 along with their standard billing form for the services
Section 173G. IV. The Department must have an accurate original certification
form on file before any provider will be paid for a sterilization,
hysterectomy or abortion. The first certification form submitted
by a provider for a particular claim will be the one which is
reviewed for payment purposes.
Section 173G. V. The Department will not pay for canceled office visits, for
appointments not kept, or for information provided by
Section 173G. VI. Obtaining Consent, Information and Certification Forms
Providers may obtain forms Form W-612, “Consent Form”
(Sterilization); W-613, “Hysterectomy Information Form”; W-
613A, “Physician Hysterectomy Certification Form -
Retroactive Eligibility”; and Form W-484, “Physician’s
Certification for Abortion (Title XIX)”, by sending a written
Department of Social Services
Utilization Review Unit
Section 173. H. Billing
I. Providers should use the standard billing form for their
provider group when billing for family planning services,
abortions and hysterectomies (e.g., physicians use the HCFA
1500). All family planning procedures should be indicated as
such on the billing form using the method appropriate for the
NOTE: Abortions and hysterectomies should not be listed
as family planning services.
II. Providers of family planning services, abortions and
hysterectomies should submit claims to the Department’s fiscal
Electronic Data Systems Corporation (EDS)
Providers should use the post office box number appropriate
for their provider type.