1     
PROHIBITING SEX TRANSITIONING PROCEDURES ON

2     
MINORS

3     
2023 GENERAL SESSION

4     
STATE OF UTAH

5     
Chief Sponsor: Rex P. Shipp

6     
Senate Sponsor: Wayne A. Harper

7     

8     LONG TITLE
9     General Description:
10          This bill prohibits a health care provider from performing a medical procedure on a
11     minor for the purpose of attempted sex transitioning or attempted sex change.
12     Highlighted Provisions:
13          This bill:
14          ▸     defines terms;
15          ▸     makes it unprofessional conduct for a health care provider to perform a medical
16     procedure on a minor for the purpose of attempted sex transitioning or attempted
17     sex change; and
18          ▸     makes technical changes.
19     Money Appropriated in this Bill:
20          None
21     Other Special Clauses:
22          None
23     Utah Code Sections Affected:
24     AMENDS:
25          58-31b-502, as last amended by Laws of Utah 2022, Chapter 290
26          58-67-102, as last amended by Laws of Utah 2022, Chapter 233
27          58-67-502, as last amended by Laws of Utah 2021, Chapter 337
28          58-68-102, as last amended by Laws of Utah 2022, Chapter 233
29          58-68-502, as last amended by Laws of Utah 2021, Chapter 337
30          58-70a-503, as last amended by Laws of Utah 2022, Chapter 290
31     ENACTS:
32          58-1-511, Utah Code Annotated 1953
33     

34     Be it enacted by the Legislature of the state of Utah:
35          Section 1. Section 58-1-511 is enacted to read:
36          58-1-511. Prohibition on hormonal transgender procedures on minors.
37          (1) As used in this section:
38          (a) "Administration of cross-sex hormones" means administering or supplying:
39          (i) to an individual whose biological sex at birth is female, a dose of testosterone or
40     other androgens at levels above those normally found in an individual whose biological sex at
41     birth is female; or
42          (ii) to an individual whose biological sex at birth is male, a dose of estrogen or a
43     synthetic compound with estrogenic activity or effect at levels above those normally found in
44     an individual whose biological sex at birth is male.
45          (b) "Health care provider" means:
46          (i) a physician licensed under:
47          (A) Chapter 67, Utah Medical Practice Act; or
48          (B) Chapter 68, Utah Osteopathic Medical Practice Act;
49          (ii) a physician assistant licensed under Chapter 70a, Utah Physician Assistant Act; or
50          (iii) an advanced practice registered nurse licensed under Subsection 58-31b-301(2)(e).
51          (c) "Hormonal transgender procedure" means:
52          (i) administration of cross-sex hormones; or
53          (ii) performing a puberty inhibition procedure.
54          (d) "Minor" means an individual who:
55          (i) is less than 18 years old; and
56          (ii) is not emancipated under Title 80, Chapter 7, Emancipation.
57          (e) (i) "Puberty inhibition procedure" means administering or supplying, alone or in
58     combination with aromatase inhibitors:
59          (A) gonadotropin-releasing hormone agonists;
60          (B) progestins; or
61          (C) androgen receptor inhibitors.
62          (ii) "Puberty inhibition procedure" does not include administering or supplying a
63     treatment described in Subsection (1)(e)(i) to an individual if the treatment is medically
64     necessary as a treatment for:
65          (A) precocious puberty;
66          (B) idiopathic short stature;
67          (C) endometriosis; or
68          (D) a sex hormone-stimulated cancer.
69          (2) A health care provider may not perform a hormonal transgender procedure on a
70     minor.
71          Section 2. Section 58-31b-502 is amended to read:
72          58-31b-502. Unprofessional conduct.
73          (1) "Unprofessional conduct" includes:
74          (a) failure to safeguard a patient's right to privacy as to the patient's person, condition,
75     diagnosis, personal effects, or any other matter about which the licensee is privileged to know
76     because of the licensee's or person with a certification's position or practice as a nurse or
77     practice as a medication aide certified;
78          (b) failure to provide nursing service or service as a medication aide certified in a
79     manner that demonstrates respect for the patient's human dignity and unique personal character
80     and needs without regard to the patient's race, religion, ethnic background, socioeconomic
81     status, age, sex, or the nature of the patient's health problem;
82          (c) engaging in sexual relations with a patient during any:
83          (i) period when a generally recognized professional relationship exists between the
84     person licensed or certified under this chapter and the patient; or
85          (ii) extended period when a patient has reasonable cause to believe a professional
86     relationship exists between the person licensed or certified under the provisions of this chapter
87     and the patient;
88          (d) (i) as a result of any circumstance under Subsection (1)(c), exploiting or using
89     information about a patient or exploiting the licensee's or the person with a certification's
90     professional relationship between the licensee or holder of a certification under this chapter and
91     the patient; or
92          (ii) exploiting the patient by use of the licensee's or person with a certification's
93     knowledge of the patient obtained while acting as a nurse or a medication aide certified;
94          (e) unlawfully obtaining, possessing, or using any prescription drug or illicit drug;
95          (f) unauthorized taking or personal use of nursing supplies from an employer;
96          (g) unauthorized taking or personal use of a patient's personal property;
97          (h) unlawful or inappropriate delegation of nursing care;
98          (i) failure to exercise appropriate supervision of persons providing patient care services
99     under supervision of the licensed nurse;
100          (j) employing or aiding and abetting the employment of an unqualified or unlicensed
101     person to practice as a nurse;
102          (k) failure to file or record any medical report as required by law, impeding or
103     obstructing the filing or recording of such a report, or inducing another to fail to file or record
104     such a report;
105          (l) breach of a statutory, common law, regulatory, or ethical requirement of
106     confidentiality with respect to a person who is a patient, unless ordered by a court;
107          (m) failure to pay a penalty imposed by the division;
108          (n) prescribing a Schedule II controlled substance without complying with the
109     requirements in Section 58-31b-803, if applicable;
110          (o) violating Section 58-31b-801;
111          (p) violating the dispensing requirements of Section 58-17b-309 or Chapter 17b, Part
112     8, Dispensing Medical Practitioner and Dispensing Medical Practitioner Clinic Pharmacy, if
113     applicable;
114          (q) falsely making an entry in, or altering, a medical record with the intent to conceal:
115          (i) a wrongful or negligent act or omission of an individual licensed under this chapter
116     or an individual under the direction or control of an individual licensed under this chapter; or
117          (ii) conduct described in Subsections (1)(a) through (o) or Subsection 58-1-501(1); [or]
118          (r) violating the requirements of Title 26, Chapter 61a, Utah Medical Cannabis Act[.];
119     or
120          (s) performing, or causing to be performed, a hormonal transgender procedure in
121     violation of Section 58-1-511.
122          (2) "Unprofessional conduct" does not include, in accordance with Title 26, Chapter
123     61a, Utah Medical Cannabis Act, when registered as a qualified medical provider, or acting as
124     a limited medical provider, as those terms are defined in Section 26-61a-102, recommending
125     the use of medical cannabis.
126          (3) Notwithstanding Subsection (2), the division, in consultation with the board and in
127     accordance with Title 63G, Chapter 3, Utah Administrative Rulemaking Act, shall define
128     unprofessional conduct for an advanced practice registered nurse described in Subsection (2).
129          Section 3. Section 58-67-102 is amended to read:
130          58-67-102. Definitions.
131          In addition to the definitions in Section 58-1-102, as used in this chapter:
132          (1) (a) "Ablative procedure" means a procedure that is expected to excise, vaporize,
133     disintegrate, or remove living tissue, including the use of carbon dioxide lasers and erbium:
134     YAG lasers.
135          (b) "Ablative procedure" does not include hair removal.
136          (2) "ACGME" means the Accreditation Council for Graduate Medical Education of the
137     American Medical Association.
138          (3) "Administrative penalty" means a monetary fine or citation imposed by the division
139     for acts or omissions determined to constitute unprofessional or unlawful conduct, in
140     accordance with a fine schedule established by the division in collaboration with the board, as a
141     result of an adjudicative proceeding conducted in accordance with Title 63G, Chapter 4,
142     Administrative Procedures Act.
143          (4) "Associate physician" means an individual licensed under Section 58-67-302.8.
144          (5) "Attempted sex change" means an attempt or effort to change an individual's body
145     to present that individual as being of a sex or gender that is different from the individual's
146     biological sex at birth.
147          (6) "Biological sex at birth" means an individual's sex, as being male or female,
148     according to distinct reproductive roles as manifested by sex and reproductive organ anatomy,
149     chromosomal makeup, and endogenous hormone profiles.
150          [(5)] (7) "Board" means the Physicians Licensing Board created in Section 58-67-201.
151          [(6)] (8) "Collaborating physician" means an individual licensed under Section
152     58-67-302 who enters into a collaborative practice arrangement with an associate physician.
153          [(7)] (9) "Collaborative practice arrangement" means the arrangement described in
154     Section 58-67-807.
155          (10) "Cosmetic breast surgical procedure" means a breast reduction surgery or a breast
156     augmentation surgery that is performed for a purpose other than:
157          (a) medical necessity; or
158          (b) to address a musculoskeletal problem.
159          [(8)] (11) (a) "Cosmetic medical device" means tissue altering energy based devices
160     that have the potential for altering living tissue and that are used to perform ablative or
161     nonablative procedures, such as American National Standards Institute (ANSI) designated
162     Class IIIb and Class IV lasers, intense pulsed light, radio frequency devices, and lipolytic
163     devices, and excludes ANSI designated Class IIIa and lower powered devices.
164          (b) Notwithstanding Subsection [(8)(a),] (11)(a), if an ANSI designated Class IIIa and
165     lower powered device is being used to perform an ablative procedure, the device is included in
166     the definition of cosmetic medical device under Subsection [(8)(a).] (11)(a).
167          [(9)] (12) "Cosmetic medical procedure":
168          (a) includes the use of cosmetic medical devices to perform ablative or nonablative
169     procedures; and
170          (b) does not include a treatment of the ocular globe such as refractive surgery.
171          [(10)] (13) "Diagnose" means:
172          (a) to examine in any manner another person, parts of a person's body, substances,
173     fluids, or materials excreted, taken, or removed from a person's body, or produced by a person's
174     body, to determine the source, nature, kind, or extent of a disease or other physical or mental
175     condition;
176          (b) to attempt to conduct an examination or determination described under Subsection
177     [(10)(a);] (13)(a);
178          (c) to hold oneself out as making or to represent that one is making an examination or
179     determination as described in Subsection [(10)(a);] (13)(a); or
180          (d) to make an examination or determination as described in Subsection [(10)(a)]
181     (13)(a) upon or from information supplied directly or indirectly by another person, whether or
182     not in the presence of the person making or attempting the diagnosis or examination.
183          [(11)] (14) "LCME" means the Liaison Committee on Medical Education of the
184     American Medical Association.
185          [(12)] (15) "Medical assistant" means an unlicensed individual who may perform tasks
186     as described in Subsection 58-67-305(6).
187          [(13)] (16) "Medically underserved area" means a geographic area in which there is a
188     shortage of primary care health services for residents, as determined by the Department of
189     Health.
190          [(14)] (17) "Medically underserved population" means a specified group of people
191     living in a defined geographic area with a shortage of primary care health services, as
192     determined by the Department of Health.
193          [(15)] (18) (a) (i) "Nonablative procedure" means a procedure that is expected or
194     intended to alter living tissue, but is not intended or expected to excise, vaporize, disintegrate,
195     or remove living tissue.
196          (ii) Notwithstanding Subsection [(15)(a)(i)] (18)(a)(i), nonablative procedure includes
197     hair removal.
198          (b) "Nonablative procedure" does not include:
199          (i) a superficial procedure as defined in Section 58-1-102;
200          (ii) the application of permanent make-up; or
201          (iii) the use of photo therapy and lasers for neuromusculoskeletal treatments that are
202     performed by an individual licensed under this title who is acting within the individual's scope
203     of practice.
204          [(16)] (19) "Physician" means both physicians and surgeons licensed under Section
205     58-67-301, Utah Medical Practice Act, and osteopathic physicians and surgeons licensed under
206     Section 58-68-301, Utah Osteopathic Medical Practice Act.
207          [(17)] (20) (a) "Practice of medicine" means:
208          (i) to diagnose, treat, correct, administer anesthesia, or prescribe for any human
209     disease, ailment, injury, infirmity, deformity, pain or other condition, physical or mental, real
210     or imaginary, including to perform cosmetic medical procedures, or to attempt to do so, by any
211     means or instrumentality, and by an individual in Utah or outside the state upon or for any
212     human within the state;
213          (ii) when a person not licensed as a physician directs a licensee under this chapter to
214     withhold or alter the health care services that the licensee has ordered;
215          (iii) to maintain an office or place of business for the purpose of doing any of the acts
216     described in Subsection [(17)(a)] (20)(a) whether or not for compensation; or
217          (iv) to use, in the conduct of any occupation or profession pertaining to the diagnosis or
218     treatment of human diseases or conditions in any printed material, stationery, letterhead,
219     envelopes, signs, or advertisements, the designation "doctor," "doctor of medicine,"
220     "physician," "surgeon," "physician and surgeon," "Dr.," "M.D.," or any combination of these
221     designations in any manner which might cause a reasonable person to believe the individual
222     using the designation is a licensed physician and surgeon, and if the party using the designation
223     is not a licensed physician and surgeon, the designation must additionally contain the
224     description of the branch of the healing arts for which the person has a license, provided that an
225     individual who has received an earned degree of doctor of medicine degree but is not a licensed
226     physician and surgeon in Utah may use the designation "M.D." if it is followed by "Not
227     Licensed" or "Not Licensed in Utah" in the same size and style of lettering.
228          (b) The practice of medicine does not include:
229          (i) except for an ablative medical procedure as provided in Subsection [(17)(b)(ii)]
230     (20)(b)(ii), the conduct described in Subsection [(17)(a)(i)] (20)(a)(i)that is performed in
231     accordance with a license issued under another chapter of this title;
232          (ii) an ablative cosmetic medical procedure if the scope of practice for the person
233     performing the ablative cosmetic medical procedure includes the authority to operate or
234     perform a surgical procedure; or
235          (iii) conduct under Subsection 58-67-501(2).
236          [(18)] (21) "Prescription device" means an instrument, apparatus, implement, machine,
237     contrivance, implant, in vitro reagent, or other similar or related article, and any component
238     part or accessory, which is required under federal or state law to be prescribed by a practitioner
239     and dispensed by or through a person or entity licensed under this chapter or exempt from
240     licensure under this chapter.
241          [(19)] (22) "Prescription drug" means a drug that is required by federal or state law or
242     rule to be dispensed only by prescription or is restricted to administration only by practitioners.
243          (23) (a) "Sex characteristic-altering surgical procedure" means, for the purpose of
244     effectuating or facilitating an individual's attempted sex change:
245          (i) castration, orchiectomy, penectomy, vaginoplasty, vulvoplasty, breast augmentation
246     surgery, or facial feminization surgery on an individual whose biological sex at birth is male;
247          (ii) mastectomy, hysterectomy, oophorectomy, metoidioplasty, phalloplasty, or chest or
248     facial masculinization procedures on an individual whose biological sex at birth is female;
249          (iii) any surgical procedure that is related to or necessary for a procedure described in
250     Subsection (23)(a)(i) or (ii), that would result in the sterilization of an individual who is
251     non-sterile; or
252          (iv) removing any otherwise healthy or non-diseased body part or tissue.
253          (b) "Sex characteristic-altering surgical procedure" does not include:
254          (i) surgery or other procedures or treatments performed on an individual who:
255          (A) is born with external biological sex characteristics that are irresolvably ambiguous;
256          (B) is born with 46, XX chromosomes with virilization;
257          (C) is born with 46, XY chromosomes with undervirilization;
258          (D) has both ovarian and testicular tissue; or
259          (E) has been diagnosed by a physician, based on genetic or biochemical testing, with a
260     sex development disorder characterized by abnormal sex chromosome structure, sex steroid
261     hormone production, or sex steroid hormone action for a male or female; or
262          (ii) removing a body part:
263          (A) because the body part is cancerous or diseased; or
264          (B) for a reason that is medically necessary, other than to effectuate or facilitate an
265     individual's attempted sex change.
266          [(20)] (24) "SPEX" means the Special Purpose Examination of the Federation of State
267     Medical Boards.
268          [(21)] (25) "Unlawful conduct" means the same as that term is defined in Sections
269     58-1-501 and 58-67-501.
270          [(22)] (26) "Unprofessional conduct" means the same as that term is defined in
271     Sections 58-1-501 and 58-67-502, and as may be further defined by division rule.
272          Section 4. Section 58-67-502 is amended to read:
273          58-67-502. Unprofessional conduct.
274          (1) "Unprofessional conduct" includes, in addition to the definition in Section
275     58-1-501:
276          (a) using or employing the services of any individual to assist a licensee in any manner
277     not in accordance with the generally recognized practices, standards, or ethics of the
278     profession, state law, or division rule;
279          (b) making a material misrepresentation regarding the qualifications for licensure under
280     Section 58-67-302.7 or Section 58-67-302.8;
281          (c) violating the dispensing requirements of Chapter 17b, Part 8, Dispensing Medical
282     Practitioner and Dispensing Medical Practitioner Clinic Pharmacy, if applicable;
283          (d) violating the requirements of Title 26, Chapter 61a, Utah Medical Cannabis Act;
284     [or]
285          (e) falsely making an entry in, or altering, a medical record with the intent to conceal:
286          (i) a wrongful or negligent act or omission of an individual licensed under this chapter
287     or an individual under the direction or control of an individual licensed under this chapter; or
288          (ii) conduct described in Subsections (1)(a) through (d) or Subsection 58-1-501(1)[.];
289     or
290          (f) performing, or causing to be performed, upon a minor as defined in Section
291     58-1-603:
292          (i) a hormonal transgender procedure in violation of Section 58-1-511;
293          (ii) a sex characteristic-altering surgical procedure; or
294          (iii) a cosmetic breast surgical procedure.
295          (2) "Unprofessional conduct" does not include:
296          (a) in compliance with Section 58-85-103:
297          (i) obtaining an investigational drug or investigational device;
298          (ii) administering the investigational drug to an eligible patient; or
299          (iii) treating an eligible patient with the investigational drug or investigational device;
300     or
301          (b) in accordance with Title 26, Chapter 61a, Utah Medical Cannabis Act:
302          (i) when registered as a qualified medical provider or acting as a limited medical
303     provider, as those terms are defined in Section 26-61a-102, recommending the use of medical
304     cannabis;
305          (ii) when registered as a pharmacy medical provider, as that term is defined in Section
306     26-61a-102, providing pharmacy medical provider services in a medical cannabis pharmacy; or
307          (iii) when registered as a state central patient portal medical provider, as that term is
308     defined in Section 26-61a-102, providing state central patient portal medical provider services.
309          (3) Notwithstanding Subsection (2)(b), the division, in consultation with the board and
310     in accordance with Title 63G, Chapter 3, Utah Administrative Rulemaking Act, shall define
311     unprofessional conduct for a physician described in Subsection (2)(b).
312          Section 5. Section 58-68-102 is amended to read:
313          58-68-102. Definitions.
314          In addition to the definitions in Section 58-1-102, as used in this chapter:
315          (1) (a) "Ablative procedure" means a procedure that is expected to excise, vaporize,
316     disintegrate, or remove living tissue, including the use of carbon dioxide lasers and erbium:
317     YAG lasers.
318          (b) "Ablative procedure" does not include hair removal.
319          (2) "ACGME" means the Accreditation Council for Graduate Medical Education of the
320     American Medical Association.
321          (3) "Administrative penalty" means a monetary fine imposed by the division for acts or
322     omissions determined to constitute unprofessional or unlawful conduct, as a result of an
323     adjudicative proceeding conducted in accordance with Title 63G, Chapter 4, Administrative
324     Procedures Act.
325          (4) "AOA" means the American Osteopathic Association.
326          (5) "Associate physician" means an individual licensed under Section 58-68-302.5.
327          (6) "Attempted sex change" means an attempt or effort to change an individual's body
328     to present that individual as being of a sex or gender that is different from the individual's
329     biological sex at birth.
330          (7) "Biological sex at birth" means an individual's sex, as being male or female,
331     according to distinct reproductive roles as manifested by sex and reproductive organ anatomy,
332     chromosomal makeup, and endogenous hormone profiles.
333          [(6)] (8) "Board" means the Osteopathic Physician and Surgeon's Licensing Board
334     created in Section 58-68-201.
335          [(7)] (9) "Collaborating physician" means an individual licensed under Section
336     58-68-302 who enters into a collaborative practice arrangement with an associate physician.
337          [(8)] (10) "Collaborative practice arrangement" means the arrangement described in
338     Section 58-68-807.
339          (11) "Cosmetic breast surgical procedure" means a breast reduction surgery or a breast
340     augmentation surgery for reasons other than:
341          (a) medical necessity; or
342          (b) to address a musculoskeletal problem.
343          [(9)] (12) (a) "Cosmetic medical device" means tissue altering energy based devices
344     that have the potential for altering living tissue and that are used to perform ablative or
345     nonablative procedures, such as American National Standards Institute (ANSI) designated
346     Class IIIb and Class IV lasers, intense pulsed light, radio frequency devices, and lipolytic
347     devices and excludes ANSI designated Class IIIa and lower powered devices.
348          (b) Notwithstanding Subsection [(9)(a)] (12)(a), if an ANSI designated Class IIIa and
349     lower powered device is being used to perform an ablative procedure, the device is included in
350     the definition of cosmetic medical device under Subsection [(9)(a)] (12)(a).
351          [(10)] (13) "Cosmetic medical procedure":
352          (a) includes the use of cosmetic medical devices to perform ablative or nonablative
353     procedures; and
354          (b) does not include a treatment of the ocular globe such as refractive surgery.
355          [(11)] (14) "Diagnose" means:
356          (a) to examine in any manner another person, parts of a person's body, substances,
357     fluids, or materials excreted, taken, or removed from a person's body, or produced by a person's
358     body, to determine the source, nature, kind, or extent of a disease or other physical or mental
359     condition;
360          (b) to attempt to conduct an examination or determination described under Subsection
361     [(11)(a)] (14)(a);
362          (c) to hold oneself out as making or to represent that one is making an examination or
363     determination as described in Subsection [(11)(a)] (14)(a); or
364          (d) to make an examination or determination as described in Subsection [(11)(a)]
365     (14)(a) upon or from information supplied directly or indirectly by another person, whether or
366     not in the presence of the person making or attempting the diagnosis or examination.
367          [(12)] (15) "Medical assistant" means an unlicensed individual who may perform tasks
368     as described in Subsection 58-68-305(6).
369          [(13)] (16) "Medically underserved area" means a geographic area in which there is a
370     shortage of primary care health services for residents, as determined by the Department of
371     Health.
372          [(14)] (17) "Medically underserved population" means a specified group of people
373     living in a defined geographic area with a shortage of primary care health services, as
374     determined by the Department of Health.
375          [(15)] (18) (a) (i) "Nonablative procedure" means a procedure that is expected or
376     intended to alter living tissue, but is not expected or intended to excise, vaporize, disintegrate,
377     or remove living tissue.
378          (ii) Notwithstanding Subsection [(15)(a)(i)] (18)(a)(i), nonablative procedure includes
379     hair removal.
380          (b) "Nonablative procedure" does not include:
381          (i) a superficial procedure as defined in Section 58-1-102;
382          (ii) the application of permanent make-up; or
383          (iii) the use of photo therapy lasers for neuromusculoskeletal treatments that are
384     preformed by an individual licensed under this title who is acting within the individual's scope
385     of practice.
386          [(16)] (19) "Physician" means both physicians and surgeons licensed under Section
387     58-67-301, Utah Medical Practice Act, and osteopathic physicians and surgeons licensed under
388     Section 58-68-301, Utah Osteopathic Medical Practice Act.
389          [(17)] (20) (a) "Practice of osteopathic medicine" means:
390          (i) to diagnose, treat, correct, administer anesthesia, or prescribe for any human
391     disease, ailment, injury, infirmity, deformity, pain, or other condition, physical or mental, real
392     or imaginary, or to attempt to do so, by any means or instrumentality, which in whole or in part
393     is based upon emphasis of the importance of the musculoskeletal system and manipulative
394     therapy in the maintenance and restoration of health, by an individual in Utah or outside of the
395     state upon or for any human within the state;
396          (ii) when a person not licensed as a physician directs a licensee under this chapter to
397     withhold or alter the health care services that the licensee has ordered;
398          (iii) to maintain an office or place of business for the purpose of doing any of the acts
399     described in Subsection [(17)(a)] (20)(a) whether or not for compensation; or
400          (iv) to use, in the conduct of any occupation or profession pertaining to the diagnosis or
401     treatment of human diseases or conditions, in any printed material, stationery, letterhead,
402     envelopes, signs, or advertisements, the designation "doctor," "doctor of osteopathic medicine,"
403     "osteopathic physician," "osteopathic surgeon," "osteopathic physician and surgeon," "Dr.,"
404     "D.O.," or any combination of these designations in any manner which might cause a
405     reasonable person to believe the individual using the designation is a licensed osteopathic
406     physician, and if the party using the designation is not a licensed osteopathic physician, the
407     designation must additionally contain the description of the branch of the healing arts for which
408     the person has a license, provided that an individual who has received an earned degree of
409     doctor of osteopathic medicine but is not a licensed osteopathic physician and surgeon in Utah
410     may use the designation "D.O." if it is followed by "Not Licensed" or "Not Licensed in Utah"
411     in the same size and style of lettering.
412          (b) The practice of osteopathic medicine does not include:
413          (i) except for an ablative medical procedure as provided in Subsection [(17)(b)(ii)]
414     (20)(b)(ii), the conduct described in Subsection [(17)(a)(i)] (20)(a)(i) that is performed in
415     accordance with a license issued under another chapter of this title;
416          (ii) an ablative cosmetic medical procedure if the scope of practice for the person
417     performing the ablative cosmetic medical procedure includes the authority to operate or
418     perform a surgical procedure; or
419          (iii) conduct under Subsection 58-68-501(2).
420          [(18)] (21) "Prescription device" means an instrument, apparatus, implement, machine,
421     contrivance, implant, in vitro reagent, or other similar or related article, and any component
422     part or accessory, which is required under federal or state law to be prescribed by a practitioner
423     and dispensed by or through a person or entity licensed under this chapter or exempt from
424     licensure under this chapter.
425          [(19)] (22) "Prescription drug" means a drug that is required by federal or state law or
426     rule to be dispensed only by prescription or is restricted to administration only by practitioners.
427          (23) (a) "Sex characteristic-altering surgical procedure" means, for the purpose of
428     effectuating or facilitating an individual's attempted sex change:
429          (i) castration, orchiectomy, penectomy, vaginoplasty, vulvoplasty, breast augmentation
430     surgery, or facial feminization surgery on an individual whose biological sex at birth is male;
431          (ii) mastectomy, hysterectomy, oophorectomy, metoidioplasty, phalloplasty, or chest or
432     facial masculinization procedures on an individual whose biological sex at birth is female;
433          (iii) any surgical procedure that is related to or necessary for a procedure described in
434     Subsection (23)(a)(i) or (ii), that would result in the sterilization of an individual who is
435     non-sterile; or
436          (iv) removing any otherwise healthy or non-diseased body part or tissue.
437          (b) "Sex characteristic-altering surgical procedure" does not include:
438          (i) surgery or other procedures or treatments performed on an individual who:
439          (A) is born with external biological sex characteristics that are irresolvably ambiguous;
440          (B) is born with 46, XX chromosomes with virilization;
441          (C) is born with 46, XY chromosomes with undervirilization;
442          (D) has both ovarian and testicular tissue; or
443          (E) has been diagnosed by a physician, based on genetic or biochemical testing, with a
444     sex development disorder characterized by abnormal sex chromosome structure, sex steroid
445     hormone production, or sex steroid hormone action for a male or female; or
446          (ii) removing a body part:
447          (A) because the body part is cancerous or diseased; or
448          (B) for a reason that is medically necessary, other than to effectuate or facilitate an
449     individual's attempted sex change.
450          [(20)] (24) "SPEX" means the Special Purpose Examination of the Federation of State
451     Medical Boards.
452          [(21)] (25) "Unlawful conduct" means the same as that term is defined in Sections
453     58-1-501 and 58-68-501.
454          [(22)] (26) "Unprofessional conduct" means the same as that term is defined in
455     Sections 58-1-501 and 58-68-502 and as may be further defined by division rule.
456          Section 6. Section 58-68-502 is amended to read:
457          58-68-502. Unprofessional conduct.
458          (1) "Unprofessional conduct" includes, in addition to the definition in Section
459     58-1-501:
460          (a) using or employing the services of any individual to assist a licensee in any manner
461     not in accordance with the generally recognized practices, standards, or ethics of the
462     profession, state law, or division rule;
463          (b) violating the dispensing requirements of Chapter 17b, Part 8, Dispensing Medical
464     Practitioner and Dispensing Medical Practitioner Clinic Pharmacy, if applicable;
465          (c) making a material misrepresentation regarding the qualifications for licensure under
466     Section 58-68-302.5;
467          (d) violating the requirements of Title 26, Chapter 61a, Utah Medical Cannabis Act;
468     [or]
469          (e) falsely making an entry in, or altering, a medical record with the intent to conceal:
470          (i) a wrongful or negligent act or omission of an individual licensed under this chapter
471     or an individual under the direction or control of an individual licensed under this chapter; or
472          (ii) conduct described in Subsections (1)(a) through (d) or Subsection 58-1-501(1)[.];
473     or
474          (f) performing, or causing to be performed, upon a minor as defined in 58-1-511:
475          (i) a hormonal transgender procedure in violation of Section 58-1-511;
476          (ii) a sex characteristic-altering surgical procedure; or
477          (iii) a cosmetic breast surgical procedure.
478          (2) "Unprofessional conduct" does not include:
479          (a) in compliance with Section 58-85-103:
480          (i) obtaining an investigational drug or investigational device;
481          (ii) administering the investigational drug to an eligible patient; or
482          (iii) treating an eligible patient with the investigational drug or investigational device;
483     or
484          (b) in accordance with Title 26, Chapter 61a, Utah Medical Cannabis Act:
485          (i) when registered as a qualified medical provider or acting as a limited medical
486     provider, as those terms are defined in Section 26-61a-102, recommending the use of medical
487     cannabis;
488          (ii) when registered as a pharmacy medical provider, as that term is defined in Section
489     26-61a-102, providing pharmacy medical provider services in a medical cannabis pharmacy; or
490          (iii) when registered as a state central patient portal medical provider, as that term is
491     defined in Section 26-61a-102, providing state central patient portal medical provider services.
492          (3) Notwithstanding Subsection (2)(b), the division, in consultation with the board and
493     in accordance with Title 63G, Chapter 3, Utah Administrative Rulemaking Act, shall define
494     unprofessional conduct for a physician described in Subsection (2)(b).
495          Section 7. Section 58-70a-503 is amended to read:
496          58-70a-503. Unprofessional conduct.
497          (1) "Unprofessional conduct" includes:
498          (a) violation of a patient confidence to any person who does not have a legal right and a
499     professional need to know the information concerning the patient;
500          (b) knowingly prescribing, selling, giving away, or directly or indirectly administering,
501     or offering to prescribe, sell, furnish, give away, or administer any prescription drug except for
502     a legitimate medical purpose upon a proper diagnosis indicating use of that drug in the amounts
503     prescribed or provided;
504          (c) prescribing prescription drugs for oneself or administering prescription drugs to
505     oneself, except those that have been legally prescribed for the physician assistant by a licensed
506     practitioner and that are used in accordance with the prescription order for the condition
507     diagnosed;
508          (d) in a practice that has physician assistant ownership interests, failure to allow a
509     physician the independent final decision making authority on treatment decisions for the
510     physician's patient;
511          (e) violating the dispensing requirements of Chapter 17b, Part 8, Dispensing Medical
512     Practitioner and Dispensing Medical Practitioner Clinic Pharmacy, if applicable;
513          (f) falsely making an entry in, or altering, a medical record with the intent to conceal:
514          (i) a wrongful or negligent act or omission of an individual licensed under this chapter
515     or an individual under the direction or control of an individual licensed under this chapter; or
516          (ii) conduct described in Subsections (1)(a) through (e) or Subsection 58-1-501(1);
517     [and]
518          (g) violating the requirements of Title 26, Chapter 61a, Utah Medical Cannabis Act[.];
519     or
520          (h) performing, or causing to be performed, a hormonal transgender procedure in
521     violation of Section 58-1-511.
522          (2) (a) "Unprofessional conduct" does not include, in accordance with Title 26, Chapter
523     61a, Utah Medical Cannabis Act, when registered as a qualified medical provider or acting as a
524     limited medical provider, as those terms are defined in Section 26-61a-102, recommending the
525     use of medical cannabis.
526          (b) Notwithstanding Subsection (2)(a), the division, in consultation with the board and
527     in accordance with Title 63G, Chapter 3, Utah Administrative Rulemaking Act, shall define
528     unprofessional conduct for a physician assistant described in Subsection (2)(a).