Representative Rex P. Shipp proposes the following substitute bill:


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     Cosponsors:
8     Nelson T. Abbott
9     Cheryl K. Acton
10     Carl R. Albrecht
11     Bridger Bolinder
12     Walt Brooks
13     Jefferson S. Burton
14     Kay J. Christofferson
Joseph Elison
Colin W. Jack
Tim Jimenez
Dan N. Johnson
Quinn Kotter
Trevor Lee
Steven J. Lund
Phil Lyman
A. Cory Maloy
Michael J. Petersen
Thomas W. Peterson
Keven J. Stratton
Mark A. Strong
Jordan D. Teuscher
Christine F. Watkins
15     

16     LONG TITLE
17     General Description:
18          This bill prohibits a health care provider from performing a medical procedure on a
19     minor for the purpose of attempted sex transitioning or attempted sex change.
20     Highlighted Provisions:
21          This bill:
22          ▸     defines terms;
23          ▸     makes it unprofessional conduct for a health care provider to perform a medical
24     procedure on a minor for the purpose of attempted sex transitioning or attempted
25     sex change under most circumstances; and
26          ▸     makes technical changes.
27     Money Appropriated in this Bill:
28          None
29     Other Special Clauses:
30          None
31     Utah Code Sections Affected:
32     AMENDS:
33          58-31b-502, as last amended by Laws of Utah 2022, Chapter 290
34          58-67-102, as last amended by Laws of Utah 2022, Chapter 233
35          58-67-502, as last amended by Laws of Utah 2021, Chapter 337
36          58-68-102, as last amended by Laws of Utah 2022, Chapter 233
37          58-68-502, as last amended by Laws of Utah 2021, Chapter 337
38          58-70a-503, as last amended by Laws of Utah 2022, Chapter 290
39     ENACTS:
40          58-1-511, Utah Code Annotated 1953
41     

42     Be it enacted by the Legislature of the state of Utah:
43          Section 1. Section 58-1-511 is enacted to read:
44          58-1-511. Prohibition on hormonal transgender procedures on minors.
45          (1) As used in this section:
46          (a) "Administration of cross-sex hormones" means administering or supplying:
47          (i) to an individual whose biological sex at birth is female, a dose of testosterone or
48     other androgens at levels above those normally found in an individual whose biological sex at
49     birth is female; or
50          (ii) to an individual whose biological sex at birth is male, a dose of estrogen or a
51     synthetic compound with estrogenic activity or effect at levels above those normally found in
52     an individual whose biological sex at birth is male.
53          (b) "Health care provider" means:
54          (i) a physician licensed under:
55          (A) Chapter 67, Utah Medical Practice Act; or
56          (B) Chapter 68, Utah Osteopathic Medical Practice Act;
57          (ii) a physician assistant licensed under Chapter 70a, Utah Physician Assistant Act; or
58          (iii) an advanced practice registered nurse licensed under Subsection 58-31b-301(e).
59          (c) "Hormonal transgender procedure" means:
60          (i) administration of cross-sex hormones; or
61          (ii) performing a puberty inhibition procedure.
62          (d) "Minor" means an individual who:
63          (i) is less than 18 years old; and
64          (ii) is not emancipated under Title 80, Chapter 7, Emancipation.
65          (e) (i) "Puberty inhibition procedure" means administering or supplying, alone or in
66     combination with aromatase inhibitors:
67          (A) gonadotropin-releasing hormone agonists;
68          (B) progestins; or
69          (C) androgen receptor inhibitors.
70          (ii) "Puberty inhibition procedure" does not include administering or supplying a
71     treatment described in Subsection (1)(e)(i) to an individual if the treatment is medically
72     necessary as a treatment for:
73          (A) precocious puberty;
74          (B) idiopathic short stature;
75          (C) endometriosis; or
76          (D) a sex hormone-stimulated cancer.
77          (2) Except as provided in Subsection (3), a health care provider may not perform a
78     hormonal transgender procedure on a minor.
79          (3) (a) A health care provider may continue to administer cross-sex hormones to a
80     minor if the minor:
81          (i) began receiving cross-sex hormones prior to May 3, 2021;
82          (ii) has continuously received cross-sex hormones for at least two years; and
83          (iii) affirmatively elects, in writing, to continue to receive cross-sex hormones.
84          (b) For a minor who does not meet the criteria described in Subsection (3)(a), a health
85     care provider who provides cross-sex hormones to the minor shall:
86          (i) unless the minor elects to discontinue receiving cross-sex hormones by an earlier
87     date, develop and implement a treatment plan to progressively decrease the dosage of cross-sex
88     hormones so that cross-sex hormone treatment is ended by November 3, 2023; and
89          (ii) consult with a mental health professional in order to monitor the minor's
90     psychological and emotional state until November 3, 2023.
91          Section 2. Section 58-31b-502 is amended to read:
92          58-31b-502. Unprofessional conduct.
93          (1) "Unprofessional conduct" includes:
94          (a) failure to safeguard a patient's right to privacy as to the patient's person, condition,
95     diagnosis, personal effects, or any other matter about which the licensee is privileged to know
96     because of the licensee's or person with a certification's position or practice as a nurse or
97     practice as a medication aide certified;
98          (b) failure to provide nursing service or service as a medication aide certified in a
99     manner that demonstrates respect for the patient's human dignity and unique personal character
100     and needs without regard to the patient's race, religion, ethnic background, socioeconomic
101     status, age, sex, or the nature of the patient's health problem;
102          (c) engaging in sexual relations with a patient during any:
103          (i) period when a generally recognized professional relationship exists between the
104     person licensed or certified under this chapter and the patient; or
105          (ii) extended period when a patient has reasonable cause to believe a professional
106     relationship exists between the person licensed or certified under the provisions of this chapter
107     and the patient;
108          (d) (i) as a result of any circumstance under Subsection (1)(c), exploiting or using
109     information about a patient or exploiting the licensee's or the person with a certification's
110     professional relationship between the licensee or holder of a certification under this chapter and
111     the patient; or
112          (ii) exploiting the patient by use of the licensee's or person with a certification's
113     knowledge of the patient obtained while acting as a nurse or a medication aide certified;
114          (e) unlawfully obtaining, possessing, or using any prescription drug or illicit drug;
115          (f) unauthorized taking or personal use of nursing supplies from an employer;
116          (g) unauthorized taking or personal use of a patient's personal property;
117          (h) unlawful or inappropriate delegation of nursing care;
118          (i) failure to exercise appropriate supervision of persons providing patient care services
119     under supervision of the licensed nurse;
120          (j) employing or aiding and abetting the employment of an unqualified or unlicensed
121     person to practice as a nurse;
122          (k) failure to file or record any medical report as required by law, impeding or
123     obstructing the filing or recording of such a report, or inducing another to fail to file or record
124     such a report;
125          (l) breach of a statutory, common law, regulatory, or ethical requirement of
126     confidentiality with respect to a person who is a patient, unless ordered by a court;
127          (m) failure to pay a penalty imposed by the division;
128          (n) prescribing a Schedule II controlled substance without complying with the
129     requirements in Section 58-31b-803, if applicable;
130          (o) violating Section 58-31b-801;
131          (p) violating the dispensing requirements of Section 58-17b-309 or Chapter 17b, Part
132     8, Dispensing Medical Practitioner and Dispensing Medical Practitioner Clinic Pharmacy, if
133     applicable;
134          (q) falsely making an entry in, or altering, a medical record with the intent to conceal:
135          (i) a wrongful or negligent act or omission of an individual licensed under this chapter
136     or an individual under the direction or control of an individual licensed under this chapter; or
137          (ii) conduct described in Subsections (1)(a) through (o) or Subsection 58-1-501(1); [or]
138          (r) violating the requirements of Title 26, Chapter 61a, Utah Medical Cannabis Act[.];
139     or
140          (s) performing, or causing to be performed, a hormonal transgender procedure in
141     violation of Section 58-1-511.
142          (2) "Unprofessional conduct" does not include, in accordance with Title 26, Chapter
143     61a, Utah Medical Cannabis Act, when registered as a qualified medical provider, or acting as
144     a limited medical provider, as those terms are defined in Section 26-61a-102, recommending
145     the use of medical cannabis.
146          (3) Notwithstanding Subsection (2), the division, in consultation with the board and in
147     accordance with Title 63G, Chapter 3, Utah Administrative Rulemaking Act, shall define
148     unprofessional conduct for an advanced practice registered nurse described in Subsection (2).
149          Section 3. Section 58-67-102 is amended to read:
150          58-67-102. Definitions.
151          In addition to the definitions in Section 58-1-102, as used in this chapter:
152          (1) (a) "Ablative procedure" means a procedure that is expected to excise, vaporize,
153     disintegrate, or remove living tissue, including the use of carbon dioxide lasers and erbium:
154     YAG lasers.
155          (b) "Ablative procedure" does not include hair removal.
156          (2) "ACGME" means the Accreditation Council for Graduate Medical Education of the
157     American Medical Association.
158          (3) "Administrative penalty" means a monetary fine or citation imposed by the division
159     for acts or omissions determined to constitute unprofessional or unlawful conduct, in
160     accordance with a fine schedule established by the division in collaboration with the board, as a
161     result of an adjudicative proceeding conducted in accordance with Title 63G, Chapter 4,
162     Administrative Procedures Act.
163          (4) "Associate physician" means an individual licensed under Section 58-67-302.8.
164          (5) "Attempted sex change" means an attempt or effort to change an individual's body
165     to present that individual as being of a sex or gender that is different from the individual's
166     biological sex at birth.
167          (6) "Biological sex at birth" means an individual's sex, as being male or female,
168     according to distinct reproductive roles as manifested by sex and reproductive organ anatomy,
169     chromosomal makeup, and endogenous hormone profiles.
170          [(5)] (7) "Board" means the Physicians Licensing Board created in Section 58-67-201.
171          [(6)] (8) "Collaborating physician" means an individual licensed under Section
172     58-67-302 who enters into a collaborative practice arrangement with an associate physician.
173          [(7)] (9) "Collaborative practice arrangement" means the arrangement described in
174     Section 58-67-807.
175          (10) "Cosmetic breast surgical procedure" means a breast reduction surgery or a breast
176     augmentation surgery that is performed for a purpose other than:
177          (a) medical necessity; or
178          (b) to address a musculoskeletal problem.
179          [(8)] (11) (a) "Cosmetic medical device" means tissue altering energy based devices
180     that have the potential for altering living tissue and that are used to perform ablative or
181     nonablative procedures, such as American National Standards Institute (ANSI) designated
182     Class IIIb and Class IV lasers, intense pulsed light, radio frequency devices, and lipolytic
183     devices, and excludes ANSI designated Class IIIa and lower powered devices.
184          (b) Notwithstanding Subsection [(8)(a),] (11)(a), if an ANSI designated Class IIIa and
185     lower powered device is being used to perform an ablative procedure, the device is included in
186     the definition of cosmetic medical device under Subsection [(8)(a).] (11)(a).
187          [(9)] (12) "Cosmetic medical procedure":
188          (a) includes the use of cosmetic medical devices to perform ablative or nonablative
189     procedures; and
190          (b) does not include a treatment of the ocular globe such as refractive surgery.
191          [(10)] (13) "Diagnose" means:
192          (a) to examine in any manner another person, parts of a person's body, substances,
193     fluids, or materials excreted, taken, or removed from a person's body, or produced by a person's
194     body, to determine the source, nature, kind, or extent of a disease or other physical or mental
195     condition;
196          (b) to attempt to conduct an examination or determination described under Subsection
197     [(10)(a);] (13)(a);
198          (c) to hold oneself out as making or to represent that one is making an examination or
199     determination as described in Subsection [(10)(a);] (13)(a); or
200          (d) to make an examination or determination as described in Subsection [(10)(a)]
201     (13)(a) upon or from information supplied directly or indirectly by another person, whether or
202     not in the presence of the person making or attempting the diagnosis or examination.
203          [(11)] (14) "LCME" means the Liaison Committee on Medical Education of the
204     American Medical Association.
205          [(12)] (15) "Medical assistant" means an unlicensed individual who may perform tasks
206     as described in Subsection 58-67-305(6).
207          [(13)] (16) "Medically underserved area" means a geographic area in which there is a
208     shortage of primary care health services for residents, as determined by the Department of
209     Health.
210          [(14)] (17) "Medically underserved population" means a specified group of people
211     living in a defined geographic area with a shortage of primary care health services, as
212     determined by the Department of Health.
213          [(15)] (18) (a) (i) "Nonablative procedure" means a procedure that is expected or
214     intended to alter living tissue, but is not intended or expected to excise, vaporize, disintegrate,
215     or remove living tissue.
216          (ii) Notwithstanding Subsection [(15)(a)(i)] (18)(a)(i), nonablative procedure includes
217     hair removal.
218          (b) "Nonablative procedure" does not include:
219          (i) a superficial procedure as defined in Section 58-1-102;
220          (ii) the application of permanent make-up; or
221          (iii) the use of photo therapy and lasers for neuromusculoskeletal treatments that are
222     performed by an individual licensed under this title who is acting within the individual's scope
223     of practice.
224          [(16)] (19) "Physician" means both physicians and surgeons licensed under Section
225     58-67-301, Utah Medical Practice Act, and osteopathic physicians and surgeons licensed under
226     Section 58-68-301, Utah Osteopathic Medical Practice Act.
227          [(17)] (20) (a) "Practice of medicine" means:
228          (i) to diagnose, treat, correct, administer anesthesia, or prescribe for any human
229     disease, ailment, injury, infirmity, deformity, pain or other condition, physical or mental, real
230     or imaginary, including to perform cosmetic medical procedures, or to attempt to do so, by any
231     means or instrumentality, and by an individual in Utah or outside the state upon or for any
232     human within the state;
233          (ii) when a person not licensed as a physician directs a licensee under this chapter to
234     withhold or alter the health care services that the licensee has ordered;
235          (iii) to maintain an office or place of business for the purpose of doing any of the acts
236     described in Subsection [(17)(a)] (20)(a) whether or not for compensation; or
237          (iv) to use, in the conduct of any occupation or profession pertaining to the diagnosis or
238     treatment of human diseases or conditions in any printed material, stationery, letterhead,
239     envelopes, signs, or advertisements, the designation "doctor," "doctor of medicine,"
240     "physician," "surgeon," "physician and surgeon," "Dr.," "M.D.," or any combination of these
241     designations in any manner which might cause a reasonable person to believe the individual
242     using the designation is a licensed physician and surgeon, and if the party using the designation
243     is not a licensed physician and surgeon, the designation must additionally contain the
244     description of the branch of the healing arts for which the person has a license, provided that an
245     individual who has received an earned degree of doctor of medicine degree but is not a licensed
246     physician and surgeon in Utah may use the designation "M.D." if it is followed by "Not
247     Licensed" or "Not Licensed in Utah" in the same size and style of lettering.
248          (b) The practice of medicine does not include:
249          (i) except for an ablative medical procedure as provided in Subsection [(17)(b)(ii)]
250     (20)(b)(ii), the conduct described in Subsection [(17)(a)(i)] (20)(a)(i)that is performed in
251     accordance with a license issued under another chapter of this title;
252          (ii) an ablative cosmetic medical procedure if the scope of practice for the person
253     performing the ablative cosmetic medical procedure includes the authority to operate or
254     perform a surgical procedure; or
255          (iii) conduct under Subsection 58-67-501(2).
256          [(18)] (21) "Prescription device" means an instrument, apparatus, implement, machine,
257     contrivance, implant, in vitro reagent, or other similar or related article, and any component
258     part or accessory, which is required under federal or state law to be prescribed by a practitioner
259     and dispensed by or through a person or entity licensed under this chapter or exempt from
260     licensure under this chapter.
261          [(19)] (22) "Prescription drug" means a drug that is required by federal or state law or
262     rule to be dispensed only by prescription or is restricted to administration only by practitioners.
263          (23) (a) "Sex characteristic-altering surgical procedure" means, for the purpose of
264     effectuating or facilitating an individual's attempted sex change:
265          (i) castration, orchiectomy, penectomy, vaginoplasty, vulvoplasty, breast augmentation
266     surgery, or facial feminization surgery on an individual whose biological sex at birth is male;
267          (ii) mastectomy, hysterectomy, oophorectomy, metoidioplasty, phalloplasty, or chest or
268     facial masculinization procedures on an individual whose biological sex at birth is female;
269          (iii) any surgical procedure that is related to or necessary for a procedure described in
270     Subsection (23)(a)(i) or (ii), that would result in the sterilization of an individual who is
271     non-sterile; or
272          (iv) removing any otherwise healthy or non-diseased body part or tissue.
273          (b) "Sex characteristic-altering surgical procedure" does not include:
274          (i) surgery or other procedures or treatments performed on an individual who:
275          (A) is born with external biological sex characteristics that are irresolvably ambiguous;
276          (B) is born with 46, XX chromosomes with virilization;
277          (C) is born with 46, XY chromosomes with undervirilization;
278          (D) has both ovarian and testicular tissue; or
279          (E) has been diagnosed by a physician, based on genetic or biochemical testing, with a
280     sex development disorder characterized by abnormal sex chromosome structure, sex steroid
281     hormone production, or sex steroid hormone action for a male or female; or
282          (ii) removing a body part:
283          (A) because the body part is cancerous or diseased; or
284          (B) for a reason that is medically necessary, other than to effectuate or facilitate an
285     individual's attempted sex change.
286          [(20)] (24) "SPEX" means the Special Purpose Examination of the Federation of State
287     Medical Boards.
288          [(21)] (25) "Unlawful conduct" means the same as that term is defined in Sections
289     58-1-501 and 58-67-501.
290          [(22)] (26) "Unprofessional conduct" means the same as that term is defined in
291     Sections 58-1-501 and 58-67-502, and as may be further defined by division rule.
292          Section 4. Section 58-67-502 is amended to read:
293          58-67-502. Unprofessional conduct.
294          (1) "Unprofessional conduct" includes, in addition to the definition in Section
295     58-1-501:
296          (a) using or employing the services of any individual to assist a licensee in any manner
297     not in accordance with the generally recognized practices, standards, or ethics of the
298     profession, state law, or division rule;
299          (b) making a material misrepresentation regarding the qualifications for licensure under
300     Section 58-67-302.7 or Section 58-67-302.8;
301          (c) violating the dispensing requirements of Chapter 17b, Part 8, Dispensing Medical
302     Practitioner and Dispensing Medical Practitioner Clinic Pharmacy, if applicable;
303          (d) violating the requirements of Title 26, Chapter 61a, Utah Medical Cannabis Act;
304     [or]
305          (e) falsely making an entry in, or altering, a medical record with the intent to conceal:
306          (i) a wrongful or negligent act or omission of an individual licensed under this chapter
307     or an individual under the direction or control of an individual licensed under this chapter; or
308          (ii) conduct described in Subsections (1)(a) through (d) or Subsection 58-1-501(1)[.];
309     or
310          (f) performing, or causing to be performed, upon a minor as defined in Section
311     58-1-603:
312          (i) a hormonal transgender procedure in violation of Section 58-1-511;
313          (ii) a sex characteristic-altering surgical procedure; or
314          (iii) a cosmetic breast surgical procedure.
315          (2) "Unprofessional conduct" does not include:
316          (a) in compliance with Section 58-85-103:
317          (i) obtaining an investigational drug or investigational device;
318          (ii) administering the investigational drug to an eligible patient; or
319          (iii) treating an eligible patient with the investigational drug or investigational device;
320     or
321          (b) in accordance with Title 26, Chapter 61a, Utah Medical Cannabis Act:
322          (i) when registered as a qualified medical provider or acting as a limited medical
323     provider, as those terms are defined in Section 26-61a-102, recommending the use of medical
324     cannabis;
325          (ii) when registered as a pharmacy medical provider, as that term is defined in Section
326     26-61a-102, providing pharmacy medical provider services in a medical cannabis pharmacy; or
327          (iii) when registered as a state central patient portal medical provider, as that term is
328     defined in Section 26-61a-102, providing state central patient portal medical provider services.
329          (3) Notwithstanding Subsection (2)(b), the division, in consultation with the board and
330     in accordance with Title 63G, Chapter 3, Utah Administrative Rulemaking Act, shall define
331     unprofessional conduct for a physician described in Subsection (2)(b).
332          Section 5. Section 58-68-102 is amended to read:
333          58-68-102. Definitions.
334          In addition to the definitions in Section 58-1-102, as used in this chapter:
335          (1) (a) "Ablative procedure" means a procedure that is expected to excise, vaporize,
336     disintegrate, or remove living tissue, including the use of carbon dioxide lasers and erbium:
337     YAG lasers.
338          (b) "Ablative procedure" does not include hair removal.
339          (2) "ACGME" means the Accreditation Council for Graduate Medical Education of the
340     American Medical Association.
341          (3) "Administrative penalty" means a monetary fine imposed by the division for acts or
342     omissions determined to constitute unprofessional or unlawful conduct, as a result of an
343     adjudicative proceeding conducted in accordance with Title 63G, Chapter 4, Administrative
344     Procedures Act.
345          (4) "AOA" means the American Osteopathic Association.
346          (5) "Associate physician" means an individual licensed under Section 58-68-302.5.
347          (6) "Attempted sex change" means an attempt or effort to change an individual's body
348     to present that individual as being of a sex or gender that is different from the individual's
349     biological sex at birth.
350          (7) "Biological sex at birth" means an individual's sex, as being male or female,
351     according to distinct reproductive roles as manifested by sex and reproductive organ anatomy,
352     chromosomal makeup, and endogenous hormone profiles.
353          [(6)] (8) "Board" means the Osteopathic Physician and Surgeon's Licensing Board
354     created in Section 58-68-201.
355          [(7)] (9) "Collaborating physician" means an individual licensed under Section
356     58-68-302 who enters into a collaborative practice arrangement with an associate physician.
357          [(8)] (10) "Collaborative practice arrangement" means the arrangement described in
358     Section 58-68-807.
359          (11) "Cosmetic breast surgical procedure" means a breast reduction surgery or a breast
360     augmentation surgery for reasons other than:
361          (a) medical necessity; or
362          (b) to address a musculoskeletal problem.
363          [(9)] (12) (a) "Cosmetic medical device" means tissue altering energy based devices
364     that have the potential for altering living tissue and that are used to perform ablative or
365     nonablative procedures, such as American National Standards Institute (ANSI) designated
366     Class IIIb and Class IV lasers, intense pulsed light, radio frequency devices, and lipolytic
367     devices and excludes ANSI designated Class IIIa and lower powered devices.
368          (b) Notwithstanding Subsection [(9)(a)] (12)(a), if an ANSI designated Class IIIa and
369     lower powered device is being used to perform an ablative procedure, the device is included in
370     the definition of cosmetic medical device under Subsection [(9)(a)] (12)(a).
371          [(10)] (13) "Cosmetic medical procedure":
372          (a) includes the use of cosmetic medical devices to perform ablative or nonablative
373     procedures; and
374          (b) does not include a treatment of the ocular globe such as refractive surgery.
375          [(11)] (14) "Diagnose" means:
376          (a) to examine in any manner another person, parts of a person's body, substances,
377     fluids, or materials excreted, taken, or removed from a person's body, or produced by a person's
378     body, to determine the source, nature, kind, or extent of a disease or other physical or mental
379     condition;
380          (b) to attempt to conduct an examination or determination described under Subsection
381     [(11)(a)] (14)(a);
382          (c) to hold oneself out as making or to represent that one is making an examination or
383     determination as described in Subsection [(11)(a)] (14)(a); or
384          (d) to make an examination or determination as described in Subsection [(11)(a)]
385     (14)(a) upon or from information supplied directly or indirectly by another person, whether or
386     not in the presence of the person making or attempting the diagnosis or examination.
387          [(12)] (15) "Medical assistant" means an unlicensed individual who may perform tasks
388     as described in Subsection 58-68-305(6).
389          [(13)] (16) "Medically underserved area" means a geographic area in which there is a
390     shortage of primary care health services for residents, as determined by the Department of
391     Health.
392          [(14)] (17) "Medically underserved population" means a specified group of people
393     living in a defined geographic area with a shortage of primary care health services, as
394     determined by the Department of Health.
395          [(15)] (18) (a) (i) "Nonablative procedure" means a procedure that is expected or
396     intended to alter living tissue, but is not expected or intended to excise, vaporize, disintegrate,
397     or remove living tissue.
398          (ii) Notwithstanding Subsection [(15)(a)(i)] (18)(a)(i), nonablative procedure includes
399     hair removal.
400          (b) "Nonablative procedure" does not include:
401          (i) a superficial procedure as defined in Section 58-1-102;
402          (ii) the application of permanent make-up; or
403          (iii) the use of photo therapy lasers for neuromusculoskeletal treatments that are
404     preformed by an individual licensed under this title who is acting within the individual's scope
405     of practice.
406          [(16)] (19) "Physician" means both physicians and surgeons licensed under Section
407     58-67-301, Utah Medical Practice Act, and osteopathic physicians and surgeons licensed under
408     Section 58-68-301, Utah Osteopathic Medical Practice Act.
409          [(17)] (20) (a) "Practice of osteopathic medicine" means:
410          (i) to diagnose, treat, correct, administer anesthesia, or prescribe for any human
411     disease, ailment, injury, infirmity, deformity, pain, or other condition, physical or mental, real
412     or imaginary, or to attempt to do so, by any means or instrumentality, which in whole or in part
413     is based upon emphasis of the importance of the musculoskeletal system and manipulative
414     therapy in the maintenance and restoration of health, by an individual in Utah or outside of the
415     state upon or for any human within the state;
416          (ii) when a person not licensed as a physician directs a licensee under this chapter to
417     withhold or alter the health care services that the licensee has ordered;
418          (iii) to maintain an office or place of business for the purpose of doing any of the acts
419     described in Subsection [(17)(a)] (20)(a) whether or not for compensation; or
420          (iv) to use, in the conduct of any occupation or profession pertaining to the diagnosis or
421     treatment of human diseases or conditions, in any printed material, stationery, letterhead,
422     envelopes, signs, or advertisements, the designation "doctor," "doctor of osteopathic medicine,"
423     "osteopathic physician," "osteopathic surgeon," "osteopathic physician and surgeon," "Dr.,"
424     "D.O.," or any combination of these designations in any manner which might cause a
425     reasonable person to believe the individual using the designation is a licensed osteopathic
426     physician, and if the party using the designation is not a licensed osteopathic physician, the
427     designation must additionally contain the description of the branch of the healing arts for which
428     the person has a license, provided that an individual who has received an earned degree of
429     doctor of osteopathic medicine but is not a licensed osteopathic physician and surgeon in Utah
430     may use the designation "D.O." if it is followed by "Not Licensed" or "Not Licensed in Utah"
431     in the same size and style of lettering.
432          (b) The practice of osteopathic medicine does not include:
433          (i) except for an ablative medical procedure as provided in Subsection [(17)(b)(ii)]
434     (20)(b)(ii), the conduct described in Subsection [(17)(a)(i)] (20)(a)(i) that is performed in
435     accordance with a license issued under another chapter of this title;
436          (ii) an ablative cosmetic medical procedure if the scope of practice for the person
437     performing the ablative cosmetic medical procedure includes the authority to operate or
438     perform a surgical procedure; or
439          (iii) conduct under Subsection 58-68-501(2).
440          [(18)] (21) "Prescription device" means an instrument, apparatus, implement, machine,
441     contrivance, implant, in vitro reagent, or other similar or related article, and any component
442     part or accessory, which is required under federal or state law to be prescribed by a practitioner
443     and dispensed by or through a person or entity licensed under this chapter or exempt from
444     licensure under this chapter.
445          [(19)] (22) "Prescription drug" means a drug that is required by federal or state law or
446     rule to be dispensed only by prescription or is restricted to administration only by practitioners.
447          (23) (a) "Sex characteristic-altering surgical procedure" means, for the purpose of
448     effectuating or facilitating an individual's attempted sex change:
449          (i) castration, orchiectomy, penectomy, vaginoplasty, vulvoplasty, breast augmentation
450     surgery, or facial feminization surgery on an individual whose biological sex at birth is male;
451          (ii) mastectomy, hysterectomy, oophorectomy, metoidioplasty, phalloplasty, or chest or
452     facial masculinization procedures on an individual whose biological sex at birth is female;
453          (iii) any surgical procedure that is related to or necessary for a procedure described in
454     Subsection (23)(a)(i) or (ii), that would result in the sterilization of an individual who is
455     non-sterile; or
456          (iv) removing any otherwise healthy or non-diseased body part or tissue.
457          (b) "Sex characteristic-altering surgical procedure" does not include:
458          (i) surgery or other procedures or treatments performed on an individual who:
459          (A) is born with external biological sex characteristics that are irresolvably ambiguous;
460          (B) is born with 46, XX chromosomes with virilization;
461          (C) is born with 46, XY chromosomes with undervirilization;
462          (D) has both ovarian and testicular tissue; or
463          (E) has been diagnosed by a physician, based on genetic or biochemical testing, with a
464     sex development disorder characterized by abnormal sex chromosome structure, sex steroid
465     hormone production, or sex steroid hormone action for a male or female; or
466          (ii) removing a body part:
467          (A) because the body part is cancerous or diseased; or
468          (B) for a reason that is medically necessary, other than to effectuate or facilitate an
469     individual's attempted sex change.
470          [(20)] (24) "SPEX" means the Special Purpose Examination of the Federation of State
471     Medical Boards.
472          [(21)] (25) "Unlawful conduct" means the same as that term is defined in Sections
473     58-1-501 and 58-68-501.
474          [(22)] (26) "Unprofessional conduct" means the same as that term is defined in
475     Sections 58-1-501 and 58-68-502 and as may be further defined by division rule.
476          Section 6. Section 58-68-502 is amended to read:
477          58-68-502. Unprofessional conduct.
478          (1) "Unprofessional conduct" includes, in addition to the definition in Section
479     58-1-501:
480          (a) using or employing the services of any individual to assist a licensee in any manner
481     not in accordance with the generally recognized practices, standards, or ethics of the
482     profession, state law, or division rule;
483          (b) violating the dispensing requirements of Chapter 17b, Part 8, Dispensing Medical
484     Practitioner and Dispensing Medical Practitioner Clinic Pharmacy, if applicable;
485          (c) making a material misrepresentation regarding the qualifications for licensure under
486     Section 58-68-302.5;
487          (d) violating the requirements of Title 26, Chapter 61a, Utah Medical Cannabis Act;
488     [or]
489          (e) falsely making an entry in, or altering, a medical record with the intent to conceal:
490          (i) a wrongful or negligent act or omission of an individual licensed under this chapter
491     or an individual under the direction or control of an individual licensed under this chapter; or
492          (ii) conduct described in Subsections (1)(a) through (d) or Subsection 58-1-501(1)[.];
493     or
494          (f) performing, or causing to be performed, upon a minor as defined in 58-1-511:
495          (i) a hormonal transgender procedure in violation of Section 58-1-511;
496          (ii) a sex characteristic-altering surgical procedure; or
497          (iii) a cosmetic breast surgical procedure.
498          (2) "Unprofessional conduct" does not include:
499          (a) in compliance with Section 58-85-103:
500          (i) obtaining an investigational drug or investigational device;
501          (ii) administering the investigational drug to an eligible patient; or
502          (iii) treating an eligible patient with the investigational drug or investigational device;
503     or
504          (b) in accordance with Title 26, Chapter 61a, Utah Medical Cannabis Act:
505          (i) when registered as a qualified medical provider or acting as a limited medical
506     provider, as those terms are defined in Section 26-61a-102, recommending the use of medical
507     cannabis;
508          (ii) when registered as a pharmacy medical provider, as that term is defined in Section
509     26-61a-102, providing pharmacy medical provider services in a medical cannabis pharmacy; or
510          (iii) when registered as a state central patient portal medical provider, as that term is
511     defined in Section 26-61a-102, providing state central patient portal medical provider services.
512          (3) Notwithstanding Subsection (2)(b), the division, in consultation with the board and
513     in accordance with Title 63G, Chapter 3, Utah Administrative Rulemaking Act, shall define
514     unprofessional conduct for a physician described in Subsection (2)(b).
515          Section 7. Section 58-70a-503 is amended to read:
516          58-70a-503. Unprofessional conduct.
517          (1) "Unprofessional conduct" includes:
518          (a) violation of a patient confidence to any person who does not have a legal right and a
519     professional need to know the information concerning the patient;
520          (b) knowingly prescribing, selling, giving away, or directly or indirectly administering,
521     or offering to prescribe, sell, furnish, give away, or administer any prescription drug except for
522     a legitimate medical purpose upon a proper diagnosis indicating use of that drug in the amounts
523     prescribed or provided;
524          (c) prescribing prescription drugs for oneself or administering prescription drugs to
525     oneself, except those that have been legally prescribed for the physician assistant by a licensed
526     practitioner and that are used in accordance with the prescription order for the condition
527     diagnosed;
528          (d) in a practice that has physician assistant ownership interests, failure to allow a
529     physician the independent final decision making authority on treatment decisions for the
530     physician's patient;
531          (e) violating the dispensing requirements of Chapter 17b, Part 8, Dispensing Medical
532     Practitioner and Dispensing Medical Practitioner Clinic Pharmacy, if applicable;
533          (f) falsely making an entry in, or altering, a medical record with the intent to conceal:
534          (i) a wrongful or negligent act or omission of an individual licensed under this chapter
535     or an individual under the direction or control of an individual licensed under this chapter; or
536          (ii) conduct described in Subsections (1)(a) through (e) or Subsection 58-1-501(1);
537     [and]
538          (g) violating the requirements of Title 26, Chapter 61a, Utah Medical Cannabis Act[.];
539     or
540          (h) performing, or causing to be performed, a hormonal transgender procedure in
541     violation of Section 58-1-511.
542          (2) (a) "Unprofessional conduct" does not include, in accordance with Title 26, Chapter
543     61a, Utah Medical Cannabis Act, when registered as a qualified medical provider or acting as a
544     limited medical provider, as those terms are defined in Section 26-61a-102, recommending the
545     use of medical cannabis.
546          (b) Notwithstanding Subsection (2)(a), the division, in consultation with the board and
547     in accordance with Title 63G, Chapter 3, Utah Administrative Rulemaking Act, shall define
548     unprofessional conduct for a physician assistant described in Subsection (2)(a).